Schmidt Eric M, Krahn Dean D, McGuire Marsden H, Tavakoli Sara, Wright David M, Solares Hugo E, Lemke Sonne, Trafton Jodie
Center for Innovation to Implementation, HSR&D, Veterans Affairs Palo Alto Health Care System.
Department of Psychiatry, William S. Middleton Memorial Veterans Hospital.
Psychol Serv. 2017 Feb;14(1):13-22. doi: 10.1037/ser0000098.
U.S. health systems, policy makers, and patients increasingly demand high-value care that improves health outcomes at lower cost. This study describes the initial design and analysis of the Mental Health Management System (MHMS), a performance data and quality improvement tool used by the Veterans Health Administration (VHA) to increase the value of its mental health care. The MHMS evaluates access to and quality of mental health care, organizational structure and efficiency, implementation of innovative treatment options, and, in collaboration with management, resource needs for delivering care. Performance on 31 measures was calculated for all U.S. VHA facilities (N = 139). Pearson correlations revealed that better access to care was significantly associated with fewer mental health provider staffing vacancies (r = -.24) and higher staff-to-patient ratios for psychiatrists (r = .19) and other outpatient mental health providers (r = .27). Higher staff-to-patient ratios were significantly associated with higher performance on a number of patient and provider satisfaction measures (range of r = .18-.51) and continuity of care measures (range of r = .26-.43). Relationships observed between organizational and clinical performance measures suggest that the MHMS is a robust informatics and quality improvement tool that can serve as a model for health systems planning to adopt a value perspective. Future research should expand the MHMS framework to measure patient and health systems costs and psychosocial outcomes, as well as evaluate whether quality improvement solutions implemented as a result of using organizational information leads to higher-value mental health care. (PsycINFO Database Record
美国的医疗系统、政策制定者和患者越来越需要高价值的医疗服务，即以更低的成本改善健康结果。本研究描述了心理健康管理系统（MHMS）的初始设计与分析，该系统是退伍军人健康管理局（VHA）用来提高其心理健康护理价值的绩效数据和质量改进工具。MHMS评估心理健康护理的可及性和质量、组织结构与效率、创新治疗方案的实施情况，并与管理层合作评估提供护理所需的资源。计算了所有美国退伍军人健康管理局设施（N = 139）在31项指标上的表现。皮尔逊相关性分析显示，更好的护理可及性与心理健康服务提供者的人员空缺较少显著相关（r = -0.24），与精神科医生（r = 0.19）和其他门诊心理健康服务提供者的更高医患比显著相关（r = 0.27）。更高的医患比与多项患者和服务提供者满意度指标（r范围为0.18 - 0.51）以及护理连续性指标（r范围为0.26 - 0.43）上的更高表现显著相关。组织绩效指标和临床绩效指标之间观察到的关系表明，MHMS是一个强大的信息学和质量改进工具，可以作为计划采用价值视角的医疗系统的典范。未来的研究应扩展MHMS框架，以衡量患者和医疗系统成本以及心理社会结果，并评估因使用组织信息而实施的质量改进解决方案是否能带来更高价值的心理健康护理。（PsycINFO数据库记录）
