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Rogers participates in pilot study regarding the future of measurement-based care

11/15/22 04:30:pm

Innovation_tn.jpgRogers recently completed a pilot study that could change how patient improvement is evaluated in inpatient behavioral health units nationwide.

The project is in collaboration with The Joint Commission, Centers for Medicare & Medicaid Services (CMS), and a third-party consulting group called Mathematica.

The goal is to determine the feasibility of using the Patient-Reported Outcomes Measurement Information System (PROMIS) in adult inpatient psychiatric care relative to long-used measures such as the Quick Inventory of Depressive Symptomatology (QIDS) and the Penn State Worry Questionnaire.

“Rogers was selected to participate in the study because we are a leader in measurement-based care,” says Jessica Cook, director, Data Analytics. “It’s remarkable that the Joint Commission views us as experts in the area and want to learn from us to define a new requirement for evidence-based assessments for all inpatient behavioral health units in the country.”

Why measurement-based care is important

Measurement-based care involves the systematic administration of symptom rating scales and the use of results to drive clinical decision-making at the level of the individual patient.

Implemented in all inpatient programs at Rogers in 2019, measurement-based care is designed to:

  • Optimize the efficiency, accuracy, and consistency of symptom assessment
  • Maximize the likelihood that nonresponse to treatment is detected by the provider
  • Allow for system-level, outcomes-based measurement to inform program development and modification

“Measurement-based care improves outcomes. It’s difficult to improve if you don’t measure,” explains Rachel Leonard, PhD, executive director, clinical strategy, who discussed the pilot in a recent Brown Bag presentation. “It also results in consistent quality and experience across locations and allows us to demonstrate that quality to patients and families, referents, and third-party payors.”

All patient self-reported measures are housed in the Rogers Online Assessment System (ROAS), which was developed by Hanjoo Lee, PhD, clinical programmer. The system assigns, manages, and tracks clinical assessments. Over the last year, assessments were collected on about 8,500 inpatient admissions, with 58% of them consisting of baseline and discharge data.

“Collecting these self-reported assessments is critical to understanding the level of improvement our patients are making and determining their satisfaction with their experience at Rogers,” Jessica says.

How the pilot was conducted

During the six-month pilot, 3,500 total assessments were completed from 2,100 patient encounters, with 66% of them including both baseline and discharge data.

Rogers clinicians also conducted cognitive interviews to determine how patients respond to the PROMIS measure, an eight-question self-reported tool designed to assess depression in adults receiving inpatient care.

Among the questions, patients were asked to rate the degree of difficulty in completing the form and to define what feeling worthless means.

The employees who conducted the cognitive interviews were Morgan Aghjian, clinical services manager in Oconomowoc; Megan O’Donnell, clinical services manager in West Allis; Nicole Nevaranta, PsyD, inpatient psychological assistant in Brown Deer; and Meaghan Cross, clinical services manager at Silver Lake clinic.

Additionally, Mathematica conducted interviews with Rogers leaders in order to find out if clinicians and patients were aligned in their perspective of symptoms.

“The clinician interviews will be used in combination with the results from the cognitive patient interviews and their assessment data to determine if PROMIS is an appropriate and helpful measure to be collected in inpatient care,” explains Dalton Kick, product owner on the Data Analytics team.

What the study means for the future

Rogers concluded its part of the project at the end of August. Now Mathematica is performing the data analysis and evaluating the burden of the PROMIS assessment on patients, its clinical utility, and overall validity in the inpatient population.

Depending on results, the Joint Commission will require all inpatient psychiatric facilities to administer a measure like this as part of standard treatment. If the Joint Commission moves forward, it would be the first time a patient assessment metric would be used to determine if patients are truly improving.

“As it stands today, we are one of few organizations that use measurement-based care to drive process improvement,” says Brian Kay, PhD, chief of staff. “If the Joint Commission decides to implement it as part of its accreditation requirements, the standards for inpatient treatment across the nation will be more closely aligned with Rogers’ philosophy and protocol.”

To learn more, please watch a Data Watch Brownbag conducted by Dr. Leonard and Dalton. You may find it by searching “Brownbag October 2022” in Rogers University.

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