Quality IMPACT

Improving the Assessment and Integration of Physical Health Needs with Adults, Adolescents and Children in Mental Hygiene Programs

• Project Background
  
• Workbook
  
• Data Sheets
  
• Participating Providers

Project Background

Rationale

National data has shown that individuals with mental health disorders have higher rates of poor physical health and increased medical morbidity and mortality compared to the general population. Adults with serious mental illness, such as schizophrenia, bipolar disorder and depression, treated in public systems die approximately 25 years earlier than the general public. While suicide and injury account for about 30-40% of excess mortality, 60% of premature deaths are due to medical conditions such as cardiovascular, pulmonary and infectious disease, obesity and diabetes. In addition, second generation antipsychotic medications have been associated with a number of physical health conditions, such as weight gain, diabetes, dyslipidemia, insulin resistance and metabolic syndrome (Parks et al., 2006). Compounding this problem are barriers to health care that persons living with a serious mental illness face: patient factors, such as lack of motivation, fearfulness, and social instability; provider factors such as competing demands and stigma; and, system factors such as fragmentation (Druss, 2006). Limited access to health care has been shown to result in fewer routine preventative services (Druss, 2002), worse diabetes care (Desai, 2002; Frayne, 2005), and lower rates of cardiovascular procedures (Druss, 2002) compared to the general public.

Aim

Many of the medical conditions that afflict those in the mental hygiene system are caused by modifiable risk factors, including smoking, alcohol consumption, drug use, poor nutrition, lack of exercise, and risky sexual practices (Parks et al., 2006). Best practice models have been developed that provide knowledge and tools to assist people with serious mental illness in making informed decisions about healthier lifestyle behaviors including addressing tobacco use and excess weight gain (Vreeland, 2007). The evidence overwhelmingly points to a critical need to focus on the overall physical health care needs of the seriously mentally ill and to assist in addressing critical health risks endemic to the population.

Development

Implementation

Participating programs will measure and monitor their progress in this quality improvement project by collecting data on: completion or update of a health screen for each treatment planning period; identification of all outstanding or unmet physical health needs; the integration of these needs into treatment planning; and follow up. Programs will also select an additional indicator set and track data as outlined under those specific indicator sets. The choices of additional indicator sets include screening for metabolic abnormalities; smoking cessation; weight management; hepatitis C virus (HCV) testing, access to treatment and prevention; and dental care. Participating Drug and Alcohol Treatment Programs were required to use HCV testing as their additional indicator set for FY09.

back to top

Citations

Desai, M.M., Rosenheck, R.A., Druss, B.G., & Perlin, J.B. (2002). Mental disorders and quality of diabetes care in the Veterans Health Administration. American Journal of Psychiatry, 159(9), 1584-1590.

Druss, B.G., Rosenheck, R.A., Desai, M.M., & Perlin, J.B. (2002) Quality of preventive medical care for patients with mental disorders. Medical Care, 40(2), 129-136.

Parks, J., Svendsen, D., Singer, P., Foti, M., & Mauer, B. (2006) Morbidity and Mortality in People with Serious Mental Illness.

back to top

Workbook

• FY09 HI CQI Workbook for Mental Health Providers (PDF)

back to top

Data Sheets

Individual Tracking Sheets (ITS)

These optional paper and pencil forms can be used in conjunction with the electronic Data Sheets. These forms collect information on individual consumers.

• MH Core Indicators Individual Tracking Sheet (PDF)
• MH HCV Indicators Individual Tracking Sheet (PDF)
• Metabolic Abnormalities Indicators Individual Tracking Sheet (PDF)

Electronic Data Sheets

Each electronic Data Sheet assists with the collection of information on the Health Project's Core Indicator set and an Additional Indicator set chosen by each program. The Additional Indicator sets include HCV Prevention, Assessment, Testing and Follow-up, Metabolic Abnormalities, Weight Management, Dental Care and Smoking Cessation.

• MH Core Indicators + HCV FY09 Data Sheets (Excel)
• MH Core Indicators + Metabolic Abnormalities FY09 Data Sheets (Excel)
• MH Core Indicators + Weight Management FY09 Data Sheets (Excel)
• MH Core Indicators + Dental Care FY09 Data Sheets (Excel)
• MH Core Indicators + Smoking Cessation FY09 Data Sheets (Excel)

back to top

Participating Providers

back to top