Clinical Focus on Quality
Since its inception in 2004, the Behavioral Health Clinical Program has spearheaded system-wide efforts to improve care for patients suffering from mental health issues. The program provides leadership for Intermountain's efforts to deliver the best care for these patients in a variety of settings, including outpatient clinics, day treatment, residential care, and acute inpatient units. Consultative care is delivered in many hospitals, emergency rooms, and primary care clinics.
The Behavioral Health Clinical Program works to benchmark, share best clinical and administrative strategies, and develop Care Process Models (CPM) for system-wide implementation. The program focuses on supporting the most cost-effective care while decreasing practice variation.
Most people in Utah with mental health issues are first seen and treated outside the specialty mental health setting, most commonly at a primary care office. Behavioral Health works closely with the Primary Care Clinical Program to address these needs.
The Behavioral Health Clinical Program has improved care by:
- Integration. We work closely with SelectHealth to meet the mental health needs of their enrollees and partner in improvement projects. We utilize the electronic healthcare record to allow other providers access to treatment information.
- Care Process Models. We have developed and implemented system-wide Care Process Models (CPM) for depression in Primary Care, as well as for bipolar, attention deficit, and hyperactivity disorders.
- Bipolar identification and treatment. The Bipolar CPM was developed and implemented in 2006-2007. Bipolar disorder is an illness that affects 2-6 percent of the population, has a very high mortality rate, and is one of the most costly illnesses to treat. All our inpatient units and clinics now screen for this illness and have identified thousands more people suffering from this condition than previously thought. We partnered with SelectHealth to provide education and to identify and decrease prescribing variation. In addition, there has been a dramatic reduction in hospital stays, emergency room visits, ambulance trips, and total costs.
- Reduction of patient restraint. Restraining hospitalized patients was common 10 years ago and was a contributor to the stigma of mental health. Today, in our system we have been able to reduce the use of restraints and seclusion by standardizing our treatment philosophy, identifying early the signs of increasing agitation, and training staff in interventions.
- Therapeutic Alliance. Research has shown that clinical outcomes for both therapy and pharmacology depend on good relationships between patients and providers. A clinical measure of both satisfaction and the quality of this relationship is called the "Therapeutic Alliance." In 2008 and 2009 the Behavioral Health Clinical Program's goal focused on improving the patient perception of the Therapeutic Alliance. The goal was exceeded both years.
Mental health patients have medical needs similar to the average person, and cardiovascular disease (CVD) is the most frequent cause of mortality. It appears that many patients with mental illness die 25 years sooner than their peers, largely due to their neglected medical illnesses. The Behavioral Health Clinical Program has made it our 2010 Board goal to screen for the CVD risk factors of obesity, hypertension, diabetes, smoking, and high cholesterol. Currently, we are screening the majority of new patients and are on track to exceed the goal. Additional goals for decreasing cardiovascular risk factors will be identified through this process.
The Behavioral Health Clinical Program will continue to provide leadership for the best and most compassionate care wherever patients go for treatment in Intermountain.