A national quality-evaluation initiative with a long track record in acute care is expanding its breadth with a new set of comparative performance indicators designed expressly for psychiatric care.
Beginning April 1, the Maryland Quality Indicator Project's proprietary compilation of data definitions and implementation manuals will be used by an initial lineup of 92 psychiatric-care facilities nationwide-both freestanding hospitals and psychiatric units of acute-care hospitals. The participating facilities will collect data on any or all of the four indicators:
Unplanned departures resulting in discharge.
Transfers to an acute-care unit.
Readmissions within 15 days of discharge.
The overall project, started in 1985 by the Maryland Hospital Association, now has more than 1,000 participating hospitals throughout the United States. In addition to supplying performance indicators for internal quality-improvement purposes, the project compiles aggregate data and other feedback for industrywide comparisons.
For the indicators specific to psychiatric care, a panel of psychiatrists, psychologists, quality-assurance specialists and administrators collaborated with 52 psychiatric facilities to come up with subject areas most likely to produce "red flags" requiring immediate attention, said Jane Lawphers, director of the Quality Indicator Project.
With inpatient stays getting shorter under managed-care scrutiny, the rate of readmissions was one trend to be concerned about, Lawphers said. A high rate could indicate insufficient time to stabilize and improve a psychiatric problem, she said.
And as providers bear more of the risk for patient care, the prospect that patients need to be readmitted for the same problem becomes a financial issue as well as a clinical concern, she added.
Unlike some indicators developed as decisionmaking tools for healthcare purchasers, the measures hatched by the Quality Indicator Project are mainly to pinpoint and rapidly respond to quality-management issues, said Nell Wood, director of program development.
For example, a higher-than-normal transfer of psychiatric patients to an acute-care unit could indicate a problem with appropriate medical assessment at time of admission, she said. That's particularly a problem for psychiatric conditions with a high medical component such as anorexia and substance abuse, Wood said.
But a rash of transfers also may be explained by other circumstances, such as patient falls, that present themselves after admission. The indicator just compels managers to look further and ask questions about the reasons for what may be a high incidence compared with industry peers, she said.
The same goes for the indicator on unplanned departures, Lawphers said. The indicator measures the incidence of patients checking out against medical advice or simply without telling anyone.
In those situations, a facility can look at the management leading up to that point to find out if it had a bearing on the departure, she said.
In keeping with its mission as an ongoing research project, the developers of the psychiatric indicators will be "learning as we go" during implementation, Wood said.
The psychiatric-care participants pledged to provide sufficient training and assure the integrity of data within their organizations, Lawphers said.
Of the 92 initial participants, 74 are psychiatric units of acute-care hospitals already participating in the Quality Indicator Project, Wood said. The remaining 18 are freestanding psychiatric facilities that are new to the project.
Wood said prospective participants can join by contacting one of the project's sponsoring multihospital systems or one of 24 participating state or regional hospital associations.