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Selecting Surveys to Measure Treatment Impact

Laura Mills, Ph.D. (QM, Psych) Director, Research & Evaluation, Pine River Institute

When you are about to start measuring the impact of your work, you might first ask, ‘What measurement instrument is the best?’. Asking this question first, however, might result in your measuring factors that don’t resonate with your practice, or omitting factors that are important outcome indicators. The resources and culture shift required to implement evaluation are too costly for this. It’s vital to start right, which means a little bit of ground work. This article outlines some steps to start right, and ultimately, optimize your evaluation efforts.

Step One. Decide Why.

Why are you doing evaluation? Do you want to demonstrate your impact to clients, families, staff, accreditation, state, county or payor? Do you want to validate your treatment approach? Understand where to invest in professional development or make program changes? Engage a university research partner? Maybe you want to do all of this, and evaluation makes that possible, but write down your reasons for evaluation. This will be your guide and will keep you in scope.

Step Two. Get Curious!

‘Success’ is what you want to measure, and ‘success’ means something different for each of your stakeholders. Engage them! Ask clients (lots of them!), ‘if in a year you can say that treatment worked for you, what does that mean?’ Try not to prompt responses; you’ll be surprised with the indicators that are important to your clients. If they really don’t know, you might ask if success means they are working, schooling, medication-free, handling stress, relating to family, social, etc. But keep your input minimal.
Ask your staff what they work on with their clients. In what areas do they foster change? If they see a ‘success’ client in a year, what does that mean? Ask your executive team, ‘why are we here?’ ‘in what ways are we having an impact?’
If you plan to use your evaluation to broaden knowledge, you may want to explore ‘mechanisms of change’- why do you work, or what fosters treatment success. Ask clients ‘what was a moment of change for you?’; ask clinicians ‘what is your magic?’; ask executives ‘where do we expect treatment fidelity?’.

Step Three. List Key Indicators.

Using information from your environmental scan, list the common outcome indicators, and if applicable, process indicators. Outcome indicators are your success markers such as substance use, mental health, criminality, hospitalization, vocation, etc. Process indicators are the mechanisms of change such as treatment completion or progression, therapeutic alliance, family engagement, fidelity to a manualized approach, etc.

Step Four. Be a Journalist.

Who will complete the instrument (client, parent, clinician, referrer)? Where will it be completed (online, on-site)? How will it be administered (paper, device, in a group)? If there is a user cost, do you have the resources? Do you need quantitative responses or qualitative? When will it be administered (before, during, after)? Importantly, if you want to measure change, you measure indicators before and after treatment!

Step Five. Find Your Instruments!

You can explore many sources, such as university libraries and google scholar to see the thousands of measurement tools available. Your ground work will help you narrow the options, thankfully! OutcomeTools has several dozen instruments available to view.
Read every question! Have your stakeholders review different instruments. The tool must align with your language and your purpose. Look for problems such as double-barreled questions (asks two questions in one), hard to remember items (dosage of alcohol or substances), too much jargon, difficult time anchors, assumptive questions (e.g., does your child think about suicide), no ‘other’ or ‘don’t know’ option where it’s needed.

Step Six. Implement!

This is where the work gets real! Implementation is a huge undertaking, requiring a working culture shift, huge leadership support, and all-hands-on-deck. For some, evaluation will seem like just another task in their already overburdened day; demonstrate the benefits to them! Show clinicians the scores of one of their clients. Ask them if the scores resonate with their experience. Ask them about the client, the treatment approach, challenges, surprises, successes. Most often, clinicians are so happy to share their experience and see the results of their hard work.
One way to really engage all stakeholders in evaluation is to implement Feedback Informed Treatment, which is periodic measurements of key indicators that are used to inform and guide treatment. This is a powerful way to close the gap between research and practice. Feedback Informed Treatment is also a way to increase your post-treatment survey response rates. When clients see the results of evaluation during treatment, they are more likely to respond to requests for contribution after treatment.
If we can help you get started with these steps or have questions, please reach out to our expert staff at OutcomeTools – team@bestnotes.com or 866-543-6646.

 

For more information on this topic, please see our recent webinar here!

date:  Apr 09, 2019
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Why Behavioral Health and Addiction Treatment Providers Should Track Outcomes (and How to Start)

The Joint Commission, a non-profit organization that accredits nearly 21,000 U.S. healthcare organizations and programs, requires behavioral health organizations to assess patient outcomes with “a standardized tool or instrument.”

This is intended to help “inform goals and objectives identified in individual plans of care, treatment, or services…as well as to evaluate outcomes of care, treatment, or services provided to the population(s) served.”

More than a requirement, measuring patient outcomes has other benefits for behavioral health organizations. While many providers still face barriers to tracking outcomes, the right approach and tools can help organizations succeed.

Benefits to Measuring Behavioral Health Outcomes

Measuring patient outcomes lets providers know if the treatment is working, so they can make adjustments or referrals as needed.
Payer reimbursement is shifting from fee-for-service to value-based care, which involves tracking and measuring outcomes.
Research indicates that behavioral health patients show improvements faster when they can observe their improvements and outcomes over time.
Measuring outcomes helps providers fully utilize their electronic health record (EHR) solutions, improving the return on investment.
Tracking treatment outcomes can help behavioral health providers better coordinate care and improve integration with a patient’s other providers.
Measuring outcomes preserves accountability to regulatory agencies and payers.

Barriers to Behavioral Health Outcome Measurement

Many behavioral health and addiction treatment providers do not use standardized metrics to measure patient outcomes. Unlike with physical health, patient outcomes in behavioral health are usually subjective and tailored to the individual. This makes it more difficult to measure patient outcomes in a meaningful way.

Providers also need a robust EHR solution to help track, store, and manage the data that they create by measuring and tracking treatment outcomes. Many smaller behavioral health organizations, however, are less willing to adopt EHR platforms and technology. Often they are concerned about the expense of an EHR system and the potential workflow disruption, and may not recognize the value of an EHR system.

How to Start Measuring Behavioral Health Outcomes

According to the Joint Commission, behavioral health outcome measurement should involve:

Using a standardized tool
Measuring at regular, frequent intervals
Using the data produced to inform care, treatment, and services
Aggregating data across all clients to improve quality across the organization

Behavioral health and addiction treatment organizations can meet the challenge of defining and measuring treatment outcomes. This process may include the following:
Determine what outcomes need to be addressed, as well as who will receive information about the results.
Determine what measurements are needed.
Develop clear criteria for these measurements, including frequency of measurement and delivering results.
Consider which tools will provide data that shows effectiveness and value.
Train staff on interpreting the results and how to use the results to inform care, treatment, and services.
Document the results in the chosen EHR, such as progress notes, treatment plans, test results, and other clinical documents.
Use performance measurement data to implement changes.

An EHR That Helps Track Outcomes

BestNotes EHR, created specifically for behavioral health and addiction treatment organizations, helps you track your chosen treatment outcomes. Create and manage patient progress notes, track vitals and lab results, and manage intake assessments and discharge summaries.

Contact us today to learn more about how BestNotes EHR can help you improve care, track patient outcomes, and increase practice revenue.

date:  Apr 02, 2019
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Why Interoperability Matters to Behavioral Health and Addiction Treatment Professionals

In a previous BestNotes blog post, we provided an overview of interoperability, what it looks like, and its history. But why does it matter specifically to behavioral health providers and those working in addiction treatment?

Interoperability in Practice

Because it facilitates communication, interoperability can benefit patients, providers, and payers in a variety of ways:
Improved care: Data sharing among providers is an important benefit of interoperability. As both providers and payers focus more on value-based care, which emphasizes improved patient outcomes, clinicians need a picture of a patient’s entire health. This often requires a patient’s different clinicians to be in contact with each other.

Increased efficiency: When information can be shared quickly and consistently, clinicians can make better decisions, faster. This can help them better focus on patient needs, improving outcomes. Better data sharing also puts less of a burden on patients to convey information from one provider to another, or between the provider and payer.

Lowered costs: Greater efficiency in data sharing can lower costs by reducing the risk of errors in billing or patient records, which also helps save staff members’ time. By improving care, interoperability can lower healthcare costs by reducing the risk of diagnosis or treatment errors, or removing the need for unnecessary testing.

More providers and payers recognize the value of data sharing, and electronic health record (EHR) technology is becoming more widely implemented. This will make interoperability an increasingly important issue for behavioral health and addiction treatment providers to address.

Interoperability Regulations

Clinical implementation aside, there are numerous regulatory changes that have made (or will make) interoperability an unavoidable issue in healthcare.

As policymakers and regulators promote not only EHR use but interoperability, new laws and standards may extend to behavioral health. Here are a few things behavioral health providers may want to keep an eye on:

Launching Interoperability Under HITECH Act

The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, was intended to promote meaningful use of health information technology. This law legislatively mandated the Office of the National Coordinator for Health Information Technology (ONC), which is intended to support the adoption of health IT and promote interoperability.

Medicare’s MyHealthEData Initiative Would Encourage Interoperability

In February 2019, the U.S. Department of Health and Human Services (HHS) proposed new rules to support interoperability in electronic health information (EHI). These proposals are intended to increase choice, competition, and innovation in health information. Under the rule, patients would be given electronic access to their EHI at no cost.

Does your EHR promote interoperability?

As interoperability becomes more prominent, behavioral health providers should make it a goal when choosing and integrating their EHR system.
BestNotes offers EHR and CRM solutions tailored specifically for behavioral health and addiction treatment providers, with features that help you collaborate and exchange information with those who need it. Contact us today to learn more or schedule a demo.

date:  Mar 27, 2019
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Documentation that never gets old!

One of the primary problems with Electronic Health Records in the Behavioral Health industry is change is constant; the clinical documentation you customize today will be outdated within months. It’s overwhelming to keep up-to-date with new CARF, Joint Commission, Payer, Managed Care, State or County regulations. After years of research and development, BestNotes is proud to release a series of pre-built clinical documentation and workflows that are regularly updated.

BestNotes now offers two documentation profiles depending on your clinical focus: Behavioral Health or Addiction Treatment. The clinical workflow begins at admission and continues through the following treatment process:

Addiction Treatment Profile

Admissions / Intake
Online Patient Application
Pre-Screen
Assessment
Comprehensive Diagnostic Assessment (Multi-Dimensional Format)
Psychiatric Evaluation
History and Physical
Treatment Planning
Master Treatment Plan
Treatment Plan Review
Treatment
Individual Progress Note
Group Progress Note & Report
Medical/Psychiatric Progress Note
Collaboration of Care Note
Drug UA Note & Report
Treatment Team Note
Utilization Review document
Continuity of Care
Discharge Summary

Behavioral Health Profile

Admissions / Intake
Online Patient Application
Pre-Screen
Assessment
Comprehensive Diagnostic Assessment
Psychiatric Evaluation
Substance Use Assessment (Dimensional Format)
Case Management Assessment
Peer Support Assessment
Recovery Coaching Assessment
Treatment Planning
Master Treatment Plan & Review
Case Management Plan
Skill Building (CBRS) Plan
Peer Support Plan
Recovery Coaching Plan
Treatment
Individual Progress Note
Group Progress Note
Medical/Psychiatric Progress Note
Case Management Progress Note
Peer Support Progress Note
Recovery Coaching Progress Note
Skill Building/CBRS Progress Note
Client Status Report
Collaboration of Care Note
Continuity of Care
Discharge Summary

Never worry about being out-of-date with your clinical documentation again. Updates happen automatically so you’ll always be ready for your next audit. If you have any questions or would like to review this project more in depth, please contact us at 866-543-6646 or email us at team@bestnotes.com.

date:  Mar 26, 2019
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