The Department of Quality Improvement and Psychiatric Services (QIPS) helps
psychiatrists acquire tools and information necessary to provide quality
treatment and concentrates on issues involving quality of care, substance use
disorders, and children's mental health.
Some APA members may have participated in the excellent track at the annual
meeting last month, "Rethinking Alcohol Use Disorders: Science,
Diagnosis, Treatment, and Policy." The series was sponsored by the
National Institute on Alcohol Abuse and Alcoholism and APA and was facilitated
by QIPS staff. We were proud to offer this focused educational experience to
our members and other meeting attendees.
Three related priority issues that are being addressed by QIPS are practice
guidelines, clinical-performance measurements, and electronic health
In response to demands from the public and policymakers for increased
attention to scientifically proven medical treatments, APA's Steering
Committee on Practice Guidelines, supported by QIPS staff, has produced 14
guidelines. The following three revisions will be provided to APA members this
summer as supplements to their copies of the American Journal of
Psychiatry: Practice Guideline for Psychiatric Evaluation, 2nd edition
(June issue); Practice Guideline for the Treatment of Patients With Eating
Disorders, 3rd edition (July issue); and Practice Guideline for Treatment of
Patients With Substance Use Disorders, 2nd edition (August issue). All of the
guidelines, as well as Guideline Watches and Quick Reference Guides are
at no cost to members.
A 2006 Compendium of Practice Guidelines and a 2006 Compendium
of Quick Reference Guides can be purchased from American Psychiatric
Publishing Inc. at its Web site at<www.appi.org>.
QIPS staff, working with APA's Council on Quality Care, have supported
performance measurements developed with the goal of improving quality of care
rather than reducing cost of or access to care. The QIPS staff have positioned
APA at national venues where development, identification, and endorsement of
national performance measures are occurring. Examples include the AMA's
Physician Consortium for Performance Improvement (PCPI), which produces
measures developed by physicians for use by physicians. APA members and staff
served in a leadership role in the PCPI development of performance measures
for the treatment of depression in adults and in children and adolescents.
This past spring, APA gained a seat on the PCPI Executive Committee. This
fall we will begin work with the PCPI on performance measures for the
treatment of substance use disorders.
APA members and QIPS staff also have worked with the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO), National Association of
Psychiatric Health Systems, and National Association of State Mental Health
Program Directors to identify five "core measures" for
hospital-based inpatient psychiatric programs. Reporting on the five core
measures will replace reporting on nine other measures currently required by
QIPS staff monitor the growing number of coalitions, such as the National
Quality Forum and the Ambulatory Quality Alliance, that have assumed roles in
measurement development and approval processes. Performance measures in many
cases are not well constructed, well understood, or well executed. However,
further development of this concept has gained momentum and public support. It
is APA's view that physicians with clinical knowledge and experience will be
able to develop more meaningful, useful measures than individuals whose
interests are primarily financial or political and should be active in these
APA committees and QIPS staff have operated on the principle that
measurement programs must minimize the data-collection burden placed on the
reporting physician or practice.
Concerns about data collection and reporting often lead to discussion of
implementation of electronic health records (EHRs) and related health
information technology (HIT). While computer programs are likely to simplify
data collection and reporting, current estimates are that only 14 percent of
physicians are using electronic health records. Many physicians are waiting
for the standards for design and use of EHRs to be clarified. The challenges
to federal agencies, hardware and software vendors, and clinicians to
collaboratively achieve clarity are enormous.
QIPS staff continually monitor national activity leading to the development
of standards, interoperable software and hardware, certification processes for
these products, "architecture" for national and regional health
information networks, security mechanisms, and disparate federal, state, and
local laws or policies governing privacy.
APA's Committee on Confidentiality is crafting recommendations to protect
the privacy of electronic health records, and the Committee on EHRs is
preparing recommendations about electronic options needed by psychiatrists to
carry out their clinical roles when patients request their EHRs.
With guidance from the Committee on EHRs, QIPS staff have created a new
electronic health record Web page in the Members Corner of the APA Web site at<www.psych.org/members/ehr/index.cfm>
to provide more EHR information to psychiatrists. The site include links to
educational resources and tools, updates on HIT developments, a resource for
APA members to post and read HIT software reviews, and a forum for members to
communicate about EHR software and issues. We invite you to complete the EHR
survey posted on the site. ▪