Best-practices efforts in mental health

The best practices followed in healthcare particularly mental care are as follows :

 Although psychiatry has lagged behind the medical industry in the search for best practices, there is evidence of progress. For example, last year NCQA introduced three indicators for the treatment of depression. After a year of data collection, it appears that at least one measure—follow-up with a provider during the first 12 weeks of acute treatment—shows considerable regional variability. Furthermore, larger health plans have higher compliance rates than smaller plans . It remains to be determined whether this indicator will differentiate providers with better-than-average care or whether improvement will occur over multiple reporting periods, as was the case in general medicine.

Collaborative partnerships in which providers receive comparative data on processes and outcomes of psychiatric care have also been forming. American Psychiatric Association- NetOutcomes Quality Care 2000 is a joint project developed by the American Psychiatric Association (APA) and the Center for Outcomes Research and Effectiveness of the University of Arkansas for Medical Sciences. Through an Internet-based treatment outcomes system, participating APA members can benchmark the clinical outcomes of their patients with depression and determine whether their performance compares favorably with that of other providers.

A similar project, coordinated by the department of psychiatry at the University of Cincinnati College of Medicine , compares process and outcomes of care for behavioral health group practices across the country. Data from the project suggest that the proliferation of consensus and evidence-based guidelines may contribute to improved patient care. However, because of confidentiality constraints, the authors were unable to examine which factors distinguished the innovative from the average provider settings.

Finally, implementation of best practices from research is occurring at individual sites, such as the Center for Behavioral Health in Bloomington, Indiana, where clinicians are being trained in empirically supported treatments and patient outcomes are benchmarked against results of clinical trials .

Perhaps the most advanced capabilities in, and the most systematic approach to, benchmarking can be found in the VA. Its extensive service utilization and pharmacy databases allow comparisons across hospitals and specialty clinics, resulting in multiple reports of practice variations in lengths of stay for psychiatric inpatient admissions, prescriptions for antidepressant and antipsychotic medications, and extent and type of psychosocial interventions for veterans with psychiatric diagnoses in primary and specialty care clinics .

More recently, the VA has instituted the Quality Enhancement Research Initiative. The initiative addresses several areas of concern for veterans, including mental health. The project translates research findings into clinical practice through dissemination and implementation of findings and guidelines, development of toolkits and feedback mechanisms, and other intervention materials. The overarching goal is to reduce inappropriate variations in treatment.

Other initiatives include the benchmarking efforts of the National Association of State Mental Health Program Directors, which has released a comprehensive set of performance and outcomes indicators for public mental health programs.

Despite these developments, our knowledge of best practices in psychiatry remains limited. We have ventured into provider profiling, yet we have minimal information about what constitutes the best in our field. We have advocated outcomes measurement for years, yet we have published few studies linking effectiveness to specific care processes. We have documented variability in provider practices, but we have avoided the more intensive drill-down process to determine what works well for which patients.