JCAHO seeks hospitals to test psychiatric measures

"This is our first foray into performance measures for inpatient psychiatric care," said Linda Hanold, director of performance measures and health informatics for JCAHO. "We will implement these as test measures starting in January. Utilizing volunteer institutions gives a broader test base before we roll out the final measures."

The new performance measures have been in preparation since 2004, said JCAHO associate project director Celeste Milton. Two dozen key groups have weighed in on the proposed measures, including the National Association of Psychiatric Health Systems (NAPHS), the American Psychiatric Association (APA), and ASHP. About 600 hospitals nationwide provide inpatient psychiatric care, and Milton is looking for 30 to 50 institutions to test the new measures. Once behavioral health measures become part of the JCAHO survey process in late 2008, individual hospital evaluations could be used in pay-for-performance programs, Milton said. Consumers and third-party payers could also use JCAHO survey results to help evaluate, compare, and select competing psychiatric institutions.

The initial psychiatric measures cover five areas:

And several areas directly involve pharmacy, Thompson noted, including risk assessment, chemical restraints, use of multiple antipsychotic medications, and discharge medication planning.

"Hospitalization can be a very good opportunity to simplify and rationalize medication regimens," said Kathleen McCann, director of clinical and regulatory affairs for NAPHS. "Simpler is almost always better when it comes to medication usage."

A recent ASHP survey showed that only 22% of hospitals now provide discharge medication counseling managed by a pharmacist for patients with complex and high-risk medication regimens. ASHP's 2015 program calls for 75% of patients with complex, high-risk medication regimens to receive pharmacy-based discharge counseling.

"The psychiatric setting is always complex," Thompson said. "It takes a very thorough, thoughtful assessment of the patient and the situation. Not all psychiatric patients are just on psychiatric meds."

Concern over the quality of inpatient psychiatric care has been growing for years. APA convened its own expert panel in the late 1990s, an association spokeswoman noted. APA's primary concern has been to create performance measures that can provide uniform and reliable comparisons across all care settings.

NAPHS is also looking for measures to be used across multiple settings. "We are following the traditions of both JCAHO and the Centers for Medicare & Medicaid Services in developing core measures that are publicly reported," McCann said.

Behavioral health measures must be as broadly applicable as measures for heart failure or pneumonia treatment. Part of that process is a constant reevaluation of performance measures. Milton noted that the current measures will almost certainly be adjusted based on results of the year-long field trial. Once these measures become part of the survey process, other measures will be added.

The initial measures are based on inpatient care, but acute care performance measures began on the inpatient side and have been extended into ambulatory care and other settings, McCann noted. She predicted a similar progress for psychiatric care measures.