Handbook of Quality Assurance in Mental Health PDF
Preview Handbook of Quality Assurance in Mental Health
Handbook of Quality Assurance in Mental Health Handbook of Quality Assurance in Mental Health EDITED BY GEORGE STRICKER [l!slilule of Adm11ced Ps!iclwlogica/ Shtdies Adelphi U11h'ersi~1 Cardell Ci~1, New York AND ALEX R. RODRIGUEZ Preferred Health Care, Ltd, Willo11, COilllecliwl Springer Science+Business Media, LLC Library of Congress Cataloging in Publication Data Handbook of quality assurance in mental health. Includes bibliographies and index. 1. Mental health services-Standards-United States. 2. Quality assurance-United States. I. Stricker, George. II. Rodriguez, Alex R. [DNLM: 1. Mental Health Services United States. 2. Quality Assurance, Health Care-United States. WM 30 H2358] RA790.5.H3 1987 362.2'068 87-29101 ISBN 978-1-4684-5238-9 ISBN 978-1-4684-5236-5 (eBook) DOI 10.1007/978-1-4684-5236-5 © 1988 Springer Science+Business Media New York Originally published by Plenum Press, New York 1988 Softcover repriot of the hardcover I st edition 1988 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical. photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Contributors MICHAEL J. BENNETT Harvard Community Health Plan, Harvard Medical School, Boston, Massachusetts 02215 RUSSELL J. BENT School of Professional Psychology, Wright State University, Dayton, Ohio 45435 DONALD N. BERSOFF Ennis, Friedman, & Bersoff, 1200 17th Street, N.W., Washington, D.C. 20036 ROBERT H. BROOK Rand Corporation, 1700 Main Street, Santa Monica, California 90406-2138 WILLIAM J. CHESTNUT Indiana University, Student Health Center, Bloom- ington, Indiana 47405 J. JARRETT CLINTON Office of Health Affairs, The Pentagon, Department of Defense, Washington, D.C. 20310 LAWRENCE H. COHEN Department of Psychology, University of Delaware, Newark, Delaware 19716 JOSEPH N. CRESS 4645 Brady Street, Davenport, Iowa 52806 PATRICK H. DELEON Office of Senator Daniel K. Inouye, 722 Hart Senate Of- fice Building, Washington, D.C. 20510 ROBERT W. GIBSON Sheppard and Enoch Pratt Hospital, 6501 North Char- les Street, Baltimore, Maryland 21285-6815 PETER G. GOLDSCHMIDT World Development Group, 5101 River Road, Bethesda, Maryland 20816. JUDY E. HALL New York State Education Department, Cultural Education Center, Albany, New York 12230 v vi CONTRIBUTORS AGNES B. HATFIELD Department of Education, University of Maryland, College Park, Maryland 20742 KIT KINPORTS Ennis, Friedman, & Bersoff, 1200 17th Street, N.W., Washing- ton, D.C. 20036 NANCY LANE-PALES 3112 Westover Drive, S.E., Washington, D.C. 20020 ROBERT S. LONG Mutual of Omaha Insurance Company, Omaha, Nebraska 68175 LORRAINE L. LUFT Peninsula Hospital Community Mental Health Center, 1783 El Camino Real, Burlingame, California 94010 MYRENE McANINCH Accreditation Program for Psychiatric Facilities, Joint Commission on Accreditation of Hospitals, 875 North Michigan Avenue, Chi cago, Illinois 60611 ELIZABETH MElD 10 Minot Avenue, Auburn, Maine 04210 DONALD E. NEWMAN Peninsula Hospital Community Mental Health Center, 1783 El Camino Real, Burlingame, California 94010 BETH EGAN O'KEEFE 2100 52nd Avenue, Moline, Illinois 61265 NORMAN R. PENNER American Psychiatric Association, 1400 K Street, N.W., Washington, D.C. 20005 ALEX R. RODRIGUEZ Preferred Health Care, Ltd., 15 River Road, Wilton, Con- necticut06897 ABRAM ROSENBLATT Department of Psychology, University of Arizona, Tucson, Arizona 85721 LEE SECHREST Department of Psychology, University of Arizona, Tucson, Arizona 85721 SHARON A. SHUEMAN Shueman Troy and Associates, 246 North Orange Grove Boulevard, Pasadena, California 91103 H. BERNARD SMITH Private practice, Washington, D.C. 20005 MILTON THEAMAN 565 West End Avenue, New York, New York 10024 WARWICK G. TROY California School of Professional Psychology, 2235 Beverly Boulevard, Los Angeles, California 90057 CONTRIBUTORS vii GARY R. VANDENBOS American Psychological Association, 1200 17th Street, N.W., Washington, D.C. 20036 KENNETH B. WELLS Rand Corporation, 1700 Main Street, Santa Monica, California 90406-2138 JOAN G. WILLENS Private practice; Beverly Hills, California 90212 JACK A. WOLFORD Western Psychiatric Institute and Clinic, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania 15213 Contents PART I INTRODUCTION Chapter 1 An Introduction to Quality Assurance in Mental Health 3 Alex R. Rodriguez Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Definitions of Quality Assurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 The Driving Forces in Quality of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Quality Assurance and Related Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Problems in Evaluations and Assuring Quality . . . . . . . . . . . . . . . . . . . . . . . . 24 The Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 PART II GENERAL ISSUES Chapter 2 Historical Trends in Quality Assurance for Mental Health Services 39 Kenneth B. Wells and Robert H. Brook Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Historical Events in Mental Health Quality Assurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Trends Affecting the Development of Quality Assurance . . . . . . . . . . . . . . . 43 Specific Issues in Mental Health Quality Assurance . . . . . . . . . . . . . . . . . . . 44 Research in Quality Assurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 The Future of Quality Assurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 ix X CONTENTS Chapter 3 Research on Mental Health Quality Assurance 65 Lawrence H. Cohen Evaluation of Treatment Process 65 Explicit Screening Criteria ........................................ . 67 Implicit Process Judgments ....................................... . 68 Outcome-Based Quality Assurance in Mental Health ................ . 70 Treatment Documentation ........................................ . 71 Selection of Peer Reviewers ...................................... . 72 Attitudes toward Peer Review .................................... . 73 Corrective Feedback to Clinicians ................................. . 74 Continuing Medical Education .................................... . 74 Effects of Quality Assurance on Quality of Care ..................... . 74 Medical Studies ................................................. . 76 Mental Health Quality Assurance and Cost Control ................. . 77 Conclusions .................................................... . 77 References ..................................................... . 77 Chapter 4 Evaluating Peer Review .......................................... . 81 Lee Sechrest and Abram Rosenblatt Process and Outcome ............................................ . 82 Process Evaluation and Peer Review ............................... . 82 Design Issues ................................................... . 87 Experimentation ................................................ . 91 Outcome Evaluation ............................................. . 97 Conclusion 98 References ..................................................... . 99 Chapter 5 Education for Quality Assurance 103 Russell ]. Bent Quality: A General Concept, a Specific Activity . . . . . . . . . . . . . . . . . . . . . . 103 Quality Assurance in the Curriculum of the Clinical Psychologist . . . . . . 105 Service by Objectives: A Goal-Oriented Management Information System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 The Quality-Assurance Service-Review Process . . . . . . . . . . . . . . . . . . . . . . 112 The Clinical-Practice Proficiency Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . 114 Monitoring Student Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Appendix A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 CONTENTS xi Appendix B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Appendix C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Appendix D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Chapter 6 The Effects of Contemporary Economic Conditions on Availability and Quality of Mental Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Alex R. Rodriguez Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 The Economic Dialectic in American Health Care . . . . . . . . . . . . . . . . . . . . . 137 The Cost Crisis: Real and Imaginary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 The Cost-Containment Imperative: Regulation and Competition . . . . . . . . 143 The Effect of Changes on Mental Health Services . . . . . . . . . . . . . . . . . . . . . 151 The Impact of Changes on Quality Assurance Systems . . . . . . . . . . . . . . . . 153 Professional Issues in Current and Future Quality Assurance . . . . . . . . . . . 155 Policy Issues Affecting Quality in Mental Health . . . . . . . . . . . . . . . . . . . . . . 156 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Chapter 7 The Role of the Consumer in Quality Assurance 169 Agnes B. Hatfield and H. Bernard Smith The Growth of the Consumer Movement 170 Quality Assurance: A Consumer Perspective . . . . . . . . . . . . . . . . . . . . . . . . . 172 The Empowerment of Consumers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 Summary and Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 Chapter 8 Alternative Futures for Assuring the Quality of Mental Health Services 185 Peter G. Goldschmidt Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 Mental Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 Quality Assurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 Thinking about the Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 Managing the Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 Alternative Futures for the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 2025: Continued Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 2025: Economic Collapse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
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