Research in progress on quality improvement

QI as a Foundation for Improving Evidence-Based Practice (NIMH R34 MH074788-01)

There are serious problems with the quality of mental health care in the U.S., including widespread gaps between evidence-based guidelines and current clinical practice, as well as problems with access, detection, continuity, equity and efficiency of care. Faced with these well-known deficits and requirements from accreditors and payers to address them, hospitals have invested substantially in programs to conduct measurement-based quality improvement (QI) activities. However, the extent to which these programs address priorities for improving mental health care is not known. Nor is it known whether these activities result in meaningful improvements in care. The long-term goal of our research program is to improve mental health care by enabling healthcare organizations to identify meaningful problems with quality of care and address them effectively. The specific aims of this study are to:

1) Identify the objectives for inpatient QI adopted by hospital psychiatry departments and compare them to a national, Institute of Medicine framework of improvement priorities

2) Identify organizational variables that influence departments' progress toward achieving their QI objectives

3) Determine the 'fit' between these organizational variables and potential QI objectives addressing evidence-based practices for schizophrenia and depression.

To accomplish these aims, we are conducting interviews with department leaders and survey inpatient clinicians in a representative sample of 32 hospital psychiatry departments in two large states. Based on a conceptual model grounded in organizational theory, we are using multivariate methods to test relationships between organizational variables and QI objectives, and use qualitative methods to identify facilitators and barriers to achieving improvement. The findings of our research will provide the basis for an R01 study to develop and test an intervention to enable hospital psychiatry departments to adopt evidence-based QI objectives and implement them effectively.