The Journal of the Arkansas Medical Society Issue 1 Vol 115 - Page 12

A C L O S E R L O O K AT Q U A L I T Y EDITORIAL PANEL Chad T. Rodgers, MD, FAAP; Elena M. Davis, MD, MPH; Michael Moody, MD; J. Gary Wheeler, MD, MPS Increase Screening of Depression and Alcohol Use Disorders BY CAITLIN FENERTY MOORE, MPH, CPHQ N early 20 percent of Medicare beneficiaries live with at least one mental health or substance use condition, according to the Nation- al Council for Behavioral Health and the Institute of Medicine. However, less than 40 percent of these older adults receive treatment. 1 In the Medicare population, depression has a higher in- patient readmission rate than all other conditions, except heart failure. 2 A major concern of the medical community is the prevalence of undetected or misdiagnosed alcohol use disorders (AUD) and depression. As the population of adults over age 65 grows, identification through screening, within primary care practices, is the first step to help improve the lives of Medicare beneficiaries with these conditions. Alcohol is the most commonly abused substance and can cause serious medical complications. 3 AUDs coupled with depression can be even more life-threatening among older adults. These mental conditions often go undetected when physical ail- ments are being treated. 4 Older adults are also less likely to seek mental health care because of a stigma about mental health treatment. A MULTI-STATE APPROACH The TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO), partnering with AFMC to serve Arkansas, is addressing these concerns through its Behavioral Health project, with a grant awarded by the Centers for Medicare & Medicaid Ser- vices (CMS). Community coalitions of primary care clinicians, inpatient psychi- atric facilities (IPFs), hospitals, special- ists, partners and other stakeholders throughout Arkansas, Missouri, Okla- homa, Puerto Rico and Texas, are work- ing to increase screening for depression and AUDs in primary care settings and reduce the 30-day readmission rate for patients discharged from IPFs. They also want to increase the number of Medicare beneficiaries who have an outpatient visit with a behavioral health provider after an IPF hospitalization. Since the project began in June 2015, more than 1,000 participating practices have joined the Behavioral Health Learning and Action Network (BHLAN). These providers are working to reach a goal of screening 75 per- cent of their Medicare patients annu- ally for depression and AUD. Since the beginning of the project participants in Arkansas have screened 77,764 beneficiaries for AUD and 107,866 beneficiaries for depression, through mid-2017, according to CMS’ reports. SHARING BEST PRACTICES AFMC’s quality improvement specialists consistently seek to iden- tify high performers in the behavioral health work. Each quarter that new data is available, the AFMC team com- pletes individual scorecards for each participating practice. The scorecard helps them work effectively with the fa- cilities to review their rates, rate trends and goals. When a team identifies a particularly high-performing practice, they give the practice a chance to participate in a success story to share achievements, tips and best practices for other providers in the BHLAN. One of Arkansas’ high-performing providers is ARcare, with 38 practice sites in Arkansas. ARcare began focusing on improved depression screening by developing standing orders for nurses to perform Patient Health Questionnaire-2 (PHQ-2) and PHQ-9 testing and creating reminder alerts in the electronic health record (EHR). ARcare created monthly scorecards and shared them with all clinical staff. Within four months, screenings increased from less than 5 percent to more than 90 percent. Later, they added AUD screening and a plan for addressing positive screens. ARcare now averages more than 90 percent screening rates for both AUD and depression. THE ARKANSAS FOUNDATION FOR MEDICAL CARE, INC. (AFMC) WORKS COLLABORATIVELY WITH PROVIDERS, COMMUNITY GROUPS AND OTHER STAKEHOLDERS TO PROMOTE THE QUALITY OF CARE IN ARKANSAS THROUGH EDUCATION AND EVALUATION. FOR MORE INFORMATION ABOUT AFMC QUALITY IMPROVEMENT PROJECTS, CALL 1-877-375-5700. • JULY 2018 12 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY VOLUME 115