1. Focus on Quality Depression Screening and QI Tools
June 12, 2019
Indiana Primary Health Care Association

2. Welcome!
Please keep phones muted while not speaking to eliminate background noise.
If you are using your computer for audio, click the microphone button next to your name to mute.
Do not place calls on hold, so we don’t hear hold music.
Use the chat box features if you have any questions that come up during the presentation.
Please complete the evaluation poll by the end of the meeting.
Note, this meeting will be recorded and shared with peers.

3. Agenda Data Benchmarks- Depression Screening
Depression Screening Workflows & SBIRT
INSPECT integration & Workflows
Peer Sharing on INSPECT Use
Quality Improvement Tools- A3 Model
PCMH & Behavioral Health
Announcements and Events
Jasmine introduce

4. Introductions
If you only called in please state your name and health center
If there are multiple people in the room, enter their names and into the Chat Box.
Carla

5. Welcome, Lolade Gabriella Oladele!!!
Born 03/21/2019
Weight-7lbs 1oz
Length in

6. Clinical Quality Metrics
Measures of Focus
Colorectal Cancer Screening
Cervical Cancer Screening
Hypertension Control
Childhood Immunization
Diabetes Control
Behavioral Health Screening
Clinical Quality Metrics
We have 6 measures of focus; this quarter we begin with a focus on Depression Screening and Behavioral Health

7. Today’s Objectives After this session I will be able to:
Identify at least two workflows for depression screening and SBIRT
Describe how to integrate INSPECT into workflows at the health center
Use the A3 model as a quality improvement tool
Indicate promising practices and describe lessons learned from peers

8. IPHCA’s 2019 Annual Conference: STOP Addictions
Resources Available on IPHCA Website
Some topics covered:
Social determinants of health
Harm reduction in needle exchange
Oral health treatment
Community partners
SBIRT and Motivational interviewing concepts
Care team’s role in SUD
Didn’t have FoQ due to IPHCA Annual Conference

9. Depression Screening & Follow- up (NQF 0418)
Percentage of patients aged 12 years and older screened for depression using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen.

10. How Do You Follow-up if Positive Screen??
Follow-up within 1 day must include one or more of the following:
Additional evaluation for depression, e.g PHQ-9
Suicide Risk Assessment
Referral to a practitioner who is qualified to diagnose and treat depression
Other interventions or follow-up for the diagnosis or treatment of depression
Pharmacological interventions
Measure specs from Azara DRVS

11. Focus on Quality Data Review- Indiana
No HP 2020 Average Overall, not much improvement as a state from 2017 to 2018, however there has been a significant increase in the number of Look-Alikes during 2018 who reported during UDS 2018, so the denominators are significantly different from 2017.

12. Depression Screening & Follow up Indiana
Indiana outperforms National average 2017!!
Blue- 2017
Black- 2018

13. Depression Screening & Follow Up Improvers
Health Center Name
2018 UDS Rate
Percent Increase from 2017
Shalom Health Center
87% 6%
Purdue- NCNC
84% 1%
Family Health Center of Clark County
77%
12%
NorthShore Health Centers
75%
10%
Maple City Health Care Center
74%
Neighborhood Health Clinics
71% 3%
Jane Pauley CHC
Southlake Communty Mental Health
69% 7%
Aspire Health Center
11%
Riggs CHC
67% 8%
Windrose Health Network
60%
38%
Meridian Health Services
58%
18%
Greene County Health
55%
24%
Valley Professionals CHC
49%
Indiana Health Centers
46%
Open Door Health Services
36% 2%
Madison County CHC

14. Screening Rate Improvements
17 CHCs saw improvements on depression screening and follow up in 2018
15 CHCs surpassed the National Average of 60% from 2017
Several QI tools can be used to improve on this measure and other clinical measures

15. Today’s Guest Presenters
Donna Vaughan, LMHC
Director of Integrated Primary Care
WindRose Health Networks
Stephanie Jeffery & Nicole Hall
Director of Quality & Risk Management
Valley Professionals CHC
Elkin Salinas
HCCN Project Coordinator
Community Clinic Association of LA County

16. PHQ-2 and SBIRT
Depression Screening

17. Peer Sharing on Collecting Depression Screening and INSPECT
How are you using INSPECT in your EHR workflow
Current challenges and promising practices
INSPECT integration: Eskenazi, Regional, HealthLinc, Community Healthnet, Riggs, NorthShore, VPCHC

18. Quality improvement tool
A3 for PDSA Display- Elkin Salinas
Quality improvement tool

19. Link to Website
QI Toolkit

20. Behavioral Health and Patient Centered Medical Home
Behavioral health is big component in a patient centered medical home. There is even an opportunity for health centers to strive for a distinction in behavioral health integration through the National Committee for Quality Assurance (NCQA).
Concept: Team-Based Care and Practice Organization
TC 08 (2 Credits) Behavioral Health Care Manager: has at least one care manager qualified to identify and coordinate behavioral health needs.
Concept: Knowing and Managing Your Patients(KM)
KM 01 (Core) Problem Lists: Documents an up-to-date problem list for each patient with current and active diagnoses. The patient’s active problem list or diagnoses should include acute nd chronic conditions, behavioral health diagnoses and oral health issues, as well as past diagnoses that are relevant to the patient’s current care.
KM 02 (Core) Comprehensive Health Assessment: Comprehensive health assessment includes 9 items, including mental health/substance use history of patient and family and behaviors affecting health.
KM 03 (Core) Behavioral Health Screening: Conducts behavioral health screenings and/or assessments using a standardized tool. (Implement 2 or more – Anxiety; Alcohol use disorder; Substance use disorder; Pediatric behavioral health screening; Post-traumatic stress disorder; Attention deficit/hyperactivity disorder; Postpartum depression.)
Carla

21. BH and PCMH (Cont.)
KM O4 (1 Credit) Behavioral Health Screenings: Conducts behavioral health screenings and/or assessments using a standardized tool. (Implement two or more)
KM 20 (Core) Clinical Decision Support: Implements clinical decision support following evidence-based guidelines for care of - practice must demonstrate at least four criteria and mental health condition (depression is one example) can be one of the four.
Concept: Care Management and Support (CM)
CM 01 (Core) Identifying Patients for Care Management: Considers the following when establishing a systematic process and criteria for identifying patients who may benefit from care management – practice must include at least three in its criteria and behavioral health conditions is listed.
CM 02 (core) Monitoring Patients for Care Management: Monitors the percentage of the total patient population identified through its process and criteria. If behavioral health conditions is selected from CM 01, then it must be included here.
CM 04 (core) Person-Centered Care Plans: Establishes a person-centered care plan for patients identified for care management. Dependent on behavioral selection from CM 01.
CM 05 (Core) Written Care Plans: Provides a written care plan to the patient/family/caregiver for patients identified for care management. Dependent on behavioral selection from CM 01.
Carla

22. BH and PCMH (Cont.)
CM 06, 07, 08. (1 credit each) all relate to the individual care plans and are dependent on the selection from CM 01.
Concept: Care Coordination and Care Transitions (CC)
CC 09 (2 credits) Behavioral Health Referral Expectations: Works with behavioral healthcare providers to whom the practice frequently refers to set expectations for information sharing and patient care.
CC 10 (2 Credits) Behavioral Health Integration: Integrates behavioral healthcare providers into the care delivery system of the practice site
Concept: Performance Measurement and Quality Improvement (QI)
QI 01 (Core) Clinical Quality Measures: Monitors at least five clinical quality measures across the four categories (must monitor at least one measure of each type – behavioral health is one category.
QI08 (Core) Goals and Actions to Improve Clinical Quality Measures: Sets goals and acts to improve upon at least three measures across at least three of the four categories (behavioral health is one category).
Contact Carla Chance, for questions and more info

23. Evaluation Poll
Please complete the brief evaluation before signing off.

24. Announcements & Events
SBIRT Trainings
$20 for Members, $40 non-members
June 14th in Muncie
June 17th in Indianapolis
June 18th in Jeffersonville
Project ECHO- Opioid Use Disorder for Prescribers and Dispensers
Free Registration Open, began May 29th and continues for year
More details in May CHC Digest
Visit indianapca.org “Events” for more IPHCA events