Patient-Centered Care: Improving Outcomes that Matter to Patients in the Real World (Text Version)

On September 27, 2010, Steven S. Sharfstein made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (675 KB). 

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Slide 1

Patient-Centered Care: Improving Outcomes that Matter to Patients in the Real World

Steven S. Sharfstein, M.D.
AHRQ Conference
September 27, 2010

Slide 2

Sheppard Pratt

• Served more than 57,000 individuals in 2009, including children, adolescents, and adults.
• 37 locations in 12 Maryland counties, Baltimore City, and Northern Virginia.
• Comprehensive continuum, including hospitals, residential treatment centers, psychiatric rehabilitation programs, outpatient mental health and substance abuse treatment clinics, and special education schools.

Mission Statement:.Sheppard Pratt, a not-for-profit behavioral health system, is dedicated to the improvement of quality of life in communities by serving the behavioral health and special education needs of individuals, families, and organizations.

Image: A map of the Northern Virginia, Maryland, and Delaware area is shown.

Slide 3

Evidence-Based Practices Psychiatric Rehabilitation Programs

• High Fidelity:
  • Supported employment.
  • Assertive community treatment.
  • Integrated dual disorders treatment.
  • Family psycho-education.
  • Multisystemic therapy.
• Seeking Fidelity: Illness Management and Recovery.
• Planning This Year: Permanent Supportive Housing.
• Evidence-supported Practice: Transition to Independence Process.

Slide 4

Supported Employment Pilot—Components

• Five-Year Pilot at 8 Sites in 7 Jurisdictions.
• Serving More than 600 Low-Income SMI/Year.
• Integrating Three Interventions:
  • EBP supported employment.
  • Customized employment.
  • Benefits counseling.
• Technical Assistance for Replication.
• Public-Private Partnership.

Slide 5

Supported Employment Pilot—Research

• Dartmouth College
  • Measuring
    • Impact of benefits counseling.
    • Cost-benefit analysis of state funding.
  • Eight non-Sheppard Pratt organizations in two comparison groups
• Boston University
  • Measuring impact of adding a vocationally-focused illness management and recovery curriculum to EBP SE.

Slide 6

Implementing EBP in Real World—Challenges and Recommendations

• Challenge #1: EBPs More Expensive to Implement
• Recommendations:
  • More research studies should include cost-benefit analyses relative to state funding.
  • More states should employ Maryland strategy of implementation, focusing on incentives vs. mandates.

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Implementing EBP in Real World—Challenges and Recommendations

• Challenge #2: Difficult for Front-Line Stakeholders to Let Go of Traditional Approaches and Beliefs
  • Zero exclusion and rapid job search for EBP SE.
  • Discovery process for customized employment.

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Implementing EBP in Real World—Challenges and Recommendations

• Recommendations:
  • Use independent fidelity assessment process to reinforce and inspire provider staff.
  • States develop fidelity assessment expertise.
  • Providers do better job of articulating interventions for families and funders.

Slide 9

Implementing EBP in Real World—Challenges and Recommendations

• Challenge #3: Tension Between EBP Integration vs. Recovery Model Consumer Choice
  • EBPs require integration of services, which is most effectively implemented by one provider agency.
  • Recovery model values consumer choice of providers, which can result in multiple agencies providing one EBP.

Slide 10

Implementing EBP in Real World—Challenges and Recommendations

• Recommendations:
  • Reframe choice as:
    • Between EBP providers.
    • Between EBP and non-EBP services.
  • Compromise where possible for certain EPBs.
  • Coordination vs. integration.
    • States need flexible definition of coordination.

Slide 11

Final Comment

• There is no EBP for acute inpatient care.
• Need for comparative effectiveness studies:
  • Ultra-acute care versus acute care.
  • Hospital care versus residential diversion.
• A major public health issue.