Handbook of Quality Assurance in Mental Health

503 Pages·1988·12.75 MB·English

by  Alex R. Rodriguez (auth.)

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