VHA Mental Health Information System: Applying Health Information Technology to Monitor and Facilitate Implementation of VHA Uniform Mental Health Services Handbook Requirements.

*Program Evaluation and Resource Center, VA Palo Alto Health Care System, Menlo Park, CA †North East Program Evaluation Center, VA West Haven Health Care System, West Haven, CT ‡Department of Veterans Affairs, Mental Health Operations, Washington, DC §Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX ∥Serious Mental Illness Treatment Evaluation Center, VA Ann Arbor Health Care System, Ann Arbor, MI.
Medical care (Impact Factor: 3.23). 03/2013; 51 Suppl(3):S29-36. DOI: 10.1097/MLR.0b013e31827da836
Source: PubMed


: To describe the design and deployment of health information technology to support implementation of mental health services policy requirements in the Veterans Health Administration (VHA).
: Using administrative and self-report survey data, we developed and fielded metrics regarding implementation of the requirements delineated in the VHA Uniform Mental Health Services Handbook. Finalized metrics were incorporated into 2 external facilitation-based quality improvement programs led by the VHA Mental Health Operations. To support these programs, tailored site-specific reports were generated.
: Metric development required close collaboration between program evaluators, policy makers and clinical leadership, and consideration of policy language and intent. Electronic reports supporting different purposes required distinct formatting and presentation features, despite their having similar general goals and using the same metrics.
: Health information technology can facilitate mental health policy implementation but must be integrated into a process of consensus building and close collaboration with policy makers, evaluators, and practitioners.

Download full-text


Available from: Greg Greenberg, Mar 01, 2015
42 Reads
  • Source
    • "Although evidence supports the efficacy of topiramate for alcohol dependence [7-9,21-23], system monitoring metrics and quality measures of pharmacotherapy for AUD used within VHA [19] and developed elsewhere [24] only include FDA-approved medications (naltrexone, acamprosate, and disulfiram). This may not only underestimate actual overall patient utilization of pharmacotherapy for AUD but also unnecessarily penalize those facilities with higher rates of topiramate utilization. "
    [Show abstract] [Hide abstract]
    ABSTRACT: As a quality improvement metric, the US Veterans Health Administration (VHA) monitors the proportion of patients with alcohol use disorders (AUD) who receive FDA approved medications for alcohol dependence (naltrexone, acamprosate, and disulfiram). Evidence supporting the off-label use of the antiepileptic medication topiramate to treat alcohol dependence may be as strong as these approved medications. However, little is known about the extent to which topiramate is used in clinical practice. The goal of this study was to describe and examine the overall use, facility-level variation in use, and patient -level predictors of topiramate prescription for patients with AUD in the VHA. Using national VHA administrative data in a retrospective cohort study, we examined time trends in topiramate use from fiscal years (FY) 2009--2012, and predictors of topiramate prescription in 375,777 patients identified with AUD (ICD-9-CM codes 303.9x or 305.0x) treated in 141 VHA facilities in FY 2011. Among VHA patients with AUD, rates of topiramate prescription have increased from 0.99% in FY 2009 to 1.95% in FY 2012, although substantial variation across facilities exists. Predictors of topiramate prescription were female sex, young age, alcohol dependence diagnoses, engagement in both mental health and addiction specialty care, and psychiatric comorbidity. Veterans Health Administration facilities are monitored regarding the extent to which patients with AUD are receiving FDA-approved pharmacotherapy. Not including topiramate in the metric, which is prescribed more often than acamprosate and disulfiram combined, may underestimate the extent to which VHA patients at specific facilities and overall are receiving pharmacotherapy for AUD.
    Addiction science & clinical practice 07/2013; 8(1-1):12. DOI:10.1186/1940-0640-8-12
  • Medical care 03/2013; 51 Suppl(3 Suppl 1):S4-5. DOI:10.1097/MLR.0b013e3182848a3d · 3.23 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Primary care screening programs for mental health disorders are designed to detect patients who might benefit from treatment. As such, the utility of these programs is predicated on the actions that take place in response to a positive screen. Our objective was to characterize the cascade of care delivery steps following a positive screen for a mental health disorder. Method We examined the care received by primary care patients over the year following a new positive screen for depression, PTSD, or alcohol misuse. We characterized whether the care adhered to practice guidelines for related mental health disorders and whether involvement of mental health specialists led to higher use of guideline-adherent practices. Results Many patients received appropriate treatment in the primary care setting and those whose scores were consistent with more severe illness were more likely to receive care in a mental health setting. Patients with positive screens for depression and PTSD who went on to be seen in mental health clinics received care that was consistent with treatment guidelines for the related disorder most of the time. In the case of patients with positive screens for alcohol misuse, few received guideline-recommended medications in any setting. However, a substantial portion of patients received some alcohol-related counseling from their primary care physicians during the visit in which their alcohol misuse was detected. Conclusion It appears that the treatment system for mental health problems, which extends from primary care settings to mental health sub-specialty settings, can provide adequate care when patients’ mental health problems are identified through screening. The care provided in all settings can be improved, and additional steps to enhance the quality of care are warranted. This should include additional efforts to align screening and treatment.
    General Hospital Psychiatry 11/2014; 36(6). DOI:10.1016/j.genhosppsych.2014.07.009 · 2.61 Impact Factor
Show more