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Office of Mental Health

 

Past Initiative
The Medication-Focused PSYCKES-CQI Initiative

Overview:  The New York State Office of Mental Health (OMH) and the Department of Health have collaborated on an ongoing continuous quality improvement initiative (CQI) since 2008.  In Phases I and II (2008-2012) of the Psychiatric Services and Clinical Knowledge Enhancement System (PSYCKES) CQI Initiative, the goal was to decrease the prevalence of questionable psychotropic prescribing practices among Medicaid enrollees in New York State.  Project options for mental health clinics participating in the initiative included reducing the use of: 1) high/moderate risk antipsychotics for individuals having a cardiometabolic disorder, 2) multiple concurrent psychotropic medications, 3) higher than recommended doses of psychotropic medications, and 4) higher-risk psychotropic prescribing practices in children and youth.  The PSYCKES-Medicaid application served as a health information technology tool to inform quality improvement processes and clinical decision-making, and to measure project impact. The medication-focused quality indicator sets are still available in PSYCKES. 

Project Tools:  OMH designed a number of tools to help support clinics’ CQI processes and changes in prescribing.

Project Impact: 

Medicaid Analysis:  To determine the impact of the PSYCKES-CQI Initiative for Medicaid enrollees, analyses were conducted for participating clinics and non-participating clinics on a quarterly basis.  The non-participating clinic group included clinics not eligible to participate in the PSYCKES-CQI Initiative, primarily hospital-affiliated clinics that were not members of the Greater New York Hospital Association-OMH Quality Collaborative in 2011.

Phase 1 results showed sustained gains throughout the project period.  As of the end of September 2011, the Polypharmacy Summary Indicator significantly decreased by -15.8% (Average Annual Percentage Change (AAPC) = -6.4% 95% Confidence Interval (CI): -6.8, -5.9) in participating clinics, remaining stable in nonparticipating clinics (AAPC= 0.5%, 95% CI: -12.9, 15.9).  The Cardiometabolic Summary Indicator maintained significant decreases in participating clinics (AAPC: -9.7%, 95% CI: -10.7, -8.7), compared to a modest, non-significant decrease in nonparticipating clinics (AAPC: -2.5%, 95% CI: -5.9, 1.0). 

Phase 2 results showed statistically significant declines in the Polypharmacy Summary Indicator (AAPC: -7.1%, 95% CI: -9.5, -4.6), the Cardiometabolic Summary Indicator (AAPC: -5.6%, 95% CI: -8.0, -3.2), and the Dose Summary Indicator (AAPC: -10.0%, 95% CI: -13.7, -6.2). Non-participating clinics showed smaller declines in the Polypharmacy Summary Indicator (AAPC: -2.8%, 95% CI: -4.7, -0.9), the Cardiometabolic Summary Indicator (AAPC: -3.2%, 95% CI: -5.3, -1.0), and the Dose Summary Indicator (AAPC: -8.2%, 95% CI: -13.2, -3.0).

Monthly Self-Report Data:  Clinics participating in the medication-focused CQI Initiative used a Plan-Do-Check-Act (PDCA) quality improvement model to achieve change.  Clinics reported monthly on the number of positive cases identified, number of clinical reviews conducted, and number of medication changes made to achieve a non-positive status in the previous month and to date.  The project goal was to achieve at least a 30% rate of change.  As of November 30, 2012, the last month that the clinics reported on their activity, 62% of participating clinics with at least 10 positive cases had achieved the target goal of changing the medication regimen of 30% or more of identified positive cases for their Phase I project.

Comments or questions about the information on this page can be directed to the PSYCKES Team.