title: Using organizational and clinical performance data to increase the value of mental health care.
abstract: U.S. health systems, policy makers, and patients increasingly demand high-value care that improves health outcomes at lower cost. This study describes the initial design and analysis of the Mental Health Management System (MHMS), a performance data and quality improvement tool used by the Veterans Health Administration (VHA) to increase the value of its mental health care. The MHMS evaluates access to and quality of mental health care, organizational structure and efficiency, implementation of innovative treatment options, and, in collaboration with management, resource needs for delivering care. Performance on 31 measures was calculated for all U.S. VHA facilities (N = 139). Pearson correlations revealed that better access to care was significantly associated with fewer mental health provider staffing vacancies (r = -.24) and higher staff-to-patient ratios for psychiatrists (r = .19) and other outpatient mental health providers (r = .27). Higher staff-to-patient ratios were significantly associated with higher performance on a number of patient and provider satisfaction measures (range of r = .18-.51) and continuity of care measures (range of r = .26-.43). Relationships observed between organizational and clinical performance measures suggest that the MHMS is a robust informatics and quality improvement tool that can serve as a model for health systems planning to adopt a value perspective. Future research should expand the MHMS framework to measure patient and health systems costs and psychosocial outcomes, as well as evaluate whether quality improvement solutions implemented as a result of using organizational information leads to higher-value mental health care. (PsycINFO Database Record
authors.affiliation: Center for Innovation to Implementation, HSR&D, Veterans Affairs Palo Alto Health Care System.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Schmidt
authors.affiliation: Department of Psychiatry, William S. Middleton Memorial Veterans Hospital.
authors.forename: Dean D
authors.initials: DD
authors.lastname: Krahn
authors.affiliation: Mental Health Services, Veterans Affairs Central Office.
authors.forename: Marsden H
authors.initials: MH
authors.lastname: McGuire
authors.affiliation: Center for Innovation to Implementation, HSR&D, Veterans Affairs Palo Alto Health Care System.
authors.forename: Sara
authors.initials: S
authors.lastname: Tavakoli
authors.affiliation: Center for Innovation to Implementation, HSR&D, Veterans Affairs Palo Alto Health Care System.
authors.forename: David M
authors.initials: DM
authors.lastname: Wright
authors.affiliation: Center for Innovation to Implementation, HSR&D, Veterans Affairs Palo Alto Health Care System.
authors.forename: Hugo E
authors.initials: HE
authors.lastname: Solares
authors.affiliation: Center for Innovation to Implementation, HSR&D, Veterans Affairs Palo Alto Health Care System.
authors.forename: Sonne
authors.initials: S
authors.lastname: Lemke
authors.affiliation: Center for Innovation to Implementation, HSR&D, Veterans Affairs Palo Alto Health Care System.
authors.forename: Jodie
authors.initials: J
authors.lastname: Trafton
mesh_terms: D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration / Q000592:standards; D006801:Humans; D008491:Medical Informatics Applications; D008605:Mental Health Services / Q000191:economics / Q000458:organization & administration / Q000592:standards; D058996:Quality Improvement / Q000191:economics / Q000458:organization & administration / Q000592:standards; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics / Q000458:organization & administration / Q000592:standards