There is renewed interest to assay access to care, quality of care and patient satisfaction within the mental health community composed of many stakeholders: patients, care providers, third parties, the mental health agency, etc.
This is a historical note on the Puerto Rico Psychiatric Society -Quality Summit of 1998. This coming year marks the 10th anniversary of such first Quality Summit sponsored by this organization of over 150 psychiatrists.
SEE REFERENCE TO THE ENTIRE QUALITY SUMMIT AT THE WEBSITE
http://www.puertoricopsychiatricsociety.org
under Calidad y Cuidado Dirigido
CONCLUSIONS AND RECOMMENDATIONS
This report has attempted to summarize the Quality Summit. The following indicators were recommended to measure access and quality of care:
1) the number of people receiving care
2) frequency of visits
3) time intervals between visits
4) types of treatments provided
5) evidence that patients are provided information regarding diagnosis and treatment 6) evidence that the diagnosis rendered was appropriate to history and examination
7) evidence that treatment was appropriate to the diagnosis
8) evidence that care was provided in a cost effective manner
The conference participants also recommended that future managed care contractual arrangements be written to require systematic and externally conducted evaluations of the quality of care rendered. In addition, parity and confidentiality legislation must be enacted if there is to be any assurance that mental health services will be adequate to the needs of the citizens of Puerto Rico. In order to assure that access is uniform throughout the island, information on indicators of acces must be provided in an open and timely way from ASSMCA and MCO's.
The following indicators were recommended to measure appropriateness of care:
1) effective credentialling, based on licensure and training, of all professionals providing patient care
2) monitoring of hospital readmission rates 30 days post-discharge
3) a treatment standard of 50% of patients returning to a primary social role
4) peer review of 50% of active cases
5) prescribing privileges for medications is restricted to those with proper licensure and training
6) a standard of 0% be set for requiring the submission of a complete medical record for purposes of utilization review by insurance or managed care organizations
7) surveys of psychiatrists indicate that at least 80% believe they are able to offer the an optimal standard of care for their patients.
The conference participants urged the maintenance of a continuous dialogue between clinical groups and managed care organizations which prior to this conference had not occurred on Puerto Rico. Furthermore, the Puerto Rican District Branch of the APA should be actively engaged in reviewing government service delivery plans for patient with mental disorders and in providing peer review for care offered through managed care contracts.
In order to protect the doctor-patient confidentiality, legislation should be enacted that protects the privacy of this relationship. All care for major mental disorders should require that a psychiatrist oversees, supervises or actually provides the direct care to the patient. Finally, an adequate budget should be set and funded that will assure a universal and thorough education of citizens regarding the Health Reform and how to successfully obtain entitlement services. The participants also recommended the further development of consumer-advocacy groups.
Enactment of the new Mental Health Law was strongly supported as was increased activity by the State Planning Council within ASSMCA. Regarding special populations, the conference participants urged the creation, by law, of an agency that would be charged with oversight of the managed care companies and government contracts with the MCOs. There is a particular need for reimbursement of patient care services beyond acute care, such as rehabilitation and services provided in schools. We need also need to measure and monitor longer term social outcomes for the functioning of children and the elderly who are served by the mental health sector.
In order to assure that the voice of the mentally ill and disadvantaged is heard, there must be an agency that will provide oversight for the functioning of the system. This agency should report directly to the legislature or to the Insurance Commissioner to guarantee proper and consistent input in policy and budgetary matters.P> Today's discussion on quality should become a continuous dialogue on quality. Moreover, every effort should be made to improve relations among the professional organizations representing psychiatrists as well as between psychiatrists and other mental health associations. We are recommending an interdisciplinary dialogue through the creation of a new committee on interdisciplinary collaboration. Because so little has been done in the form of collaboration between psychiatrists and primary care practitioners, the latter group should be invited to the Psychiatric Convention in September 1998.
We also need to improve upon and solidify relations between professional organizations and government agencies. The APA Puerto Rico President-elect should be assigned to lead the proposed inter-organizational collaboration committee. The Puerto Rico chapter of the APA would benefit from an executive director with government a public relations skills. The district branch must reach out to nurses, psychologists, pharmacists, social workers, occupational therapists and other mental health disciplines. The work of the organizations, collectively, would be greatly enhance by the creation of a committee that represented a coalition of interdisciplinary organizations.
_ Group I. Glorisa Canino, Erick Santos, Rosso, Margarita Alegria, Jorge Torres, Pilar Christian
Group II: Llado, Polo, Carlos Perez Cortes, Roberto J. Fumero, Rita Rodriguez , Myrna Segarra, Harold Figueroa, Enrique Vazquez Quintana, Marina Diaz, Irma Moreira, Felicita Cintron, Sr. Rebollo, Luz Medina.
Group III: Ramon Parrilla, Luis Canepa, Ileana Vazquez, Angela Diaz, Jose Luis Lopez, Ramon Ortiz
Group IV: Nuria Sabate, Varela, Olmo, Caro, Caban, Fransceschini, Lima, Huertas.
Group V: Galarza, Costas, Silvia Arias, Rosita Esteras, Jose Nunez Lopez, Luz Minerva Guevara, Maria Sanchez Bonilla.
CONSENSUS DEVELOPMENT PANEL
Glorisa Canino
Director, Research Institute
Medical Sciences Campus
University of Puerto Rico
Erick Santos, M.D.
Chief Drug Dependence Treatment Program
VA Medical Center,
San Juan, Puerto Rico
Jorge Rosso
Consultant on Health to the Governor
Fortaleza
Government of Puerto Rico
Margarita Alegria, PhD.
Researcher,
Medical Sciences Campus
University of Puerto Rico
Jorge Torres Administrator,
First Hospital Panamericano
Cidra, Puerto Rico,
Pilar Christian
President,
Mental Health Planning Board
Mental Health and Anti Addiction Services Administration
Goverment of Puerto Rico
San Juan, Puerto Rico
Victor Llado, M.D.
Private Practice of Psychiatry
Past President PR Psychiatric Society
San Juan, Puerto Rico
Dr. Polo, M. D.
Consultant to the Administrator
Mental Health and Anti Addiction Services Organization
Government of Puerto Rico
Roberto J. Fumero, M.D.
Caribbean Behavioral HealthCare
Trujillo Alto, Puerto Rico
Rita Rodriguez-Falciani ,Esq.
Consultant to ASSMCA
San Juan, Puerto Rico
Myrna Segarra, M.D.
Training Director
Puerto Rico Institute of Psychiatry
Harold Figueroa,
Private Practice
Former Consultant to ASSMCA Administrator
Guaynabo, Puerto Rico
Enrique Vazquez Quintana,
President, Puerto Rico College of Physicians and Surgeons
Hato Rey, Puerto Rico
Marina Diaz,
Consultant Options Inc.
San Juan, Puerto Rico
Irma Moreira,
Director
Caribbean Behavioral Healthcare
San Juan, Puerto Rico
Felicita Cintron,
Consultant
ASSMCA
San Juan, Puerto Rico
Sr. Rebollo
Luz Medina
Ramon Parrilla, M.D.
President, Puerto Rico Psychiatric Society
San Juan, Puerto Rico
Luis Canepa, M.D.
Medical Director
Options Inc.
San Juan, Puerto Rico
Ileana Vazquez, M.D.
Private Practice
Treasurer, Puerto Rico Psychiatric Society
San Juan, Puerto Rico
Angela Diaz, M.D.
Liaison Psychiatrist
VA Medical Center
San Juan, Puerto Rico
Jose Luis Lopez, M.D.
Psychiatric Resident
Puerto Rico Institute of Psychiatry
San Juan, Puerto Rico
Carlos Perez Cortes, M.D.
Private Practice
Humacao, Puerto Rico
Ramon Ortiz
Patient Representative
Alianza Puertorriquena de Salud Mental
Ponce, Puerto Rico
Nuria Sabate, M..D.
Child and Adolescent Psychiatrist
Private Practice
San Juan, Puerto Rico
Alberto Varela, M.D.
Private Practice
Inspira
Hato Rey, Puerto Rico
Neftali Olmo, M.D.
Medical Director, CompCare
Hato Rey, Puerto Rico
Osvaldo Caro, M.D.
Private Practice
Caguas, Puerto Rico
Carlos Caban, M.D.
Past President PRPS
Private Practice
Condado, Puerto Rico
Jose Fransceschini
Private Practice
Bayamon, Puerto Rico
Jose Lima
Private Practice
San Juan, Puerto Rico
Sarah Huertas, M.D.
Private Practice of Child Psychiatry
President Elect
Puerto Rico Psychiatric Society
Haydee Costa, M.D.
Private Practice of Forensic Psychiatry
Former President, PRPS
San Juan, Puerto Rico
Silvia Arias, PhD
President, NAMI Puerto Rico
NAMI Board Member
San Juan, Puerto Rico
Rosita Esteras,
Executive Director
MEPSI Center
Bayamon, Puerto Rico
Jose Nunez Lopez,
Former Commissioner for Mental Health
Caguas, Puerto Rico
Luz Minerva Guevara, MD
Chief, Department of Psychiatry
University of Puerto Rico
Medical Sciences Campus
Maria Sanchez Bonilla
Private Practice of Geriatric Psychiatry
Hato Rey, Puerto Rico
_ PLANNING COMMITTEE
Ramon Parrilla, M.D.
President, Puerto Rico Institute of Psychiatry
Medical Director
First Hospital Panamericano
Cidra, Puerto Rico
Carlos Caban, M.D.
Past President, Puerto Rico Psychiatric Association
Private Practice
Condado, Puerto Rico
CONFERENCE SPONSORS
American Psychiatric Association
