VA inpatient psychiatric hospitals fall short on quality measures

Man with therapist

November 1, 2016—For veterans and others entering inpatient psychiatric care, an admissions screening can be key to identifying the most appropriate treatment. But a new study by researchers from Harvard T.H. Chan School of Public Health finds that hospitals run by the U.S. Department of Veteran’s Affairs (VA) are failing to ask patients important questions about their trauma history, substance use, violence risk, and strengths (such as optimism and stable employment) 39% of the time, on average. By comparison, the study found that for-profit and nonprofit hospitals conduct such screenings nearly all of the time.

The researchers also found that the VA is falling short on other quality measures. For example, they found the VA failed to provide appropriate justification for discharging patients on multiple antipsychotics 61% of the time, and created a continuing care plan for patients upon discharge just about half of the time.

The study was published online October 17, 2016 in Psychiatric Services.

“These results are very troubling,” said lead author Morgan Shields, SM ’16. “They further substantiate the need for VA hospitals to receive greater regulation and financial resources.” Shields, now a doctoral student at the Heller School for Social Policy and Management at Brandeis University, conducted the research while a student at Harvard Chan School.

She and co-author Meredith Rosenthal, professor of health economics and policy, looked at how well VA, for-profit, and nonprofit hospitals perform on seven quality measures for inpatient psychiatric care known as the Hospital-Based Inpatient Psychiatric Services (HBIPS) measure set. HBIPS was established by the Joint Commission—the organization that accredits health care facilities in the United States—and incorporated into the Centers for Medicare and Medicaid Services’ payment program.

Measure patient experiences

According to Shields, even when HBIPS is followed by hospitals, it does not go far enough toward providing data that researchers and policymakers need to improve the mental health care system. “All facilities have to do is check yes that they have followed a protocol,” she said. “There is no mechanism measuring what they do with the information, or how it affects patients’ experiences with their care.”

In an editorial published online October 19 in Health Affairs, Shields and colleagues called for the establishment of a national surveillance system that would focus less on processes in inpatient psychiatric facilities, and more on patients’ experiences. It would track physical and emotional harms to patients, in addition to their satisfaction with their care.

They also proposed that this system be incorporated into plans for a new Center for Behavioral Health Statistics and Quality, part of a mental health care reform bill passed by the U.S. House of Representatives over the summer.

Even if the bill never passes the Senate, where it’s likely to remain stalled until after the presidential election, Shields sees her work as adding key evidence to the conversation around mental health care reform—especially relevant at a time when some researchers and policymakers are proposing a return to more extended inpatient stays at psychiatric facilities.

“Before we expand use of these facilities, it is important to understand the quality of care they are providing,” Shields said.

Amy Roeder

Photo: iStock

Learn more

VA officials promise action in response to PhD student’s findings of shameful quality of inpatient psychiatric care (Brandeis University Heller School News)

Is anybody paying attention? Harm and death within inpatient psychiatric facilities (Huffington Post blog post co-authored by Morgan Shields)