Managed care organizations and the Department of Veterans Affairs are increasingly collecting and reporting performance on "quality indicators" in order to modify clinicians' practices and improve patient care. Feedback about performance on quality indicators appears to be more effective in modifying practices when clinicians perceive the indicators to be clinically meaningful and to fall under their "sphere of influence." Thus, information about providers' perceptions and attitudes is key in planning and implementing an effective feedback process.
This study examined front-line mental health providers' (MHPs) perceptions of quality indicators for mental health services. Our primary objective was to characterize MHPs' perceptions of widely-used quality indicators, including: a) the clinical value/importance of the indicators, b) clinician ability to influence indicator performance, c) clinician willingness to accept incentives/risk for indicator performance, and d) perceived barriers to instituting a constructive feedback process. The study's secondary objective was to explore provider and workplace characteristics that are associated with more positive perceptions of indicators and feedback.
Mental health providers' perceptions were ascertained through focus groups and a survey distributed to practitioners in a stratified random sample of 52 VAMCs. Mental health practitioners providing eight or more hours of direct patient care per week and making independent treatment decisions were eligible for the survey. The study sample included psychiatrists, psychologists, social workers, and advanced practice nurses. Analyses are concerned with accurate characterization of providers' attitudes and perceptions towards quality indicators and quality monitoring processes.
The qualitative portion of the study has been completed. In focus groups, front-line MHPs indicated that quality monitoring and feedback were valuable but only IF: front line staff was involved in developing, implementing, and interpreting indicators, data quality was improved, and adequate systems existed for data collection.
We are now completing data analyses and drafting a manuscript outlining the results from the study survey. Preliminary findings indicate that mental health providers are most positively inclined towards patient satisfaction monitors, followed by process and access indicators. Although outcome monitors were viewed as potentially valuable, providers felt less able to influence these monitors.
Understanding providers' perceptions of quality indicators is essential in planning and implementing a credible and effective feedback process. Data on practitioner perspectives will be helpful in determining which quality indicators to implement and which organizational levels to target for feedback.
- Valenstein M, Mitchinson A, Ronis DL, Alexander JA, Duffy SA, Craig TJ, Barry KL. Quality indicators and monitoring of mental health services: what do frontline providers think? The American journal of psychiatry. 2004 Jan 1; 161(1):146-53.