11

TMAP

22

NorthSTAR NorthSTAR IMPLEMENTATION IMPLEMENTATION PLANNING TEAMPLANNING TEAM

12-13-200212-13-2002

33

PLANNING MEETING GOALSPLANNING MEETING GOALS

Define specific goals for successful Define specific goals for successful implementationimplementation

Define activities to achieve goalsDefine activities to achieve goalsTroubleshoot barriers to carrying out Troubleshoot barriers to carrying out

activitiesactivitiesAssign activities to achieve goals to team Assign activities to achieve goals to team

membersmembers Identify timeline for completing activitiesIdentify timeline for completing activities

44

CONSULTANTS TO PROCESSCONSULTANTS TO PROCESS

Dr. Steve Shon, TDMHMR Medical Dr. Steve Shon, TDMHMR Medical DirectorDirector

Dr. Ken Altshuler, TDMHMR Board of Dr. Ken Altshuler, TDMHMR Board of Directors & UTSMC ProfessorDirectors & UTSMC Professor

Carole Matyas, ValueOptions V-PCarole Matyas, ValueOptions V-PDr. Lynelle Yingling, DANSA Board ChairDr. Lynelle Yingling, DANSA Board Chair

55

Review of BasicsReview of Basics

Dr. ShonDr. Shon

66

Everyone “Just Doing Their Everyone “Just Doing Their Best”Best”

77

TMAP: Aligning the ArrowsTMAP: Aligning the Arrows

88

AlgorithmAlgorithm

“A step by step procedure for

solving a problem or

accomplishing some end.”

Webster’s Dictionary

99

GOALS OF MEDICATION GOALS OF MEDICATION GUIDELINES/ALGORITHMSGUIDELINES/ALGORITHMS

Systematic Approach to Medication ManagementSystematic Approach to Medication Management

Quantifiable and Reliable Outcome MeasuresQuantifiable and Reliable Outcome Measures

Documentation of Medications and OutcomesDocumentation of Medications and Outcomes

Enhance Medication Adherence by PatientsEnhance Medication Adherence by Patients

1010

Clinical Reasons for AlgorithmsClinical Reasons for Algorithms

Facilitate clinical decision-makingFacilitate clinical decision-making Improve quality of careImprove quality of care Make treatment plans consistent across Make treatment plans consistent across

sites and physicianssites and physicians Tailor treatment to individualsTailor treatment to individuals Provide adequate clinical documentationProvide adequate clinical documentation Define where new medications fit for Define where new medications fit for

optimal outcomesoptimal outcomes

1111

Administrative ReasonsAdministrative Reasonsfor Algorithmsfor Algorithms

Accountability for scarce resourcesAccountability for scarce resources Uniform expectations for providersUniform expectations for providers Improve cost efficiencyImprove cost efficiency Predictable costsPredictable costs Define where new medications are cost- Define where new medications are cost-

effectiveeffective Define costs related to specific Define costs related to specific

treatments or outcomestreatments or outcomes

1212

Medication AlgorithmsMedication Algorithms

Three disorder groupsThree disorder groupsMajor depressive disordersMajor depressive disordersSchizophreniaSchizophreniaBipolar disordersBipolar disorders

Strategies (identifying the Strategies (identifying the whatwhat))

Tactics (identifying the Tactics (identifying the howhow)) Specific guidelinesSpecific guidelines Planned revisionsPlanned revisions

1313

DOCUMENTATIONDOCUMENTATION

1414

1515

1616

PATIENT AND FAMILY PATIENT AND FAMILY EDUCATIONEDUCATION

1717

Educational MaterialsEducational Materials

Patient objectivesPatient objectivesTeaching patients disease managementTeaching patients disease management

Involving patients in treatment choicesInvolving patients in treatment choices

Optimizing treatment benefitsOptimizing treatment benefits

Provider objectivesProvider objectivesOptimizing treatment benefitsOptimizing treatment benefits

Teaching optimal medication useTeaching optimal medication use

Clarifying and documenting clinicalClarifying and documenting clinicaldecision-makingdecision-making

Patient objectivesPatient objectivesTeaching patients disease managementTeaching patients disease management

Involving patients in treatment choicesInvolving patients in treatment choices

Optimizing treatment benefitsOptimizing treatment benefits

Provider objectivesProvider objectivesOptimizing treatment benefitsOptimizing treatment benefits

Teaching optimal medication useTeaching optimal medication use

Clarifying and documenting clinicalClarifying and documenting clinicaldecision-makingdecision-making

1818

The Texas Medication The Texas Medication Algorithm Project (TMAP): Algorithm Project (TMAP): Outcomes for Persons with Outcomes for Persons with

Schizophrenia (SCZ)Schizophrenia (SCZ)

1919

SCZ Adjusted Mean Symptoms SCZ Adjusted Mean Symptoms (BPRS(BPRS1818): All Subjects): All Subjects

41.8

25

30

35

40

45

50

55

Baseline 1 2 3 4

TAUnonALO (n=144)ALO+ED (n=165)

Quarter

BPR

S1

8

2020

SCZ: Sum of Cognition z Scores: All Subjects

00

1

2

Baseline 1st Quarter 3rd Quarter

Sum

of z

Sco

res

TAUnonALGO (n=122)ALGO+ED (n=137)

2121

CognitiveImpairment

PositiveSymptoms

Negative Symptoms

AdaptiveFunction

Cognitive Impairment Predicts Cognitive Impairment Predicts Functional OutcomesFunctional Outcomes

Velligan et al. Schizophr Res 1997;25:21-31.Velligan et al. Schizophr Res 1997;25:21-31.

2222

HOSPITALIZATIONS FOR SCZHOSPITALIZATIONS FOR SCZ

ALGOALGO

PatientsPatients 165165

% Admits% Admits 3.0% 3.0%

# Admitted# Admitted 5 5

Days/Pt.Days/Pt. 1.481.48

# of Admits# of Admits 6 6

TAUTAU

PatientsPatients 300300

% Admits% Admits 8.7% 8.7%

# Admitted# Admitted 26 26

Days/Pt.Days/Pt. 3.843.84

# of Admits# of Admits 36 36

2323

The Texas Medication The Texas Medication Algorithm Project (TMAP): Algorithm Project (TMAP):

Outcomes for Persons Outcomes for Persons with Bipolar Disorder with Bipolar Disorder

(BPD)(BPD)

2424

BPD Adjusted Mean BPD Adjusted Mean Manic/Hypomanic Symptoms (CARS-Manic/Hypomanic Symptoms (CARS-

M): All SubjectsM): All Subjects

11.0

0

2

4

6

8

10

12

14

Baseline 1 2 3 4

CAR

S-M

TAUnonALGO (n=124)ALGO+ED (n=141)

Quarter

2525

The Texas Medication The Texas Medication Algorithm Project (TMAP): Algorithm Project (TMAP): Outcomes for Persons with Outcomes for Persons with Major Depressive Disorder Major Depressive Disorder

(MDD)(MDD)

2626

MDD Adjusted Mean SymptomsMDD Adjusted Mean Symptoms(IDS-C(IDS-C3030): All Subjects): All Subjects

2727

http://www.mhmr.state.tx.us/centraloffice/medicaldirector

Official TMAP/TIMA/CMAP

Internet Sites

Official TMAP/TIMA/CMAP

Internet Sites

2828

Goals for NS TMAP Goals for NS TMAP ImplementationImplementation

Develop a clear implementation planDevelop a clear implementation planBegin changes with incorporating medical Begin changes with incorporating medical

records used with TMAP by summerrecords used with TMAP by summerBegin with computerized versionBegin with computerized version

2929

Activities to Achieve GoalsActivities to Achieve Goals

Initial workgroup [VO, Dr. Shon, Dr. Initial workgroup [VO, Dr. Shon, Dr. Altshuler, DANSA ED + PAC] review Altshuler, DANSA ED + PAC] review TDMHMR implementation guides for TDMHMR implementation guides for appropriateness/adaptationappropriateness/adaptation

VO meet with Dr. Altshuler to plan VO meet with Dr. Altshuler to plan electronic requirementselectronic requirements

VO pilot with 1 or 2 providers to refine the VO pilot with 1 or 2 providers to refine the process before full implementationprocess before full implementation

3030

Barriers & How To OvercomeBarriers & How To Overcome

Startup costStartup cost Ongoing cost of medsOngoing cost of meds Mental mindsetMental mindset Training large number Training large number

of private providers [1 of private providers [1 day of training initially]day of training initially]

Develop a uniform Develop a uniform plan with a large plan with a large number of providers number of providers

Possible software grantPossible software grant Long-term reduced medsLong-term reduced meds Careful planningCareful planning Possibly minimize time Possibly minimize time

required by using required by using teleconferencingteleconferencing

Pilot first & streamlinePilot first & streamline

3131

Assignment of Specific TasksAssignment of Specific Tasks

Share implementation guides with Share implementation guides with initial workgroup for review & possible initial workgroup for review & possible modificationmodification

Meet to plan electronic requirementsMeet to plan electronic requirements

DavidDavid

[to Carole, [to Carole, DANSA DANSA PAC, Dr. PAC, Dr. Altshuler]Altshuler]

David, David, Carol, Dr. Carol, Dr. AltshulerAltshuler

3232

TimelineTimeline

Spring Spring 20032003

SummerSummer20032003

Fall Fall 20032003

Plan for implementation definedPlan for implementation defined

Pilot project fully implemented and Pilot project fully implemented and evaluatedevaluated

Plan for complete NS Plan for complete NS implementation definedimplementation defined

3333

Next Step to SuccessNext Step to Success

3434

Demonstration of Software Demonstration of Software ResourceResource

Dr. AltshulerDr. Altshuler