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TMAP

TMAP. NorthSTAR IMPLEMENTATION PLANNING TEAM. 12-13-2002. PLANNING MEETING GOALS. Define specific goals for successful implementation Define activities to achieve goals Troubleshoot barriers to carrying out activities Assign activities to achieve goals to team members

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TMAP

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  1. TMAP

  2. NorthSTAR IMPLEMENTATION PLANNING TEAM 12-13-2002

  3. PLANNING MEETING GOALS • Define specific goals for successful implementation • Define activities to achieve goals • Troubleshoot barriers to carrying out activities • Assign activities to achieve goals to team members • Identify timeline for completing activities

  4. CONSULTANTS TO PROCESS • Dr. Steve Shon, TDMHMR Medical Director • Dr. Ken Altshuler, TDMHMR Board of Directors & UTSMC Professor • Carole Matyas, ValueOptions V-P • Dr. Lynelle Yingling, DANSA Board Chair

  5. Review of Basics Dr. Shon

  6. Everyone “Just Doing Their Best”

  7. TMAP: Aligning the Arrows

  8. Algorithm “A step by step procedure for solving a problem or accomplishing some end.” Webster’s Dictionary

  9. GOALS OF MEDICATION GUIDELINES/ALGORITHMS • Systematic Approach to Medication Management • Quantifiable and Reliable Outcome Measures • Documentation of Medications and Outcomes • Enhance Medication Adherence by Patients

  10. Clinical Reasons for Algorithms • Facilitate clinical decision-making • Improve quality of care • Make treatment plans consistent across sites and physicians • Tailor treatment to individuals • Provide adequate clinical documentation • Define where new medications fit for optimal outcomes

  11. Administrative Reasonsfor Algorithms • Accountability for scarce resources • Uniform expectations for providers • Improve cost efficiency • Predictable costs • Define where new medications are cost- effective • Define costs related to specific treatments or outcomes

  12. Medication Algorithms • Three disorder groups • Major depressive disorders • Schizophrenia • Bipolar disorders • Strategies (identifying the what) • Tactics (identifying the how) • Specific guidelines • Planned revisions

  13. DOCUMENTATION

  14. PATIENT AND FAMILY EDUCATION

  15. Educational Materials • Patient objectives • Teaching patients disease management • Involving patients in treatment choices • Optimizing treatment benefits • Provider objectives • Optimizing treatment benefits • Teaching optimal medication use • Clarifying and documenting clinicaldecision-making

  16. The Texas Medication Algorithm Project (TMAP): Outcomes for Persons with Schizophrenia (SCZ)

  17. SCZ Adjusted Mean Symptoms (BPRS18): All Subjects BPRS18 Quarter

  18. SCZ: Sum of Cognition z Scores: All Subjects

  19. Cognitive Impairment Predicts Functional Outcomes Positive Symptoms Adaptive Function Cognitive Impairment Negative Symptoms Velligan et al. Schizophr Res 1997;25:21-31.

  20. ALGO Patients 165 % Admits 3.0% # Admitted 5 Days/Pt. 1.48 # of Admits 6 TAU Patients 300 % Admits 8.7% # Admitted 26 Days/Pt. 3.84 # of Admits 36 HOSPITALIZATIONS FOR SCZ

  21. The Texas Medication Algorithm Project (TMAP): Outcomes for Persons with Bipolar Disorder (BPD)

  22. BPD Adjusted Mean Manic/Hypomanic Symptoms (CARS-M): All Subjects Quarter

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

  24. MDD Adjusted Mean Symptoms(IDS-C30): All Subjects

  25. Official TMAP/TIMA/CMAP Internet Sites http://www.mhmr.state.tx.us/centraloffice/medicaldirector

  26. Goals for NS TMAP Implementation • Develop a clear implementation plan • Begin changes with incorporating medical records used with TMAP by summer • Begin with computerized version

  27. Activities to Achieve Goals • Initial workgroup [VO, Dr. Shon, Dr. Altshuler, DANSA ED + PAC] review TDMHMR implementation guides for appropriateness/adaptation • VO meet with Dr. Altshuler to plan electronic requirements • VO pilot with 1 or 2 providers to refine the process before full implementation

  28. Startup cost Ongoing cost of meds Mental mindset Training large number of private providers [1 day of training initially] Develop a uniform plan with a large number of providers Possible software grant Long-term reduced meds Careful planning Possibly minimize time required by using teleconferencing Pilot first & streamline Barriers & How To Overcome

  29. Share implementation guides with initial workgroup for review & possible modification Meet to plan electronic requirements David [to Carole, DANSA PAC, Dr. Altshuler] David, Carol, Dr. Altshuler Assignment of Specific Tasks

  30. Spring 2003 Summer2003 Fall 2003 Plan for implementation defined Pilot project fully implemented and evaluated Plan for complete NS implementation defined Timeline

  31. Next Step to Success

  32. Demonstration of Software Resource Dr. Altshuler

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