Hospital Based Inpatient Psychiatric Services

 

History and Development of the HBIPS Measures

NRI is proud to be one of the collaborating organizations that created and implemented the Hospital Based Inpatient Psychiatric Services (HBIPS) Core Measure Set. The Joint Commission mandated the set for all free-standing psychiatric hospitals effective January 1, 2011. The Centers for Medicare and Medicaid Services mandated six of the HBIPS measures for the Inpatient Psychiatric Facilities Quality Reporting program effective October 1, 2012.

 

The Foundation

Acute care hospitals have used standardized core measure sets developed consistently under the guidance of The Joint Commission, while psychiatric hospitals remained with measures developed by independent vendors. Before the HBIPS set, these vendor-driven measures served only the needs of their individual clients which created hundreds of measures for psychiatric providers; however, there was no consistency across vendors. This lack of common measures resulted in the lack of national learning and the inability to benchmark quality of care for psychiatric hospitalization.

 

NRI convened a workgroup in 2001 comprised of technical, clinical, and administrative leadership to develop core measure sets for behavioral healthcare organizations. Following this early technical development, NRI approached the National Association of State Mental Health Program Directors (NASMHPD) and the National Association of Psychiatric Healthcare Systems (NAPHS) to engage in the first public-private test of a common set of performance measures. The successful pilot led these organizations, along with the American Psychiatric Association (APA), to engage The Joint Commission to begin development of a core measure set for psychiatric hospitals in 2003.

 

Development of the HBIPS Core Measure Set

The synergistic collaboration of NRI, NAPHS, NASMHPD, and APA compelled The Joint Commission to move forward with core measures for inpatient psychiatric hospitals. A stakeholders meeting, including over 25 organizations and associations was held in early 2004 to solicit broad support for the process and garner resources for the effort. The stakeholders represented all aspects of inpatient psychiatric care from clinical specialties, consumers, funding agencies, state hospitals, private hospitals, and researchers; thus broad supported from the field set the work plan in action and outlines a timeline for inpatient psychiatric services core measures.

 

Through a Technical Advisory Panel for The Joint Commission, a framework for measures developed that highlighted the domains of assessment, treatment planning and implementation, hope and empowerment, patient driven care, patient safety, continuity and transition of care, and outcomes. Throughout 2005, various meetings and task groups focused on reviewing nearly 100 candidate measures, finally culling eighteen measures for public comment. From these comments, targeted workgroups provided The Joint Commission with a set of five measures to advance into initial data compilation with volunteer hospitals addressing the domains of assessment (screenings), patient safety (restraint, seclusion, and polypharmacy), and continuity of care (providing aftercare plan to next care provider).

 

The Final HBIPS Core Measure Set

Following the year-long test phase, the Technical Advisory Panel for The Joint Commission reviewed issues identified and discussed the clinical utility and comparability of the measure results. The focus of the test phase was to evaluate the data elements, the extraction processes, and the measure calculation algorithms; rates calculated during this phase were not used as metrics of performance. Rather, the Technical Advisory Panel revised the measures based on the insights from the test and supported a final measure set for advancement through The Joint Commission review process. Participation in the final set to meet The Joint Commission accreditation requirements for performance measures was made available to psychiatric facilities and units beginning with October 2008 discharges/episodes of care.

 

The set is comprised of seven measures that fall into two groups: discharge measures and event measures. The discharge measures are calculated when a patient is discharged or transferred. Event measures are calculated for all patients served in inpatient psychiatric services. In addition, each measure is calculated for four age strata: children (1-12 years), adolescent (13-17 years), adult (18-64 years), and older adults (65 years and older).

 

Participation has grown since the set opened in October 2008.

  • 170 psychiatric hospitals began use in October 2008 with The Joint Commission

  • 300 psychiatric hospitals reported HBIPS data by the end of 2009 with The Joint Commission

  • 450 psychiatric hospitals and psychiatric units reported HBIPS data in January 2011 with The Joint Commission

  • 500 psychiatric hospitals and psychiatric units reported HBIPS data for October 2012 to The Joint Commission

  • Countless other psychiatric hospitals and psychiatric units have adopted the HBIPS set for internal management, without a requirement for reporting to The Joint Commission

  • 1600 psychiatric hospitals and psychiatric units reported HBIPS data for October 2012 to the Centers for Medicare and Medicaid Services

 

 

The Future

The purpose of any core measure set is to assist facilities in their quality improvement processes by measuring their performance against best practices which indicate positive clinical outcomes. The Joint Commission is using the combined data from all participants to define current operating targets of performance. In addition, The Joint Commission has set an overall accountability rate for performance across all measures. The Centers for Medicare and Medicaid Services (CMS) adoption of these measures in their quality reporting program provides further incentive to improve the care provided to patients of psychiatric services.