Outcome Measures
Outcomes are measured through:
- Length of stay (LOS)-- the goal is to decrease the Length of Stay without increasing the rapid re-admission rate
- Rapid readmission rates - a rapid re-admission is defined as a re-admission within 30 days of discharge and indicates the patient was not sufficiently stabilized to be discharged. The goal is to have low rates of rapid re-admissions
- Number of patients served - the goal is to serve as many patients as possible while maintaining a low rapid re-admission rate. The higher the number of patients served the more effective the services are to the entire state of Utah.
- Planned Scheduled Treatment (PST) hours-the actual hours spent in one to one direct therapy with a patient. This outcome measure provides information for program evaluation and management.
- SOQ (Severely & Persistently Mentally Ill Outcome Questionnaire): This is an empirically validated self report questionnaire that measures the amount of change in an adult patient's psychiatric condition and ability to function. This number should show a statistically reliable change in the form of a decrease in number from admission to discharge.
- BPRS (Brief Psychiatric Rating Scale): This is a clinician rated empirically validated measure of change. This number should show a statistically reliable change in the form of a decrease from admission to discharge.
- Utilization Reviews are done on an ongoing basis through patient chart review. A monthly Utilization Review and Process Improvement meeting is held to assess the status of the hospital and make plans for change and improvement.
- Certification by CMS is an ongoing process which includes quarterly audit meetings with the Department of Health. The Federal CMS surveyors visit the hospital biannually to evaluate the status of patient care.
- Accreditation by JCAHO is an ongoing process-an onsite survey was completed in March 2005 with Full Accreditation being granted to the hospital. In January 2006 the hospital was required to submit a periodic performance review - the hospital was again given continuing full accreditation status. The periodic performance review is done annually and on-site visits by surveyors is at least every 3 years.
- Monthly data (i.e. risk management and clinical outcomes) is submitted to the National Research Institute (NRI) and benchmarked with State Hospitals nation wide. This allows USH to assess successes or needs for improvement. The data from NRI is sent to JCAHO
