Compliance with Practice Guidelines Improves Slightly; Still Below Standard
To monitor the quality of care delivered to members, Magellan’s Southwest and Michigan Care Management Centers review treatment records from our high-volume providers to determine how well they follow recommendations in our adopted clinical practice guidelines.
The overall results for providers whose treatment records were reviewed in 2007 indicated 79 percent of the elements reviewed were consistent with the guidelines, only a slight improvement from last year’s result of 78 percent. The score remains below the 85 percent standard.
Scoring
Results are based on presence of particular elements in the treatment record, as detailed in our Major Depression (MDD) - Suicide Management Audit Tool. This tool emphasizes three scoring domains that correspond with crucial aspects of assessment and treatment for members who may be depressed and/or suicidal.
How Providers Can Improve Compliance
We have identified several opportunities for improvement, listed by provider type:
- Assess for other psychiatric disorders that could account for the symptoms or complicate treatment (therapists)
- In addition to the assessment for current suicidal ideation and plans, assess for a history of suicidal ideation and attempts (psychiatrists and therapists)
- Document severity level of MDD (e.g., mild, moderate or severe) (psychiatrists)
- Deliver education about MDD and its treatment to the member, and, if appropriate, to the family (psychiatrists and therapists)
- Assess the need for psychotherapy (psychiatrists)
- Document medication education (psychiatrists)
- If MDD is of moderate severity or above, use a combination of psychotherapy and antidepressant medication, or document why not (psychiatrists and therapists)
Providers who fail to meet the clinical practice guidelines standards receive individualized feedback regarding deficient areas and, when the deficiencies are great enough, a plan of corrective action is implemented and further records are requested to demonstrate compliance.
Magellan appreciates your commitment to providing quality care to our members. We welcome your input into these or other Magellan Clinical Practice Guidelines.