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## Complete Summary

#### TITLE

Hospital-based inpatient psychiatric services: the percentage of
patients admitted to a hospital-based inpatient psychiatric setting who
are screened within the first three days of admission for all of the
following: risk of violence to self or others, substance use,
psychological trauma history and patient strengths.

#### SOURCE(S)

Joint Commission. Specifications manual for national hospital inpatient
quality measures: hospital-based inpatient psychiatric services core
measure set. Version 2.0. Oakbrook Terrace (IL): Joint Commission; 2008
Jun. various p.

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of patients admitted to a
hospital-based inpatient psychiatric setting who are screened within the
first three days of admission for all of the following: risk of violence
to self or others, substance use, psychological trauma history and
patient strengths.

#### RATIONALE

Substantial evidence exists that there is a high prevalence of
co-occurring substance use disorders as well as history of trauma among
persons admitted to acute psychiatric settings. Professional literature
suggests that these factors are under-identified yet integral to current
psychiatric status and should be assessed in order to develop
appropriate treatment. Similarly, persons admitted to inpatient settings
require a careful assessment of risk for violence and the use of
seclusion and restraint. Careful assessment of risk is critical to
safety and treatment. Effective, individualized treatment relies on
assessments that explicitly recognize patients\' strengths. These
strengths may be characteristics of the individuals themselves, supports
provided by families and others, or contributions made by the
individuals\' community or cultural environment. In the same way,
inpatient environments require assessment for factors that lead to
conflict or less than optimal outcomes.

#### PRIMARY CLINICAL COMPONENT

Psychiatric inpatients; admission screening (risk of violence to self or
others, substance use, psychological trauma history, patient strengths)

#### DENOMINATOR DESCRIPTION

Psychiatric inpatient discharges (see the related \"Denominator
Inclusions/Exclusions\" field in the Complete Summary)

#### NUMERATOR DESCRIPTION

Psychiatric inpatients with admission screening within the first three
days of admission for **all** of the following: risk of violence to self
or others; substance use; psychological trauma history; and patient
strengths

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

-   One or more research studies published in a National Library of
    Medicine (NLM) indexed, peer-reviewed journal

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [Practice guideline for the assessment and treatment of patients
    with suicidal
    behaviors.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=4529)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Overall poor quality for the performance measured\
Use of this measure to improve performance

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

American Psychiatric Association. Practice guideline for the assessment
and treatment of patients with suicidal behaviors. Arlington (VA):
American Psychiatric Association; 2003 Nov. 117 p. \[846 references\]

Lyons JS, Uziel-Miller ND, Reyes F, Sokol PT. Strengths of children and
adolescents in residential settings: prevalence and associations with
psychopathology and discharge placement. J Am Acad Child Adolesc
Psychiatry2000 Feb;39(2):176-81.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10673828)

NASMHPD. Position statement on services and supports to trauma
survivors. Alexandria (VA): NASMHPD; 2005.

Rapp CA. The strengths model: case management with people suffering from
severe and persistent mental illness. London: Oxford University Press;
1998.

Ruiz P. Addressing culture, race, & ethnicity in psychiatric practice.
Psychiatr Ann2004;34(7):527-32.

Ziedonis DM. Integrated treatment of co-occurring mental illness and
addiction: clinical intervention, program, and system perspectives. CNS
Spectr2004 Dec;9(12):892-904, 925. \[66 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15618940)

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Hospitals

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Measure is not provider specific

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Single Health Care Delivery Organizations

#### TARGET POPULATION AGE

All patients age one year and older

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Children

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Mental disorders are common in the United States and internationally. An
estimated 26.2 percent of Americans ages 18 and older --- about one in
four adults --- suffer from a diagnosable mental disorder in a given
year. When applied to the 2004 U.S. Census residential population
estimate for ages 18 and older, this figure translates to 57.7 million
people.

#### EVIDENCE FOR INCIDENCE/PREVALENCE

Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence,
severity, and comorbidity of 12-month DSM-IV disorders in the National
Comorbidity Survey Replication. Arch Gen Psychiatry2005
Jun;62(6):617-27.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15939839)

U.S. Census Bureau population estimates by demographic characteristics.
Table 2: annual estimates of the population by selected age groups and
sex for the United States: April 1, 2000 to July 1, 2004
(NC-EST2004-02). Population Division, U.S. Census Bureau; 2005 Jun 9.

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unlike most disabling physical diseases, mental illness begins very
early in life. Half of all lifetime cases begin by age 14; three
quarters have begun by age 24. Thus, mental disorders are really the
chronic diseases of the young. For example, anxiety disorders often
begin in late childhood, mood disorders in late adolescence, and
substance abuse in the early 20\'s. Unlike heart disease or most
cancers, young people with mental disorders suffer disability when they
are in the prime of life, when they would normally be the most
productive.

#### EVIDENCE FOR ASSOCIATION WITH VULNERABLE POPULATIONS

National Institute of Mental Health. Mental illness exacts heavy toll,
beginning in youth. National Institutes of Health (NIH); 2005.

#### BURDEN OF ILLNESS

Even though mental disorders are widespread in the population, the main
burden of illness is concentrated in a much smaller proportion --- about
6 percent, or 1 in 17 --- who suffer from a serious mental illness. In
addition, mental disorders are the leading cause of disability in the
U.S. and Canada for ages 15 to 44. Many people suffer from more than one
mental disorder at a given time. Nearly half (45 percent) of those with
any mental disorder meet criteria for 2 or more disorders, with severity
strongly related to comorbidity.

#### EVIDENCE FOR BURDEN OF ILLNESS

Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence,
severity, and comorbidity of 12-month DSM-IV disorders in the National
Comorbidity Survey Replication. Arch Gen Psychiatry2005
Jun;62(6):617-27.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15939839)

National Institute of Mental Disorders (NIMD). The numbers count: mental
disorders in America. \[internet\]. Bethesda (MD): National Institute of
Mental Health (NIMH); 2008 Apr\[accessed 2008 Apr 29\].

World Health Organization. The World Health report 2004: changing
history, annex table 3: burden of disease in DALYs by cause, sex, and
mortality stratum in WHO regions, estimates for 2002. Geneva: WHO; 2004.

#### UTILIZATION

Unspecified

#### COSTS

Major mental disorders cost the nation at least \$193 billion annually
in lost earnings alone, according to a new study funded by the National
Institutes of Health\'s National Institute of Mental Health (NIMH). The
study was published online ahead of print May 7, 2008, in the *American
Journal of Psychiatry*.

\"Lost earning potential, costs associated with treating coexisting
conditions, Social Security payments, homelessness and incarceration are
just some of the indirect costs associated with mental illnesses that
have been difficult to quantify,\" said NIMH Director Thomas R. Insel,
M.D. \"This study shows us that just one source of these indirect costs
is staggeringly high.\"

Direct costs associated with mental disorders like medication, clinic
visits, and hospitalization are relatively easy to quantify, but they
reveal only a small portion of the economic burden these illnesses place
on society. Indirect costs like lost earnings likely account for
enormous expenses, but they are very difficult to define and estimate.

#### EVIDENCE FOR COSTS

Kessler RC, Heeringa S, Lakoma MD, Petukhova M, Rupp AE, Schoenbaum M,
Wang PS, Zaslavsky AM. Individual and societal effects of mental
disorders on earnings in the United States: results from the national
comorbidity survey replication. Am J Psychiatry2008 Jun;165(6):703-11.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=18463104)

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Patient-centeredness\
Safety\
Timeliness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Inpatients discharged with a psychiatric diagnosis

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients with *International Classification of Diseases, Ninth Revision,
Clinical Modification (ICD-9-CM) Principal or Other Diagnosis Codes* for
mental disorders as defined in the appendices of the original measure
documentation.

**Exclusions**

-   Patients for whom there is an inability to complete admission
    screening for *Violence Risk, Substance Use, Psychological Trauma
    History and Patient Strengths* within the first three days of
    admission

-   Patients with a Length of Stay greater than or equal to 365 days

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Institutionalization

#### DENOMINATOR TIME WINDOW

Does not apply to this measure

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Psychiatric inpatients with admission screening within the first three
days of admission for **all** of the following: risk of violence to self
or others; substance use; psychological trauma history; and patient
strengths

**Exclusions**\
None

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Fixed time period

#### DATA SOURCE

Administrative data\
Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Analysis by subgroup (stratification on patient factors, geographic
factors, etc.)

#### DESCRIPTION OF ALLOWANCE FOR PATIENT FACTORS

Allowance for patient age is made via stratification of results:

-   Overall rate

-   Children age 1-12 years

-   Adolescent age 13-17 years

-   Adult age 18-64 years

-   Older adult age greater than or equal to 65 years

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

All of the Hospital-Based Inpatient Psychiatric Services (HBIPS)
measures have undergone a rigorous process of public comment, alpha
testing and broad-scale pilot testing and are recognized by the field as
important indicators of hospital-based inpatient psychiatric care. As a
final step, the HBIPS measure set will be submitted to the National
Quality Forum (NQF) for consideration and endorsement. Refer to the
original measure documentation for further information.

#### EVIDENCE FOR RELIABILITY/VALIDITY TESTING

Joint Commission. Specifications manual for national hospital inpatient
quality measures: hospital-based inpatient psychiatric services core
measure set. Version 2.0. Oakbrook Terrace (IL): Joint Commission; 2008
Jun. various p.

### Identifying Information

#### ORIGINAL TITLE

Admission screening for violence risk, substance use, psychological
trauma history and patient strengths completed.

#### MEASURE COLLECTION

[Hospital-Based Inpatient Psychiatric Services
(HBIPS)](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=10&doc=12539)

#### DEVELOPER

Joint Commission, The

#### FUNDING SOURCE(S)

All external funding for measure development has been received and used
in full compliance with The Joint Commission\'s Corporate Sponsorship
policies, which are available upon written request to The Joint
Commission.

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

The composition of the group that developed the measure is available at:
<http://www.jointcommission.org/NR/rdonlyres/656011F6-F6E7-4BC8-A82D-E436EDB2F01C/0/TAPMembersListforWeb6108.pdf>.

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

Expert panel members have made full disclosure of relevant financial and
conflict of interest information in accordance with the Joint
Commission\'s Conflict of Interest policies, copies of which are
available upon written request to The Joint Commission.

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2008 Jun

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

Joint Commission. Specifications manual for national hospital inpatient
quality measures: hospital-based inpatient psychiatric services core
measure set. Version 2.0. Oakbrook Terrace (IL): Joint Commission; 2008
Jun. various p.

#### MEASURE AVAILABILITY

The individual measure, \"Admission Screening for Violence Risk,
Substance Use, Psychological Trauma History and Patient Strengths
Completed,\" is published in \"Specifications Manual for National
Hospital Inpatient Quality Measures: Hospital-Based Inpatient
Psychiatric Services Core Measure Set.\" This document is available from
[The Joint Commission Web
site](http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/Hospital+Based+Inpatient+Psychiatric+Services.htm).

#### NQMC STATUS

This NQMC summary was completed by The Joint Commission on May 30, 2008
and reviewed accordingly by ECRI Institute on July 7, 2008.

#### COPYRIGHT STATEMENT

The Specifications Manual for National Hospital Inpatient Quality
Measures - Hospital-Based Inpatient Psychiatric Services (HBIPS) Core
Measure Set \[Version 2.0, June, 2008\] periodically updated by The
Joint Commission. Users of the Specifications Manual for National
Hospital Inpatient Quality Measures - Hospital-Based Inpatient
Psychiatric Services (HBIPS) Core Measure Set must update their software
and associated documentation based on the published manual production
timelines.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008