What is the problem that needs to be addressed? Please describe how it is related to mental health.
Based upon the public reporting of Mental Illness/Homeless issues (https://www.ocregister.com/2018/12/19/234-homeless-people-who-have-died-in-orange-county-will-be-remembered-at-these-2018-memorial-services/ https://www.ocregister.com/2017/02/07/orange-county-homeless-deaths-hit-all-time-high/ https://www.nbclosangeles.com/news/local/OC-Sheriff-People-Who-Died-in-2018-Were-Homeless-506368791.html), there doesn’t seem to be a regional Morbidity and Mortality (M&M) meeting/conference (https://psnet.ahrq.gov/resources/resource/17043/Psychiatry-morbidity-and-mortality-rounds-implementation-and-impact https://psnet.ahrq.gov/search?topic=Journal-Article&f_resource_typeID=68&pageSize=50&f_topicIDs=628,308 https://www.sciencedirect.com/science/article/pii/S0924933817324513 https://www.psychiatrictimes.com/novel-approach-morbidity-and-mortality-analysis-psychiatry-residency). M&M conferences serve as an important feedback mechanism for providers to learn from the patients who experienced iatrogenic health decline or death. Because of the structure of Cal-Optima’s payer network and Orange County’s patchwork of homeless/mental health service contracts, a Patient-Centered Medical Home does not exist. Thus, when a person experiences significant morbidity or mortality the causes of that morbidity or mortality are not shared among the people that have provided services to that person. The feedback loop is missing for the vast majority of service providers in Orange County, CA that serve mentally ill or homeless individuals.
Why is this a concern for Orange County? What can Orange County and other counties learn from this project?
Knowing what causes morbidity and mortality is important. Sharing that knowledge with the people providing services involved in morbidity and mortality is important. Orange County, CA tends not to share information among its contractors, leaders, and citizens. County contracts specifically forbid publishing results in peer-reviewed or other journals to share information. This is a platform project – meaning the platform isn’t novel, but having the platform provides numerous advantages and learning opportunities.
What is currently being done to resolve this problem in our county and throughout the United States? If applicable: Is it working; why or why not?
Morbidity and Mortality conferences have a long history in the surgical and procedural medical specialties. M&M conferences for psychiatry are a new entry in the past decade.
What is new or different about this project idea? Please describe how this differs from what is already being done (Question 6). Please list any research that was done on this topic.
M&M conferences tend to occur within one referral network (i.e. Hoag hospital has an M&M conference for its surgical teams, but Hoag doesn’t likely share that M&M conference with Kaiser Permanente). The way Psychiatric and Homeless services are structured in Orange County means that a meaningful referral network doesn’t exist and therefore the meaningful feedback of M&M doesn’t get shared with the numerous providers providing services. The structure of the ideal M&M would include peer specialists/mentors/leads, wrap-around service providers, the 13+ facilities operating Psychiatric facilities in Orange County, homeless service providers, Churches, etc. This is the consequence of the lack of an Accountable Care Organization (ACO) within one referral network serving the population experiencing Mental Health/Homelessness.
What is the project idea? Please describe how this project will operate.
Put in the legal/incentive infrastructure to get the service providers – including cross-referral network providers, peer specialists, Churches, Wrap Around Service Providers, etc – for homeless/mentally ill patient populations into a monthly Morbidity and Mortality conference. The Morbidities and Mortalities discovered over the past month will be reviewed during the conference, including medical record review and presentations by the providers who served the person who experienced the Morbidity/Mortality. Ideally, autopsy results would be shared to provide feedback on what was missed (i.e. a Rabies diagnosis). Train the para-professionals (i.e. homeless service providers, peer-specialists, Churches, etc) on the high-risk warning signs for morbidity and mortality (i.e. wounds that don’t heal, signs of Syphilis, bloody diarrhea, dehydration, stroke, heart attack, bone/joint fractures, etc). Many of the diseases behind these high-risk warning signs may not have a provider in Orange County, CA willing to treat the underlying disease due to the likelihood that the treatment will cause greater M&M than not treating. In such a case the person experiencing the disease should be fast-tracked to SSI/SSDI/hospice and the appropriate resources be made available for the person to have a sense of end of life dignity.
Respondent skipped this question