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Thursday, January 18, 2018

Heller Faculty Notes

Quality of substance abuse care is her focus

A conversation with Professor Deborah Garnick

For Deborah Garnick, improving the quality of health care has been a focus of her career.  Garnick, Sc.D., a professor at the Heller School’s Institute for Behavioral Health (IBH), arrived at Heller in 1992, recruited from the Harvard School of Public Health. 

Although Dr. Garnick investigated quality of care issues in a general sense earlier in her career, for more than a decade she has focused on quality of care for individuals with substance abuse disorders. IBH has been an ideal setting to pursue quality care because it is a major focus of the Institute, affording rich collegial interaction and collaboration. Dr. Garnick’s focus on the specification and testing of measures has resulted in publications on topics including the technical aspects of performance measurement and the adaptation of measures for use by states.  

Q: How did you first become interested in quality of care? What makes it so important?

A: Beginning with my first years in research just after completing my doctorate, I found quality of care to be a compelling topic and I have concentrated on this topic for much of the rest of my career. 

After graduate school at the University of California, San Francisco, I worked with my mentor, Dr. Harold Luft, a leader in the field of health services research. From the first project I worked on with him, which was focused on the role of quality in how people choose hospitals, I began to realize that quality of care was an interesting and important topic. We also examined why hospitals with higher volumes of certain surgical procedures seemed to have better outcomes. This research, and the hundreds of studies that have since been published on this general question, have influenced the policy question of how much to concentrate certain specialized types of surgery in larger volume hospitals. 

During my time at IBH here at the Heller School, I have continued to focus on quality of care for behavioral health in general, and on quality of care for people with substance use disorders in particular. In today’s world, quality of care is receiving a lot of attention for several reasons, including health care cost inflation and the concept of “paying for value,” the need to focus on patient safety, and equity of access to health care for everyone.  

On the national scene, quality and performance measurement have gained more attention with the passage of national health reform. With more people covered by health insurance, it is imperative to measure the quality of care people receive, to create incentives for providing good care, and to implement programs focused on quality improvement.  

Q: What are your current projects?

A: I am currently involved in multiple studies, and I’ll describe two of them. One that I am excited about leading is a collaboration with five states that is funded by the National Institute on Alcoholism and Alcohol Abuse (NIAAA). Our team is focusing on a type of quality measure called a “process of care measure.” This kind of measure has to do with whether the right thing is done for the right person at the right time. One nationally used process measure we helped to develop here at Brandeis is called Treatment Engagement. This has been defined as treatment clients attending their first four treatment sessions within a 40 to 45 day period. But we are not only interested in measuring client engagement; what we really care about is measuring whether the clients who engage in treatment have positive outcomes over time, such as more employment or fewer arrests.

A second project is directed by my colleague Professor Constance Horgan. Our "Health Plan Project" is a national survey of commercial health plans for 2010 and 2012. We are gathering information about what kinds of services these plans provide and what kinds of arrangements they have for providing care for people with substance use, mental health issues or general wellness issues. We are building a national profile of what is happening in the United States. This project is especially relevant because we are observing the influence of recent Federal parity legislation requiring that insurance coverage of services to treat mental health and substance use conditions be on par with the coverage for general medical services.

Q: What is an important message that results from your research?

A: First,people should know that measuring quality of care and holding clinicians accountable for the quality of the treatment that they provide is important. And, our work has demonstrated that it is feasible to focus this measurement on the treatment of substance use disorders. 

Second, at the same time, it is key that clinicians are supported by being able to work in organizational settings where it is possible to offer high quality care and payment incentives are developed to encourage high quality. 

Finally, it is important to measure variations in the quality of treatment services so that we can use the information to make decisions about both policy and payment, and so that individuals can make educated decisions about which providers to use.

Q: What has been your greatest success?

A: I am most proud of my contributions to the development and testing of performance measures for substance use disorders, an area that had received little attention until the late 1990s. Since 1998 I have been involved in a group called the Washington Circle – along with Professor Horgan and other colleagues from the Heller School. Back in the late 90s, this group recognized that performance measures were being developed for medical care and mental health care, but not for substance abuse treatment. We set about developing performance measures for substance abuse treatment.

The Heller School was the focus for conducting some of the feasibility and pilot testing, as well as refining the performance measures. While the larger group was responsible for creating the key concepts, we at Brandeis took the lead in making sure that articles about the group’s work appeared in publications and that the performance measures developed became widely adopted across the country. 

Building on the initial performance measure specification and testing for commercial health plans, I led a collaboration with states to explore using these performance measures in the public sector.  Also, working with colleagues in IBH, we were able to obtain research grants to study these measures. 

Q: Is there anything else you would like people to know about you?

A: Every spring term, I teach a course on health care quality and performance measurement, as part of the PhD program. It is a privilege to have this opportunity to help students build a framework to look at the rich literature in this area and understand it. Every year I am impressed by the range of experience that students bring to class and every year I am pleased to interact with a varied group of students - international students, domestic students, doctoral students, and master’s students. Teaching this course is an exciting part of my life at the Heller School and I love doing it!

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