1. 1 Mayview Regional Service Area Plan Quality Improvement/Outcomes (QIO) Committee QIO Data Report Allegheny HealthChoices, Inc. August 11, 2010

2. April 2010 Report Psychiatric hospitalizations and other intensive services. – Admission rates and frequency of admissions – Discharges, average length of stay, readmission rates, and commitment status – Follow-up services after hospitalizations Use of RTF-A services Use of EAC services Early warning signs and critical incidents Early warning signs and critical incidents for MRSAP consumers with psychiatric hospitalizations Update on people transferred to Torrance State Hospital 2 Allegheny HealthChoices, Inc.

3. Community IP Admissions: MRSAP Allegheny HealthChoices, Inc. 3 Trend of IP admissions not increasing since closure

4. Community IP Admission Rate: non-MRSAP Allegheny HealthChoices, Inc. 4 Non-MRSAP admission rates are not increasing

5. Frequency of IP Admissions: MRSAP Allegheny HealthChoices, Inc. 5 Frequency of HealthChoices Inpatient Admissions for MRSAP Consumers with One or More Admissions after Mayview Discharge, January 2006 - May 2010 AlleghenyBeaverWashington Percent of MRSAP consumers with… 1 admission41%33%25% 2 admissions23%33%0% 3-5 admissions22%33%75% 6-10 admissions12%0% more than 10 admissions3%0% Total count of MRSAP admissions 2141412 Total count of MRSAP consumers with 1+ admissions 6964 Total count of MRSAP consumers2392823 Percent of MRSAP consumers with 1+ admissions29%21%17%

6. Allegheny HealthChoices, Inc. 6 Frequency of IP Admissions: non-MRSAP Frequency of HealthChoices Inpatient Admissions for non-MRSAP Consumers with One or More Admissions, January 2006 - May 2010 AlleghenyBeaverGreeneLawrenceWashington Percent of non- MRSAP consumers with… 1 admission53%62%61%60%61% 2 admissions18% 16%19% 3-5 admissions19%15%18%15% 6-10 admissions7%5%4%5%4% more than 10 admissions3%1%2%1% Total count of non-MRSAP admissions24,7812,3307221,4882,453 Total count of non-MRSAP consumers with 1+ admissions9,8581,1893327201,253

7. Discharges, ALOS, and Readmissions: MRSAP Allegheny HealthChoices, Inc. 7 Discharges, Length of Stay, and Readmissions for MRSAP HealthChoices Inpatient Hospitalizations, January 2006 – May 2010 AlleghenyBeaverWashington Total Discharges2131412 Avg # of discharges/month4.00.0 Average length of stay30.713.310.2 Median length of stay13 6.5 1-7 day readmission rate15%7%25% 8-30 day readmission rate13%21%25% 31-90 day readmission rate20%0%

8. Allegheny HealthChoices, Inc. 8 Discharges, ALOS, and Readmissions: non-MRSAP Discharges, Length of Stay, and Readmissions for non-MRSAP HealthChoices Inpatient Hospitalizations, January 2006 – May 2010 AlleghenyBeaverGreeneLawrenceWashington Total Discharges24,7492,3207151,4852,432 Avg # of discharges/month467.043.813.528.045.9 Average length of stay10.835.97.15.76.6 Median length of stay65645 1-7 day readmission rate8%5% 6% 8-30 day readmission rate12%9%11% 10% 31-90 day readmission rate14%9%14%11%

9. Commitment Status: MRSAP vs. non-MRSAP Allegheny HealthChoices, Inc. 9 HC-IP Commitment Status for MRSAP vs. Non-MRSAP 1/1/2006 - 5/31/2010 By County AlleghenyBeaverGreeneLawrenceWashington MRSAP # Admissions22015 0012 % Involuntary40%93% 0% non-MRSAP # Admissions24,7782,33072214882,453 % Involuntary11%23%10%17%6%

10. First Service Received within 7 days of Inpatient Discharge for MRSAP Consumers (HealthChoices services only*), January 2006 – May 2010 10 Discharges%ConsumersAvg. Days to First Service Allegheny At least 1 HealthChoices service20395%660 CTT12961%520 Service coordination4320%160 Outpatient MH3315%200 Inpatient MH105%70 No HealthChoices services within 7 days95%2 Total discharges213 Beaver At least 1 HealthChoices service14100%60 Case management643%31 CTT643%30 Alternative Outpatient/LTSR214%10 No HealthChoices services within 7 days00% 0 Total discharges14 Washington At least 1 HealthChoices service12100%50 Outpatient MH12100%50 Case management542%40 CTT217%20 No HealthChoices services within 7 days00%0 Total discharges12

11. Services Received 30 Days after HealthChoices Inpatient Discharge for MRSAP Consumers, January 2006 - May 2010 11 ServiceDischarges%Consumers% CTT15866%6076% Outpatient MH10544%3848% Administrative Management8335%4051% Service Coordination/ Case Management8234%2835% QMCC7029%3949% Psychiatric Hospitalizations6828%2532% Community Residential Services5523%2127% Crisis Services4017%2025% Community Support Team (CST)3414%1722% Long Term Structured Residence (LTSR)2711%1316% Family Support Services198%911% Social Rehab198%911% Med Check167%1215% Respite167%810% Extended Acute125%810% RTF-Adult104%810%

12. RTFA Utilization 12 HealthChoices RTF-A Utilization, January 2006 – May 2010 MRSAPNon-MRSAP Allegheny BeaverGreeneLawrenceWashington # Admissions926322374 # Discharges925719364 Avg. Length of Stay47.664.733.340.323.537 Median Length of Stay535731471836 1-90 Day Readmissions 03%5%0%29%0% Allegheny RTFA: – At capacity – 10-20 people on waiting list – Avg. time on waiting list is 22 days – 88% get admitted Regional RTFA: – Operating since 8/2009 – Capacity of 12 people – Census of 10 as of 7/26/10

13. EAC Utilization 13 HealthChoices Extended Acute Care Utilization, January 2006 – May 2010 MRSAP ConsumersNon-MRSAP Consumers # Admissions11154 # Discharges8136 Average length of stay151147.5 Median length of stay99105 Range of stays (days)26-4211-769 Transitional Recovery Unit (TRU) – Hospital-based (WPIC) – Operational since 2006 – 31 beds – ALOS on waiting list is 78 days – 54% get admitted MBH EAC: – Community-based – Operational since 7/2009 – 16 beds – ALOS on waiting list is 33 days – 96% get admitted

14. Allegheny HealthChoices, Inc. 14 Sample of high volume “types”# people# incidents Critical Incident Medical Hospitalization58108 Housing Change6392 Community Hosp - Involuntary4874 Community Hosp - Voluntary3051 Other Incident - Serious Nature2648 Arrest1015 Early Warning Refusal to Take Medications Posing Risk57261 Atypical Behavior - Change From Baseline78167 E/R Visit - Behavioral/Physical Health68165 Indications For Increased Service/Supports5073 Police Involvement3463 Attempts At Elopement1128 Unexcused Missed Appts - Provider1418 Complaints - Property Destruction/Eviction1017 Unduplicated Count of MRSAP Consumers and Events2001,242 Critical Incidents and Early Warning Signs Reported for People Discharged from Mayview, June 2009 - May 2010

15. Critical Incidents & Early Warning Signs by County for MRSAP Consumers, June 2009 – May 2010 Allegheny HealthChoices, Inc. 15 # MRSAP critical incidents/ early warnings Commonly reported events (at least 10% of county total) Allegheny1063 CI: medical hospitalization, housing change, psychiatric hospitalization, “other” EW: medication refusal, ER visit, atypical behavior Beaver122 CI: psychiatric hospitalization, housing change EW: atypical behavior, medication refusal, elopement, indication for increased services Lawrence1 CI: psychiatric hospitalization Washington56 CI: psychiatric hospitalization, medical hospitalization EW: ER visit Total1242

16. Number of HealthChoices Psychiatric Admissions with an Early Warning Sign 7 Days Prior to Admission, by County, for MRSAP Consumers (June 2009 – May 2010) 16 Early Warning Type Count of Admissions % of County Admissions Consumer Count Allegheny Attempts At Elopement11%1 Atypical Behavior - Change From Baseline79%6 E/R Visit - Behavioral/Physical Health68%3 Indications For Increased Service/Supports34%3 Police Involvement23%1 Refusal to Take Medications Posing Risk1419%10 Beaver Attempts At Elopement111%1 Atypical Behavior - Change From Baseline333%1 Indications For Increased Service/Supports222%2 Police Involvement111%1 Sleep Pattern Change From Baseline111%1 Unexcused Missed Appts - Provider111%1 Wash. Complaints - Property Destruction/Eviction250%1 Refusal to Take Medications Posing Risk125%1

17. Update on those transferred to TSH 21 people were transferred to Torrance State Hospital – 19 from Allegheny County – 2 from Lawrence County As of 7/14/2010, 9 of these individuals have been discharged (47%) – 7 from Allegheny, 2 from Lawrence Of those remaining, 3 are in the CSP process – CSP process is reactivated when preparing for discharge Allegheny HealthChoices, Inc. 17

18. Take-Aways Allegheny HealthChoices, Inc. 18