“If you don't know where you're going, you'll end up somewhere else.” -Yogi Berra

“ If you don’t like change, you’re going to like irrelevance even less.”– General Eric Shinseki, Chief of Staff, U. S. Army

“if you can connect all the dots between what you see today and where youwant to go, then it’s probably not ambitious enough or aspirational enough”-Shantanu Narayen, CEO, Adobe Systems

PRI Advisory Board Meeting, November 18, 2014

G. Richard Smith, MD Endowed Chair in Personalized Medicine

PRI Vision

PRI will provide leadership in the field of psychiatry and behavioral health for the state of Arkansas, and be considered as amongst the best and most sought after psychiatric programs in the world.

…by supporting robust research and training programs that enable the discovery of new treatments and the delivery of cutting-edge diagnostic and specialty behavioral health services not available elsewhere,

PRI will be the preferred choice for people seeking treatment for mental illness in the region and a destination site for people seeking specialized care for difficult-to-treat mental disorders world-wide.

…while partnering with community-based providers across the care continuum to improve access to and the quality of behavioral health care throughout Arkansas.

Four Overarching Strategies Focus clinical portfolio on “areas of excellence”

Child and Adolescent Mental Health

Brain Imaging Research

Personalized and Customized Medicine and Interventional Psychiatry

Women’s Mental Health

Drug and Alcohol Abuse

Mental Health Services Research

Trauma

Generate near-term economic return by maximizing recent investments

Become the destination diagnostic center for patients with mental illness across the state

Leverage partnerships inside Arkansas and Nationally

Major Recruitments

Director, Division of Child and Adolescent Psychiatry Director, Division of Health Services Research Center for Alcohol and Drug Addiction Director Psychosomatic Medicine Fellowship Director Collaborative Care/Integrated Care Program Director Adult Psychiatrists/Clinician Educator Child Psychiatrist/Clinician Educator Mood Disorders Clinical and Translational Research

Faculty

Peter Jensen, MD

Peter Jensen

Professor and Acting DirectorDivision of Child and Adolescent Psychiatry.

BS (Psychology) - Brigham Young University, MD - George Washington University School of Medicine, Residency in psychiatry and child psychiatry at Letterman Army

Medical Center and the Langley Porter Psychiatry Hospital at the University of California, San Francisco.  

National Positions 1989 – 1999 Associate Director for Child & Adolescent Mental

Disorders Research, National Institute of Mental Health 

1999 - 2007 Ruane Professor of Psychiatry at Columbia University 2007 – 2013 Vice Chair for Research, Department of Psychiatry,

Mayo Clinic 2007 – present President, CEO, and founder of the REACH Institute

(REsource for Advancing Children's Health)

Arkansas Children’s Hospital

Future Children’s House 2015-2016

Stacy Drury, MDAssociate Professor/Child and Adolescent

PsychiatryTulane University School of Medicine 1993 - BS (Religious Studies) – University of Virginia,

1994 - MS (Human Genetics) – University of Michigan, 2000 - PhD (Genetics & Biometry) – Louisiana State University Health

Science Center 2002 - MD – Louisiana State University Health Science Center 2007 - Residency in Adult Psychiatry and Child & Adolescent

Psychiatry – Tulane University School of Medicine

Faculty Positions 2008 - Assistant Professor, Dept. Psychiatry, Section of Child &

Adolescent Psychiatry, Tulane University School of Medicine 2013 - Associate Professor, with tenure, Dept. Psychiatry, Section of

Child & Adolescent Psychiatry, Tulane University School of Medicine

Research Focus Genetic and epigenetic contribution to recovery from early childhood

social deprivation and/or adversity/trauma

Stacy Drury, MD

Achieving Exellence

Situation Analysis

Strategic Planning

Alignment Execution Evaluation

Where are we now?

Where do we wantto be?

What external factors do we needto consider?

Who must dowhat?

Are we on track?

Strengths & Weaknesses

Opportunities & Challenges

Trends & Drivers

Primary Themes & Priorities

Mission

Vision & Values

Short & Long Term Goals

Aspirational Goals

UT System, School of Medicine & HSC

Accreditation

Collaborators/Partners

Budget & Resources

Action Plans

Communication Plan

Quantifiable Measures

Transparency

Accountability

Course Correction

Service LinesWhat is a Service Line?A service line is focused on a specific patient need such as cancer, primary care, behavioral, women’s health, etc. A service line provides an organizational structure that enables physicians and staff to work as a team, in partnership with patients and families, to provide quality care in an efficient manner.Roxanne Townsend, MD

Vice Chancellor for Clinical Programs

Service Lines vs. Departments

Service Line 1

Department

1

Department 2

Faculty

Faculty and Trainees

Service Line 2

Department 3

Facu

lty

Faculty and Trainees

Department of Psychiatry

Arkansas State Hospital

ArkansasChildren’s Hospital

VA HospitalDHSR

Education&

Training

Research

Women’s Health

Drug &Alcohol

BIRC

Child &Adolescent

Clinical

PrecisionMedicine

Trauma

PRI NWAR

InterventionalPsychiatry

PRI

Youth Home

Service Line StructureAcademic Programs/Divisions

Drug &Alcohol

Child &Adolescent

Women’s Health

Education

Clinical

ResearchDHSR

PrecisionMedicine

Trauma

PRI NWAR

InterventionalPsychiatry

BIRC

Organizational Structure:

Behavioral Health Service Line

OutpatientClinics

CELC / Exec Committee

Service Line Council

Service Line Council

VC Clinical ProgramsRoxanne Townsend, MD

Behavioral HealthService Line DirectorPedro L. Delgado, MD

Chief Svc Line Officer

Nursing DirectorJudy Seidenschnur, RN

Medical DirectorJeff Clothier, MD

Admin DirectorLaura Tyler, Ph.D.

Business Mngr.

HR Mngr.

Other

Med Director Council

Admin Director Council

Nursing Leadership RoundtableInpatient

Units

Primary Care - Specialty Care

Primary Care

Specialist

Telemedicine Consultation

On-Site Consultation

Training to maximize competence

Referral to Specialty Clinic

Supervision of Extenders

Behavioral Health Service LineBalanced Scorecard

Attribute

Alignment with UAM

S Mission

Measurement

Responsibility

Update Frequen

cy

Degree of Reliability

Relevance to PRI Success

Ability to

Influence

Source TargetMeasurement SummarySummarize the attributes associated with each measurement in the Balanced Scorecard

                             

Clinical Growth

and Access

1 3rd next available new patient appointment (MD attending or Physician Extender)       Mthly       Epic 90%

2 Number of all new patients who kept appointments       Mthly       Epic  

3 Number of total arrived over total number of available appointments       Mthly       Epic  

4 Total # of IP admissions (Little Rock only), Adult only       Mthly       Epic5.5 days @ 85% occupancy rate

Financial Sustaina

bility

1 Actual compared (Adult) to budget, PRI as a whole-SL      Mthly/YTD       SAP  

2 Collections per RVU      Mthly/YTD       SAP  

3Total revenue divided by total expense (Dept. & CS) (117 unfunded research, actual vs. budget)               SAP  

4 How do we guard against cost shifting?                  

Scorecard Continued

Research Excellenc

e

1 Number of all grants submitted       Qtly/YTD       TRACKS    

2Number of all grants funded       Qtly/YTD       TRACKS    

3 Average score for submitted & scored grants       Qtly/YTD       TRACKS    

4 Number of grants scored out of total grants submitted (exclude VA submission)       Annual       TRACKS    

5 % Growth in extramural research funding per research FTE       Annual       TRACKS    

Student Success

1 Psych NBMA Subject Examination score results from junior medical students      every 6 weeks       NBME

Measured by %ile score compared to national mean  

2 Psych-related USMLE Step I and II CK subscales       Annual        

Success measured by whether our students score above the national mean  

3Total # of trainees and # of colleges (COM,COP,COPH,CON,COHRP,PA school, etc.) represented from UAMS       Qtly       Dr. John Spollen

No Comparative bar  

4American Board of Psychiatry and Neurology board certification pass rate for general psychiatry and various fellowship graduates       Annual       Board

Success measured by whether our pass rate is above the national pass rate. Excellence being 100% pass rate.  

Scorecard Continued

Faculty and Staff Retentio

n

1 Employee turnover rate       Mthly/YTD          

2 Employee tenure in months (avg & median)       Mthly          

3 Dollars spent in education/FTE (include Grand Rounds, meetings, training)       YTD          

                     

Clinical Outcome

s

1Admission screening for violence risk, substance abuse, psychological trauma and patient strengths               ORYX/HEDIS  

2 Hours of restraint               ORYX/HEDIS  

3 Hours of seclusion               ORYX/HEDIS  

4 Post discharge continuing Care Plan developed               ORYX/HEDIS  

5 Post discharge continuing Care Plan transmitted to OP provider               ORYX/HEDIS  

6 Number of PCPs receiving discharge summaries from Epic                  

7 Patient satisfaction - Press Ganey Scores- which specific measures                  

8Ops with dx of Depression NOS (we will only focus on communication/education for pats with depression)                  

9 Number of OP visits with one completed rating scale (Fortney)                  

10 Number of IP discharges with scheduled f/u w/ a MD/APN within 14 days                  

                     

Notable Dates/Events

Kilts investiture is Dec. 3, 4 p.m. in the Hospital Lobby Gallery, Wilbur Mills Endowed Chair in Alcohol and Drug Abuse Prevention

The PRI Holiday Party is Dec. 15, 4:30 to 6:30 p.m. in the PRI atrium, wine and hors d’oeuvres will be serve

Interventional Psychiatry

Research GrantsTitle 2013-14 2014-15

Indirect IndirectHudson Use and Abuse of Prescription Opiods Among OEF/OIF Veterans $204,054.00 $74,206.00Caceda Longitudinal Neurobiological Assessment of Depressed Patients after a Suicide Attempt $14,887 Cisler Computational Modeling of Family Dynamical Behavior - Effect on Brain Representation $35,000 Curran Linking Returning Veterans In Rural Community Colleges to Mental Health Care $269,219.00 $96,631.00 NCECurran Partnership for Implementation of Evidence-Based Practices in Rural Primary Care $418,589.00 $108,716.00 $413,840.00 $108,334.00Sullivan Patient Centered Outcomes Research Institute $244,744.00 $77,330.00 Hudson Identifying Quality Indicators for Substance Use Disorders $190,274.00 $46,255.00 $197,976.00 $39,973.00Cisler Neural Network Predictors of Treatment Outcome Among Adolescent Assault Victims $123,400.00 $58,615.00Kilts Translational Training in Addiction $318,774.00 $24,289.00 $336,026.00 $4,220.00Kilts A risk factor analysis of human brain states related to development of addiction $248,333.00 $117,958.00Oliveto Clinical Efficacy of Atomoxetine for Methamphetamine Dependence $125,000.00 $58,750.00Oliveto Improving Buprenorphine Detoxification Outcomes with Isradipine $150,000.00 $71,250.00 $125,000.00 $59,375.00Oliveto Efficacy of Carvedilol in Recently Abstinent Psychostimulant Dependent Patients $159,002.00 $66,701.00 NCEOliveto Impact of CYP2D6 Phenotype on Response to Methamphetamine Dependence $136,800.00 $64,980.00 NCEMancino Clinical Efficacy of Lisdexamfetamine for Methamphetamine Dependence $125,000.00 $59,375.00 $150,000.00 $71,250.00Sigel Arkansas Network for Early Stress and Trauma $317,460.00 $82,540.00 $317,460.00 $82,540.00Stowe Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs $99,246.00 $47,142.00 $24,352.00 $11,567.00Delgado Bupropion for Depression in ESRD Patients on Hemodialysis $78,323.00 $38,378.00 125,000 54,846

$2,959,885 $975,158 $1,987,874 $550,063

Caceda Examination of choice impulsivity in impulsive suicide attempters pending $150,000 $73,500 Cheney Understanding the role of oppression and social networks in african american? pending $85,513 $39,353 Cheney The role of social network in southern african americans' substance use outcomes pending $250,000 $101,820 Cisler CAREER: Identification of Whole-brain effective connectivity pending $8,597 $4,213 Cisler Sex differences in neural mechanisms of drug use disorders pending $250,000 $122,500 Cisler Identification & modulation of brain networks mediating trauma memory recall pending $42,320 $3,386 Cucciare Veteran's Alcohol and Drug Abuse: effectiveness of couple based prevention pending $11,955 $5,858 James Neurobiomarkers of ECT-induced change in affective and non-affective cognitions pending $326,300 $159,887 James Mapping the brain stress response to predict the course of postpartum depression pending $150,000 $73,500 Mancino University of Arkansas for Medical Sciences - Substance Abuse Treatment Clinic funded $300,000 Oliveto Improving Treatments for Prescription Opioid Dependence pending $452,690 $215,028 Oliveto Identifying Inflammatory Biomarkers with Methamphetamine Use & Cognitive Impairment pending $125,000 $61,250 Oliveto Efficacy of Ketamine for Opioid Withdrawal pending $125,000 $61,250 Pemberton Facilitating Dissemination: Brief Family Engagement Intervention $50,000

$2,327,375 $921,545