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A Conceptual Framework That Includes Continuum of Care and Measure Type Is Useful to Characterize Quality Measures

• The authors identified more than 500 measures relevant to posttraumatic stress disorder, major depressive disorder, or other psychological health conditions.
• The authors selected measures according to two validity criteria, two feasibility criteria, one importance criterion, and whether the National Quality Forum had endorsed the measure (a proxy for importance, validity, reliability, feasibility, and usability).
• The authors mapped the measures to the conceptual framework dimensions, which included the continuum of care and its five phases (prevention, screening, assessment, treatment, and reintegration) and the type of measure (structure, process, outcome, patient experience, and resource use).

A Large Set of Candidate Quality Measures Provides Many Options to Support Future Efforts to Assess Care for Posttraumatic Stress Disorder and Major Depressive Disorder

• The authors identified 29 candidate measures of quality of care for PTSD and 29 for MDD. Some are condition-specific; others could apply to other psychological health conditions.
• The candidate quality measures rely on a variety of data sources, including administrative claims data, medical record review data, and patient survey data.
• Descriptions of each measure provide a foundation for understanding each measure's content and evaluating its potential value as a means of evaluating the quality of mental health care provided by the military health system.

In recent years, the number of U.S. service members treated for psychological health conditions has increased substantially. In particular, at least two psychological health conditions — posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) — have become more common, with prevalence estimates up to 20 percent for PTSD and 37 percent for MDD. Delivering quality care to service members with these conditions is a high-priority goal for the military health system (MHS). Meeting this goal requires understanding the extent to which the care the MHS provides is consistent with evidence-based clinical practice guidelines and its own standards for quality. To better understand these issues, RAND Corporation researchers developed a framework to identify and classify a set of measures for monitoring the quality of care provided by the MHS for PTSD and MDD. The goal of this project was to identify, develop, and describe a set of candidate quality measures to assess care for PTSD and MDD. To accomplish this goal, the authors performed two tasks: (1) developed a conceptual framework for assessing the quality of care for psychological health conditions and (2) identified a candidate set of measures for monitoring, assessing, and improving the quality of care for PTSD and MDD. This document describes their research approach and the candidate measure sets for PTSD and MDD that they identified. The current task did not include implementation planning but provides the foundation for future RAND work to pilot a subset of these measures.

• Chapter One

  Introduction

• Chapter Two

  Framework for Classifying Measures of Psychological Health Conditions

• Chapter Three

  Identification of Measures of Quality of Care for Posttraumatic Stress Disorder and Major Depressive Disorder

• Chapter Four

  Overview of Candidate Sets of Measures of Care Quality for Posttraumatic Stress Disorder and Major Depressive Disorder

• Chapter Five

  Summary and Recommendations

• Appendix A

  Definitions of Terms Used to Describe Quality Measures

• Appendix B

  Descriptions of Measures of Quality of Care for Posttraumatic Stress Disorder

• Appendix C

  Descriptions of Measures of Quality of Care for Major Depressive Disorder

• Appendix D

  Additional Rationale for Cost Measure

• Appendix E

  Candidate Set of Measures of Quality of Care for Posttraumatic Stress Disorder

• Appendix F

  Candidate Set of Measures of Quality of Care for Major Depressive Disorder

• Appendix G

  Sources of Measures