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Service Members with PTSD and Depression Have Complex Service Needs

• Both cohorts suffer high rates of comorbid psychological health conditions.

Administrative Data–Based Quality Measures for PTSD and Depression Identified Important Strengths and Some Areas for Improvement

• The Military Health System (MHS) generally performs well in the areas of initiating psychotherapy and follow-up after hospitalization, but is inconsistent or weaker in the areas of medication management and ongoing care.

Adequate Medication Trial Rate is Similar to or Higher than Estimates from Other Health Care Systems, and Rates of Follow-Up Medication Management are Similar but Low

A High Proportion of Service Members with PTSD or Depression Received at Least Some Psychotherapy, But the Number of Visits Appear to Be Inadequate to Allow Delivery of Evidence-Based Psychotherapy

• The MHS largely succeeds in providing patients with an initial psychotherapy visit, but could improve rates of delivering ongoing treatment.

The MHS Is a Leader in Achieving High Rates of Follow-up After Psychiatric Hospitalization

• High rates of follow-up after psychiatric hospitalization relative to other health care systems may be related to a 2011 MHS mandate describing follow-up procedures for missed behavioral health appointments.

Quality of Care for PTSD and Depression Varied by Service Branch, TRICARE Region, and Service Member Characteristics

• For example, rates of follow-up within seven days after a mental health hospitalization differed across service branches by up to 14 percent, and rates of adequate filled prescriptions for targeted medications varied by pay grade by up to 29 percent.

The U.S. Department of Defense (DoD) strives to maintain a physically and psychologically healthy, mission-ready force, and the care provided by the Military Health System (MHS) is critical to meeting this goal. Given the rates of posttraumatic stress disorder (PTSD) and depression among U.S. service members, attention has been directed to ensuring the quality and availability of programs and services targeting these and other psychological health (PH) conditions. Understanding the current quality of care for PTSD and depression is an important step toward improving care across the MHS. To help determine whether service members with PTSD or depression are receiving evidence-based care and whether there are disparities in care quality by branch of service, geographic region, and service member characteristics (e.g., gender, age, pay grade, race/ethnicity, deployment history), DoD's Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) asked the RAND Corporation to conduct a review of the administrative data of service members diagnosed with PTSD or depression and to recommend areas on which the MHS could focus its efforts to continuously improve the quality of care provided to all service members. This report characterizes care for service members seen by MHS for diagnoses of PTSD and/or depression and finds that while the MHS performs well in ensuring outpatient follow-up following psychiatric hospitalization, providing sufficient psychotherapy and medication management needs to be improved. Further, quality of care for PTSD and depression varied by service branch, TRICARE region, and service member characteristics, suggesting the need to ensure that all service members receive high-quality care.

• Chapter One

  Introduction

• Chapter Two

  Methods

• Chapter Three

  Characteristics of Service Members in PTSD and Depression Cohorts, and Their Care Settings and Treatments

• Chapter Four

  Quality of Care for PTSD and Depression

• Chapter Five

  Variations in Care for PTSD and Depression Based on Patient Characteristics

• Chapter Six

  Summary and Recommendations

• Appendix A

  Technical Specifications for Administrative Data Quality Measures for PTSD

• Appendix B

  Technical Specifications for Administrative Data Quality Measures for Depression

• Appendix C

  Rules for Processing Administrative Data for Inpatient Stays and Outpatient Visits