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High-quality care for invisible wounds should be veteran-centered, accessible, and evidence-based, and it should include outcome monitoring

• Veteran-centered care requires cultural competence (and understanding of veteran experiences and identity), ongoing assessment of veterans' care experiences, shared decisionmaking between the veteran and provider, and family/caregiver involvement in care.
• Accessibility indicates that veterans can get the care they need in a timely manner and requires reducing geographic, financial, sociocultural, and other barriers to care.
• Evidence-based care incorporates treatments and practices that are backed by the best available research.
• Outcome monitoring involves using validated instruments to regularly assess veterans' clinical outcomes and changes to functioning, well-being, relationships, and life satisfaction.

Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) — sometimes referred to as "invisible wounds" — can have significant negative effects on veterans' mental and physical health, yet many veterans have difficulty accessing high-quality care for these conditions. The Veteran Wellness Alliance, an initiative of the George W. Bush Institute, is a coalition of veteran peer network and clinical provider organizations that aims to improve access to high-quality care for post-9/11 veterans, specifically those with PTSD and TBI. Although the Veteran Wellness Alliance and other veteran-serving organizations have a common goal to improve access to high-quality care for invisible wounds, there has been no shared definition of high-quality care to guide these improvement efforts. RAND researchers conducted a literature review and interviews with Veteran Wellness Alliance partner organizations to identify standards for high-quality care, develop an initial definition, and make recommendations for implementing, refining, and disseminating the definition and its associated metrics.

Establishing a clear standard for high-quality care will help the Veteran Wellness Alliance offer meaningful guidance to its clinical partners and peer networks and will guide the broader veteran-serving community in providing the highest level of support for post-9/11 veterans who are living with the effects of these conditions.

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