Measuring the Quality of Care for Psychological Health Conditions in the Military Health System: Candidate Quality Measures for Posttraumatic Stress Disorder and Major Depressive Disorder

Measuring the Quality of Care for Psychological Health Conditions in the Military Health System: Candidate Quality Measures for Posttraumatic Stress Disorder and Major Depressive Disorder

Measuring the Quality of Care for Psychological Health Conditions in the Military Health System: Candidate Quality Measures for Posttraumatic Stress Disorder and Major Depressive Disorder

Measuring the Quality of Care for Psychological Health Conditions in the Military Health System: Candidate Quality Measures for Posttraumatic Stress Disorder and Major Depressive Disorder

Synopsis

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.

Excerpt

Providing high-quality treatment and improving outcomes for individuals with psychological health (PH) conditions is a high priority for the military health system (MHS). In the past decade, the number of individuals treated by the MHS for these conditions has grown significantly. However, the extent to which the MHS is currently providing care that is consistent with evidence-based clinical practice guidelines or MHS standards for high-quality care has been difficult to measure across the entire system. There is currently no U.S. Department of Defense–wide system in place to evaluate the quality of PH care provided, assess whether the care is improving outcomes, or identify potential areas for improvement.

To better understand these issues, the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) asked the RAND Corporation to develop a framework to help identify and classify a set of measures for monitoring the quality of care provided by the MHS for PH conditions, specifically posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). The goal of the current effort is to select and develop quality measures for PTSD and MDD treatment relevant to the MHS. The task does not include a complete implementation plan; we designed it to provide the foundation for future DCoE–RAND work to pilot and later implement a subset of these measures.

The purpose of this document is to describe a candidate set of quality measures for PTSD and MDD, including the methods used to identify and refine them. This measure set should inform ongoing efforts within DCoE to measure and improve the quality of PH care. For each measure, we provide a brief conceptual description, including the rationale for selecting the measure, the population to which it applies, and what data source might be available for implementing these measures in the MHS. This report should be useful to MHS personnel who provide care for individuals being treated for PTSD or MDD and those responsible for monitoring the quality of that care in focusing their efforts on evidence-based quality measures.

This research was sponsored by DCoE and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

For more information on the RAND Forces and Resources Policy Center, see http:// www.rand.org/nsrd/ndri/centers/frp.html or contact the director (contact information is provided on the web page).

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