NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Relationship Between Use of Quality Measures and Improved Outcomes in Serious Mental Illness
Technical Briefs, No. 18
Investigators: Bradley Gaynes, MD, MPH, Carrie Brown, MD, MPH, Linda J Lux, MPA, Brian Sheitman, MD, Mahima Ashok, PhD, Erin Boland, BA, Laura Morgan, MA, Tammeka Swinson-Evans, MOP, Lynn Whitener, PhD, and Meera Viswanathan, PhD.
Author Information and AffiliationsStructured Abstract
Background:
Provisions of the Affordable Care Act (2010) require the use of validated quality measures (QMs) to evaluate the quality of health care programs, services, and outcomes. The need for such measures is crucial in serious mental illness (SMI), a long-term illness involving substantial functional impairment over multiple symptom domains that affects more than 11 million U.S. adults. Using QMs to assess the effect of programs designed to improve the mental health of SMI populations is an important task in improving the quality of these programs and services and, ultimately, health outcomes. Although stakeholders have proposed a variety of QMs, none are used consistently across all treatment sites or all forms of SMI. Key areas of uncertainty remain. Knowledge gaps for SMI include an agreed-upon list of relevant QMs; identification of the most meaningful outcomes by which to measure the success of QMs; identification of barriers to and facilitators of their implementation; and robust assessments of whether use of such measures improves medical, psychiatric, and patient-centered outcomes.
Purpose:
The goal of this Technical Brief is to identify how QMs are currently used in the SMI population and to describe the evidence supporting their use.
Methods:
We discussed with Key Informants and performed targeted searches of published and gray literature on questions of (1) a description of QMs; (2) the context for their use; (3) research linking QMs to changes in outcomes; and (4) current key issues in future uptake, use, evidence gaps, and research priorities.
Findings:
The evidence base, which was sparse, suggests that no uniformly accepted practices exist on how to define or implement QMs for SMI, nor on which QMs are the most relevant. Outcomes against which to evaluate the effectiveness of QMs are difficult to measure. Time, the additional burden of using QMs on a resource-limited health care system, and a thin evidence base on their use were key barriers to implementation of QMs. Indeed, we found no prospective research evaluating whether the use of QMs for SMI leads to changes in outcomes. Of note, evidence does not exist that indicates that certain measures often used as proxies for quality of care actually measure quality of care or improve outcomes.
Conclusions:
The literature does not indicate an agreed-upon list of preferred relevant QMs for the SMI population, and the outcomes against which to assess the effectiveness of QMs are challenging to measure. Relatedly, and possibly of greatest practical importance, no studies have assessed whether the use of QMs improves health outcomes for patients with SMI nor do stakeholders agree on preferred outcomes. Accordingly, critical issues for the field to address include (1) determining the level of evidence (or strength of evidence) necessary to support implementation of QMs, given the complexities of studying the topic and the likely limited research funding; (2) developing the evidence base that assesses the link between QM use and outcomes; (3) considering when to invest the time and resources on measuring outcomes of care to evaluate the impact of QMs, and when process measures (proxies of the outcomes) are a reasonable and more feasible alternative; (4) determining the resource needs for QM implementation; and (5) developing validated and reliable QM tools that can be implemented feasibly in real-world practice.
Contents
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2012-00008-I, Prepared by: RTI –UNC Evidence-based Practice Center, Research Triangle Park, NC
Suggested citation:
Gaynes B, Brown C, Lux LJ, Sheitman B, Ashok M, Boland E, Morgan L, Swinson-Evans T, Whitener L, Viswanathan M. Relationship Between Use of Quality Measures and Improved Outcomes in Serious Mental Illness. Technical Brief No. 18. (Prepared by the RTI-UNC Evidence-based Practice Center under Contract No. 290-2012-00008-I.) AHRQ Publication No. 15-EHC003-EF. Rockville, MD: Agency for Healthcare Research and Quality. January 2015. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the RTI International-University of North Carolina Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2012-00008-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers–patients and clinicians, health system leaders, and policymakers, among others–make well informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, reimbursement or coverage policies, may not be stated or implied.
None of the investigators have any affiliation or financial involvement that conflicts with the material presented in this report.
- 1
540 Gaither Road, Rockville, MD 20850; www
.ahrq.gov
- NLM CatalogRelated NLM Catalog Entries
- Review Disparities Within Serious Mental Illness[ 2016]Review Disparities Within Serious Mental IllnessEvans TS, Berkman N, Brown C, Gaynes B, Weber RP. 2016 May
- Review Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task Force[ 2013]Review Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task ForceLin JS, O'Connor E, Rossom RC, Perdue LA, Burda BU, Thompson M, Eckstrom E. 2013 Nov
- How has the impact of 'care pathway technologies' on service integration in stroke care been measured and what is the strength of the evidence to support their effectiveness in this respect?[Int J Evid Based Healthc. 2008]How has the impact of 'care pathway technologies' on service integration in stroke care been measured and what is the strength of the evidence to support their effectiveness in this respect?Allen D, Rixson L. Int J Evid Based Healthc. 2008 Mar; 6(1):78-110.
- Telemedicine for the Medicare population: pediatric, obstetric, and clinician-indirect home interventions.[Evid Rep Technol Assess (Summ)...]Telemedicine for the Medicare population: pediatric, obstetric, and clinician-indirect home interventions.Hersh WR, Wallace JA, Patterson PK, Shapiro SE, Kraemer DF, Eilers GM, Chan BK, Greenlick MR, Helfand M. Evid Rep Technol Assess (Summ). 2001 Aug; (24 Suppl):1-32.
- Review Cost-Effectiveness and Affordability of Interventions, Policies, and Platforms for the Prevention and Treatment of Mental, Neurological, and Substance Use Disorders.[Mental, Neurological, and Subs...]Review Cost-Effectiveness and Affordability of Interventions, Policies, and Platforms for the Prevention and Treatment of Mental, Neurological, and Substance Use Disorders.Levin C, Chisholm D. Mental, Neurological, and Substance Use Disorders: Disease Control Priorities, Third Edition (Volume 4). 2016 Mar 14
- Relationship Between Use of Quality Measures and Improved Outcomes in Serious Me...Relationship Between Use of Quality Measures and Improved Outcomes in Serious Mental Illness
- Menopausal Symptoms: Comparative Effectiveness of TherapiesMenopausal Symptoms: Comparative Effectiveness of Therapies
- Transitional Care Interventions To Prevent Readmissions for People With Heart Fa...Transitional Care Interventions To Prevent Readmissions for People With Heart Failure
- Total Worker Health®Total Worker Health®
- Introduction - Transitional Care Interventions To Prevent Readmissions for Peopl...Introduction - Transitional Care Interventions To Prevent Readmissions for People With Heart Failure
Your browsing activity is empty.
Activity recording is turned off.
See more...