Issues for DSM-V: adding problem codes to facilitate assessment of quality of care

Challenges and opportunities in measuring the quality of mental health care

The purpose of our paper is to delineate the barriers to mental health quality measurement, and to identify strategies to enhance the development and use of quality measures by mental health providers, programs, payers, and other stakeholders in the service of improving outcomes for people with mental health and substance use disorders. Key reasons for the lag in mental health performance measurement include lack of sufficient evidence regarding appropriate mental health care, poorly defined quality measures, limited descriptions of mental health services from existing clinical data, and lack of linked electronic health information. We discuss strategies for overcoming these barriers that are being implemented in several countries, including the need to have quality improvement as part of standard clinical training curricula, refinement of technologies to promote adequate data capture of mental health services, use of incentives to promote provider accountability for improving care, and the need for mental health researchers to improve the evidence base for mental health treatment.

Performance measurement for co-occurring mental health and substance use disorders

BACKGROUND

Co-occurring mental health and substance use disorders (COD) are the norm rather than the exception. It is therefore critical that performance measures are developed to assess the quality of care for individuals with COD irrespective of whether they seek care in mental health systems or substance abuse systems or both.

METHODS

We convened an expert panel and asked them to rate a series of structure, process, and outcomes measures for COD using a structured evaluation tool with domains for importance, usefulness, validity, and practicality.

RESULTS

We chose twelve measures that demonstrated promise for future pilot testing and refinement. The criteria that we applied to select these measures included: balance across structure, process, and outcome measures, quantitative ratings from the panelists, narrative comments from the panelists, and evidence the measure had been tested in a similar form elsewhere.

CONCLUSION

To be successful performance measures need to be developed in such a way that they align with needs of administrators and providers. Policymakers need to work with all stakeholders to establish a concrete agenda for developing, piloting and implementing performance measures that include COD. Future research could begin to consider strategies that increase our ability to use administrative coding in mental health and substance use disorder systems to efficiently capture quality relevant clinical data.

Broadened use of atypical antipsychotics: safety, effectiveness, and policy challenges

Atypical antipsychotic medications are increasingly used for a wide range of clinical indications in diverse populations, including privately and publicly insured youth and elderly nursing home residents. These trends heighten policy challenges for payers, patients, and clinicians related to appropriate prescribing and management, patient safety, and clinical effectiveness. For clinicians and patients, balancing risks and benefits is challenging, given the paucity of effective alternative treatments. For health care systems, regulators, and policymakers, challenges include developing the evidence base on comparative risks and benefits; defining measures of treatment quality; and implementing policies that encourage evidence-based practices while avoiding unduly burdensome restrictions.