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Quality Improvement Tool Shows Organizational Factors Related to Access and Quality Measures in VA Mental Healthcare

Compared to U.S. medical-surgical systems, mental health systems have been less affected by and less able to benefit from policies that incentivize value, leaving little precedent to follow in adopting a value orientation in mental health. This study analyzed performance on measures included in the Mental Health Management System (MHMS) – a performance data and quality improvement tool used by VA to increase the value of mental healthcare for Veterans. The MHMS uses both patient and provider surveys and VA administrative data to, in collaboration with local VISN and facility leadership, help evaluate potential drivers of access to and quality of mental healthcare such as organizational structure and efficiency, implementation of innovative treatment options, and resource needs for delivering care. For this study, investigators examined 31 MHMS performance measures for 139 VA facilities from Q4 FY14 through Q3 of FY15. Of these facilities, 80% offered in-house acute psychiatric services, and all were mandated to connect Veterans with full mental health services as needed.


  • The MHMS quality improvement tool showed that organizational factors were associated with performance on key access and quality measures related to VA mental healthcare.
    • Better access was associated with higher staff-to-patient ratios for psychiatrists and other outpatient mental health providers, and with lower mental health provider staffing vacancies.
    • Higher mental health staff-to-patient ratios were associated with higher performance on nearly all patient and provider satisfaction measures.
    • Higher continuity of care was associated with lower no-show rates to appointments, better wait times, higher staff-to-patient ratios, lower mental health provider vacancies, and more space available for clinical work.


  • Patient health outcome measures and cost data are not yet available via MHMS.
  • Potential contributors to quality were not measured, such as local competition to hire providers and organizational culture. These issues are addressed in conversations with local management.
  • Survey response rates were lower than is desirable for mental health providers, and it is possible that responders differed from non-responders.


  • Over the past decade, VA's mental health population has grown rapidly compared to its overall patient population (71% vs. 21%, respectively), so these findings are important in showing that MHMS is a robust informatics and quality improvement tool that can serve as a model for health systems planning to adopt a value perspective.

This study was conducted and funded in partnership with VA's Office of Mental Health Operations. Dr. Schmidt is funded as an HSR&D Advanced Fellow, and both he and Dr. Trafton are part of HSR&D's Center for Innovation to Implementation (Ci2i), Menlo Park, CA.

PubMed Logo Schmidt E, Krahn D, McGuire M, Tavakoli S, Wright D, Solares H, Lemke S, and Trafton J. Using Organizational and Clinical Performance Data to Increase the Value of Mental Health Care. Psychological Services. February 2017;14(1):13-22.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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