Measuring the Quality of Mental Healthcare: Barriers and Strategies
Despite the proliferation of evidence-based guidelines for the treatment of mental disorders, quality of care and patient outcomes remain suboptimal. Among others, a recent Institute of Medicine report documented substantial gaps in evidence-based care for mental disorders, citing poor quality in detection, treatment, and follow-up care. Moreover, there is documented evidence that, worldwide, the mental health services sector lags behind in the development and implementation of performance measures and strategies for implementing them as tools to improve quality and outcomes. This article discusses the barriers to mental health quality measurement – and identifies strategies to enhance the development and use of quality measures in order to improve outcomes for people with mental health disorders.
The authors suggest that 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. The refinement of quality measures and, ultimately, enhanced outcomes in mental health will require investment in information technology, additional studies to support the evidence base, and the development of a culture of measurement-based care. Sustaining efforts to improve mental health performance measurement will require rethinking how quality measurement is used to promote the uptake of evidence-based mental healthcare across systems of care. In addition, measurement systems should cut across mental health disorders, physical disorders, and substance use disorders, which often co-occur.
The authors also note that an important example of quality measurement in mental healthcare in the U.S. is work that has been done within the VA healthcare system. As a result, the Altarum Institute and RAND are conducting a national evaluation of VA’s mental health services, using a quality measurement model. Also, the VHA Primary Care-Mental Health Integration Program has implemented performance measurement for depression, alcohol, and PTSD screening and management.
Kilbourne A, Keyser D, and Pincus H. Challenges and opportunities in measuring the quality of mental health care. The Canadian Journal of Psychiatry September 2010;55(9):127-135.
This study was partly funded by HSR&D (IIR 02-283). Dr. Kilbourne is part of HSR&D’s Center for Clinical Management Research in Ann Arbor.