Overview of Measures Included in the IBHC Measures Atlas

This section describes the processes used to identify measures and map the measures to the Integration Framework. For the purposes of the IBHC Measures Atlas, measures are cited at the level of the instrument (e.g., questionnaire, checklist) to maintain the context and, in some cases, the validity of the measurement tool. When appropriate, specific submeasures that are relevant to integrated behavioral health care (e.g., specific questions or items) are listed as guidance for the reader.

The Search for Measures

Measures of integrated behavioral health care were identified through an environmental scan, which consisted of a literature review and consultation with subject matter experts. Key elements of the environmental scan were:

  • Sources: Sources included quality measures clearinghouses; peer-reviewed scientific literature; and the “grey literature,” such as technical reports and working papers from scientific committees and government agencies.
  • Search Methodology: The methodology was informed by methods used in the previously published AHRQ Care Coordination Measures Atlas.[1] Search terms and sources were updated for this IBHC Measures Atlas based on the definition of integrated behavioral health care and common terms under the topic of health care quality measurement.
  • Limits: The search was limited to measures that were published or included in publications since 2001. Measures were included in the IBHC Measures Atlas if they were publically available. Copyrighted or otherwise protected measures are included if they are available to the public at no cost.

An in-depth description of the methods of the search strategy is available in the Methodological Details.

Review of Measures and Mapping to the Integration Framework

Measures were included in the IBHC Measures Atlas based on a series of expert reviews. Measures selected for inclusion were mapped to relevant functional domains in the Integration Framework. Finally, reviewers conducted a usability and usefulness check, during which reviewers assessed the measures on the following three criteria:

  • The degree to which each measure aligned with the measurement constructs;
  • The number of functional domains addressed by a given measure; and
  • The burden of using the measure.

Results of the usability and usefulness check were used to divide the final seventeen measures into two categories, (1) Core Measures and (2) Additional Measures, which are described below.

Measures of Integrated Behavioral Health Care

Core Measures

Core measures align closely with the Integration Framework. Some of these measures (i.e., C2, C6-8) were designed specifically to assess integrated care, while others were designed to measure coordinated care in general and can be adapted to measure integrated care.

* Measure was developed specifically to measure integration.

Additional Measures

Measures in this category do not align with the Integration Framework as well as the core measures. These measures may have been designed for a specific population or condition or have a few items relevant to IBHC Measures Atlas within a lengthy instrument.

Experienced evaluators may also wish to review the Lexicon[2] for guidance on assessing aspects of framework for which formal measures do not exist, or aspects for which use of formal measures may not be the most appropriate.

Clinical Measurement Tools

A literature search was conducted to find peer reviewed articles and reports that focus on the quality of integration between behavioral and physical health care settings.  The literature search was limited to prevalent physical and mental health conditions that are commonly comorbid such as diabetes, cardiovascular disease, depression, and anxiety.  Clinical health outcomes were used as the primary markers of quality.

The measures from the literature search were evaluated based on sensitivity, specificity, validity, and reliability. In order to be selected for the final list of clinical outcome measures, the measure was required to have at least 2 good psychometric properties. An in-depth description of the methods of the Clinical Literature Search is available in the Methodological Details.  Below is the final list of clinical outcome measurement tools from the literature search:

Anxiety

Depression

Diabetes

Physical Health Conditions

Substance Use / Substance Abuse

 

* Measure was developed specifically to measure integration.

Additional Measures

Measures in this category do not align with the Integration Framework as well as the core measures. These measures may have been designed for a specific population or condition or have a few items relevant to IBHC Measures Atlas within a lengthy instrument.