State of Behavioral Health Quality Measures

Developing a comprehensive set of well-accepted measures capable of demonstrating the value of behavioral health treatment is critical for building a case for devoting resources to mental health treatment. Two review articles in Psychiatric Services argue for greater focus on behavioral health quality measures.

  • A recent Open Forum article(PDF - 541 KB) reviews the current state of behavioral health quality measures and issues a call to action for development, collection, and routine use of functional outcome measures. Sherry Glied, Ph.D., and colleagues explain that although quality measurement has becoming more widespread, development of behavioral health quality measurements lags behind comparable medical quality measures. The authors caution that “if value in mental health care is poorly measured compared with other medical areas […], financial resources will likely be diverted from psychiatry, despite high rates of behavioral health conditions and unmet needs for treatment.” The authors identify four measurement domains: functional outcomes, clinical outcomes, process, and structure. The review’s results show that most of the focus in behavioral health measurement research has been on structure and process measurement; however, the authors argue that the use of functional outcome measures to assess the value of health care has “tremendous promise.” The authors conclude that “expanding the focus of measurement from process measures to broad outcome measures broadens opportunities for practice innovations that lead to quality improvement, increases incentives for coordination with other parts of the health and social service system, and complements attention to recovery. “
  • “Valid and reliable clinical quality measures are integral to implementing and evaluating ongoing health care reforms” states Milesh Patel, M.S., and colleagues in a recent review(PDF - 464 KB). The review examined whether current behavioral health quality measures address the priority areas of the National Behavioral Health Quality Framework (NBHQF), examined the extent to which the measures have received National Quality Forum endorsement, and quantifying the number of measures used in major reporting programs. The authors identified 510 measures, nearly one-third of which address broad mental health or substance use conditions rather than specific conditions or diagnoses. The majority of the identified measures are process measures. Only 10 percent of the measures have received National Quality Forum endorsement and 5 percent were used in major quality reporting programs. Although myriad behavioral quality measures exist, many measures address the same content (e.g., depression); while other areas of content have no measures (e.g. combined pharmacotherapy and psychosocial treatments). Overall, few behavioral health quality measures have received national endorsement. The authors recommend that “future measure development and implementation efforts should focus on identifying the strongest measures within each domain of the NBHQF and filling gaps where existing measures are insufficient.”