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Improving the Quality of Health Care for Mental and Substance-Use Conditions
Obtaining the best available comparative information on safety, effectiveness, and availability of care and providers, and using that information to guide treatment decisions.
Maximizing patient decision making and involvement in the selection of treatments and providers.
The infrastructure needed to measure, analyze, publicly report, and improve the quality of M/SU health care is less well developed than that for general health care. As a result, there has been less measurement and improvement of M/SU health care than of general health care (AHRQ, 2003; Garnick et al., 2002). A related issue is that methods used to disseminate evidence-based practice to providers have not always been evidence-based themselves. To build a stronger infrastructure to support the delivery of high-quality care, the committee recommends a five-part strategy: (1) more coordination in filling gaps in the evidence base; (2) a stronger, more coordinated, and evidence-based approach to disseminating evidence to clinicians; (3) improved diagnosis and assessment strategies; (4) a stronger infrastructure for measuring and reporting the quality of M/SU health care; and (5) support for quality improvement practices at the sites of M/SU health care.
Recommendation 4-1. To better build and disseminate the evidence base, the Department of Health and Human Services (DHHS) should strengthen, coordinate, and consolidate the synthesis and dissemination of evidence on effective M/SU treatments and services by the Substance Abuse and Mental Health Services Administration; the National Institute of Mental Health; the National Institute on Drug Abuse; the National Institute on Alcohol Abuse and Alcoholism; the National Institute of Child Health and Human Development; the Agency for Healthcare Research and Quality; the Department of Justice; the Department of Veterans Affairs; the Department of Defense; the Department of Education; the Centers for Disease Control and Prevention; the Centers for Medicare and Medicaid Services; the Administration for Children, Youth, and Families; states; professional associations; and other private-sector entities.
To implement this recommendation, DHHS should charge or create one or more entities to:
Describe and categorize available M/SU preventive, diagnostic, and therapeutic interventions (including screening, diagnostic, and symptom-monitoring tools), and develop individual procedure codes and definitions for these interventions and tools for their use in administrative datasets approved under the Health Insurance Portability and Accountability Act.