ment services provided (see http://hipaa.samhsa.gov). Similar, expanded efforts in coordination with public- and private-sector experts in coding, evidence-based practices, and use of administrative datasets could help substantially in building the evidence base on the effectiveness of different M/SU treatments.

Collection of Outcome Data from Patients

Patients are increasingly recognized as valid judges of the quality of their health care (Iezzoni, 1997); this applies equally to general and M/SU health care. In addition to reporting on their experiences with care delivery processes—such as the extent to which they were able to participate in decisions about their own care and gain skill in the self-management of their illness—consumers can provide information on the effectiveness of treatment in reducing symptoms and improving functioning (Hibbard, 2003). Moreover, “the shift toward patient-centered care has meant that a broader range of outcomes from the patient’s perspective needs to be measured in order to understand the true benefits and risks of healthcare interventions.” (emphasis added) (Stanton, 2002:2) Patient questionnaires that ask about the extent to which patients’ symptoms have been reduced as a result of treatment are already being used to measure outcomes for treatment of general medical conditions such as benign prostatic hypertrophy and cataracts. These questionnaires have been found to yield accurate and reliable information on the extent of improvement in symptoms, providing detailed and sensitive measures of treatment effectiveness from the patient’s perspective. For example, the VF-14, a 14-item questionnaire on eyesight, asks patients about the amount of difficulty they experience in pursuing usual daily activities, such as driving and reading fine print. Many insurers (including Medicare) require that the results of the VF-14 be reported as part of claims payment. The questionnaire also is required by the National Eye Institute to test the benefits of new technologies and procedures for cataract patients (Stanton, 2002).

Such consumer surveys may be an even more appropriate and valuable source of data on the outcomes of M/SU health care than on those of general health care. Laboratory tests or other physical measures, such as blood glucose levels, blood pressure, and forced expiratory lung volume, can measure outcomes of general health care accurately and easily. In contrast, fewer laboratory or other physical examination findings can measure whether mental illness or drug dependence is remitting. Thus patients are likely to be the best source of information on the extent to which their symptoms are abating and functioning is improved.

Patient reports of symptoms and functioning (outcomes of care) can readily be gathered using several clinically feasible, valid, and reliable ques-



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