tionnaires, such as the Behavior and Symptom Identification Scale (BASIS-32) (Eisen et al., 1999, 2004) and the Patient Health Questionnaire (PHQ-9) (Lowe et al., 2004). Alternatively, clinicians can assess response to treatment systematically and reliably by obtaining information from the patient, combined with other data, and following up over time by using such instruments as the Global Assessment of Functioning (GAF), the Brief Psychiatric Rating Scale (BPRS), and the Health of the Nation Outcome Scales (HoNOS) (VA Technology Assessment Program, 2002). In the alcohol and drug field, instruments such as the Addiction Severity Index (ASI), the Global Appraisal of Individual Needs (GAIN), and the Project MATCH Form 90 are widely used to measure function. In addition, patient surveys used for quality measurement purposes, such as the Experience of Care and Health Outcomes (ECHO) Survey (Anonymous, 2001) and the Mental Health Statistical Improvement Project (MHSIP) surveys, include questions on patients’ perceptions of their improvements in functioning.

If the more detailed administrative data on treatment described above were linked to patient reports of improvement in clinical symptoms and other outcomes, additional evidence could be generated on what treatments and treatment approaches are more effective than others in usual settings of care. For example, the annual Medicare Current Beneficiary Survey asks aged and disabled Medicare beneficiaries living in the community and in institutions to answer questions about many aspects of their health and health care, including their health status and ability to function. These patient self-report data are often combined with Medicare claims and expenditure data to answer a variety of questions about Medicare-covered services (CMS, 2004), such as whether particular services improve beneficiaries’ functional status (Hadley et al., 2000) and what effects variations in Medicare spending have on the delivery of care and patient outcomes (Fisher et al., 2003). In addition, the analysis of administrative data and patient outcomes can be used to facilitate experimental research by identifying target population groups that are using therapies or medications of interest and have experienced either treatment failures, partial symptom abatement, or more complete recovery (Miller and Craig, 2002). In the Veterans Health Administration (VHA), linking outcome data on patients treated for posttraumatic stress disorder with administrative data showed that long-term, intensive inpatient treatment was not more effective than short-term treatment and cost $18,000 more per patient per year (Fontana and Rosenheck, 1997; Rosenheck and Fontana, 2001). In 1999, the VHA mandated that all mental health inpatients be rated at discharge using the GAF instrument, and that all outpatients be similarly rated at least once every 90 days during active treatment. The agency now includes GAF outcome measures in its National Mental Health Program Performance Monitoring System (Greenberg and Rosenheck, 2005) (see the discussion in Appendix C).



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