. "4 Strengthening the Evidence Base and Quality Improvement Infrastructure." Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. Washington, DC: The National Academies Press, 2006.
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Improving the Quality of Health Care for Mental and Substance-Use Conditions
quality measurement and reporting infrastructure, but with some redundancy and gaps in the measures, measurement functions, and entities whose performance is being measured, and without a coordinated approach that maximizes the efficiency and effectives of the various efforts. What is needed is one or more infrastructures that perform these seven functions for the four different levels of health care delivery: (1) individual clinicians or groups of clinicians; (2) health care organizations, such as inpatient facilities; (3) health plans; and (4) public health systems (national, state, and local). Below we discuss for each of the seven functions special issues related to the delivery of M/SU health care that should influence the implementation of that function and the development of a quality measurement and reporting infrastructure for M/SU health care.
Conceptualizing the Aspects of Care to Be Measured
Because of the large number of existing process and outcome quality indicators and measures, the multiple populations of interest (e.g., children; older adults; individuals with less-frequent but severe and chronic mental illnesses, such as schizophrenia; and inpatients), the different units of analysis (clinicians; inpatient and outpatient organizations; health plans; and local, state, and national systems), and the importance of not overburdening the clinicians and organizations that will produce the measures, a framework is needed for identifying a finite number (often termed a “core” set) of valid, reliable, effective, and efficient measures that can best serve the multiple interested parties and purposes. The best-documented example of such a framework is that of the Strategic Framework Board, which designed a National Quality Measurement and Reporting System (NQMRS) for U.S. health care overall to guide such efforts as those of the National Quality Forum (McGlynn, 2003).
Within M/SU health care, multiple organizations and initiatives also have put forth frameworks or core measure sets, using different approaches to identify aspects of care delivery to be measured and select measures of the structures, processes, and outcomes of M/SU care. These initiatives include the Forum on Performance Measures in Behavioral Health and Related Service Systems (Teague et al., 2004), the Mental Health Statistics Improvement Program Quality Report (Ganju et al., 2004), the Center for Quality Assessment and Improvement in Mental Health (Hermann and Palmer, 2002; Hermann et al., 2004), the Behavioral Healthcare Performance Measurement System for inpatient care of the NRI, the Outcomes Roundtable for Children and Families (Doucette, 2003), and the Washington Circle Group (McCorry et al., 2000) (all of which are convened and/or funded by SAMHSA), as well as the previous efforts of the American College of Mental Health Administrators Accreditation Workgroup (ACMHA,