NQF endorses new mental health measures

The National Quality Forum (NQF) has endorsed four outcome-based mental health measures looking at depression and patient satisfaction in an inpatient psychiatric hospital stay. The new measures are:

  • depression remission at six months (from Minnesota Community Measurement);
  • depression remission at 12 months (from Minnesota Community Measurement);
  • depression utilization of the Patient Health Questionnaire (PHQ-9) tool (from Minnesota Community Measurement);
  • Inpatient Consumer Survey (ICS) (from National Association of State Mental Health Program Directors Research Institute, Inc.).

Hospital Peer Review spoke with the president of Minnesota Community Measurement, Jim Chase, about the three measures adopted from the group. "What's new and exciting about this is that these are measures that aren't just about a process of — our depression measures in the past have been medicine-compliance, which is important. But, what patients really want is, are they getting better over time? And, we think that by measuring that, we can also help providers to improve the care because that's what their goal is as well," Chase says.

Three measures, he says, relate to a "standardized patient assessment tool" — the PHQ-9. One measure is merely using it.

"The second two measures are then what we call remission," he says. Have patients' conditions improved significantly over time? He says clinicians actually check this now at the six- and 12-month mark. They also check if the patient is continuing to be treated, and did his or her score improve. "This is a really challenging measure, obviously, because depression is a really difficult condition; not everybody comes back. But we know that it's important for them to do and to stress that end," he says.

As the move for standardized measures in mental health increases, Chase agrees it's a new territory. With psychiatry, so much is based on patient perception. There are no X-rays, definitive blood tests, yes or no results. But, he says, the tool has been validated and "while, for any given patient, you may get variation around that, when you're talking about larger populations, which this is really about, you're going to get some very good indication of how you're doing compared to peers," he says.

Another important change with the adoption of the measures is addressing not only things you can control but "what I want the outcome to be for the patient. Could this be used in the ED? "I think there's a future for that. This particular measure was really meant to be used around when you have a patient in a practice setting where you're going to see them again. And in the ED, they're probably trying to screen them and refer them to someplace else. So, yeah, you could see how we're trying to do this a step at a time, but there's certainly going to be a call for other settings of care where it's more about screening and we're going to use patient-functional status tools for that and getting them into treatment in a medical home that can follow up on them."