Development of a Quality Measure for Adults with Post-Traumatic Stress Disorder. I. PROJECT RATIONALE


Post-traumatic stress disorder (PTSD) is a mental health disorder that sometimes results when individuals are directly or indirectly exposed to actual or threat of death, serious injury, or sexual violence (American Psychiatric Association 2013). An estimated 6.8 percent of the United States population has PTSD, with women estimated to have higher prevalence than men (9.7 percent for women versus 3.6 percent for men) (Kessler et al. 2005a; Kessler et al. 2005b) and veterans having a higher prevalence than the general population (7-20 percent for veterans of the recent wars, and estimates of about 30 percent for all veterans of the Vietnam War) (VA National Center for PTSD 2007, 2014).

Most people who experience traumatic events have a brief adjustment period during which they successfully cope with the experience. For others, symptoms worsen over time and last for months or years, disrupting their ability to function in everyday life. The cost of PTSD care can be significant. Studies have found that individuals with PTSD have increased health care service utilization, as measured by number of physical and mental health appointments and hospitalizations (Tuerk et al. 2012). The prevalence of PTSD among women with public insurance is over three times as high as for women with private insurance (Seng et al. 2009). Given the relatively higher risk of exposure to violence among people with low income, the need for effective PTSD treatment among Medicaid recipients is likely to be sizeable.

In recent years, increased national attention has led to an improvement in the types and effectiveness of treatments for individuals diagnosed with PTSD. Particularly promising are a number of psychotherapy treatment approaches -- for example, exposure therapy and cognitive processing therapy (CPT) -- that have demonstrated slightly to significantly better treatment outcome for those diagnosed with PTSD, such as reduction of symptoms and improved mental health.[1] Despite advances in the development of evidence-based treatment for adults with PTSD, the implementation of these treatments varies widely (Mellman et al. 2003), overall recovery rates remain low, and large disparities exist in the type and quality of mental health treatment across providers, patient populations, types of disorders, and even geographic regions. To enhance accountability, improve quality, and increase transparency for treatment of individuals with PTSD, the creation of quality measures is a first essential step. Well-constructed measures of evidence-based treatments could be used not only for overall quality improvement and monitoring purposes, but also for training and education and to determine the comparative effectiveness of treatments.