In September 2011, the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE), with support from the HHS National Institute of Mental Health (NIMH), contracted with Mathematica Policy Research and the National Committee for Quality Assurance (NCQA) to develop quality measures for treatment of adults with PTSD. The Veterans Affairs and Military Health System have already invested significant resources to improve the care of active and retired duty individuals with PTSD; ASPE and NIMH were interested in building upon this existing work to develop measures that could be used in civilian ambulatory treatment settings. The overall goal was to develop measures that could eventually be used to hold providers or organizations accountable for delivering high quality care; however, there was recognition that PTSD quality of care measures could also be used for training and education and by other researchers.
The first step in this 3.5-year project involved prioritizing important measure concepts. Identification of measure gaps and priorities was informed through an environmental scan and input from a technical advisory group (TAG). The process identified several potential measure concepts, including measures that screen for common co-occurring conditions, assess appropriate receipt of psychotherapy and pharmacotherapy, routinely assess and monitor PTSD symptoms, and measure patient outcomes. The measure concept "the delivery of evidence-based psychotherapy" was selected. We then identified common elements of psychotherapy for PTSD with support from a newly formed technical expert panel (TEP), developed measure specifications for a survey to assess the delivery of evidence-based psychotherapy for PTSD, and pre-tested the measure. The pre-testing involved quantitative data collection to examine the measure's preliminary psychometric properties and explore potential approaches to scoring, as well as qualitative data collection, including focus groups and site coordinator debriefings to gather information on the measure's feasibility, usefulness, and importance. Based on findings from the pre-testing, we recommended modifications to the measure specifications and additional testing of the measure to more fully understand its importance, scientific acceptability, usability, and feasibility as defined by the National Quality Forum (NQF).