Strategies for Measuring the Quality of Psychotherapy: A White Paper to Inform Measure Development and Implementation. V. Process Measures


Process measures assess whether individuals receive care or treatments that have evidence of improving outcomes. In mental health, several process measures address the management and continuity of effective medications (for example, the management of antidepressants and the continuous use of antipsychotic medications for schizophrenia). These measures are used in federal, state, and private sector reporting programs. In contrast, process measures that assess the delivery of psychotherapy have not been widely adopted. The measures listed below could, however, be adapted from existing measures:

  • Receipt of evidence-based psychotherapy for specific indications (CBT for depression, anxiety, or PTSD, for example).

  • Completion of recommended course of psychotherapy (based on completing encounters focused on specific content).

  • Continuity of psychotherapy (based on number of visits over a given period for individuals for whom ongoing psychotherapy has been recommended).

  • Consumer-reported or provider-reported content of psychotherapy.

Measures assessing the receipt of evidence-based psychotherapy would require information on diagnoses, severity of illness, and treatment history; consumer preferences for treatment; and the number, timing, and content of visits or sessions. Potential data sources for this information include claims, medical records (including EHRs or other health information technology), and surveys of consumers or providers. As explained below, each data source and type of measure has various strengths and limitations.

There may also be value in constructing measures that track the accessibility or encounters with the mental health care system but do not have evidence to support the impact of these services on outcomes. These "related health care delivery measures," as they are termed by the National Quality Measures Clearinghouse, include measures of service use and costs. For example, this might include measures of psychotherapy visits that did not specify the content of the visit or how it was appropriately targeted to a specific need of an individual. Our focus in this paper is on quality measures that can assess services with evidence of benefit on outcomes.


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