Quality Measurement and Patient Outcomes in Inpatient Behavioral Health: Assessing the Current Framework.

ABSTRACT: Quality measurement across healthcare is undertaken with a goal of improving care and outcomes for patients; however, the relationship between quality measurement and patient outcomes remains largely untested, particularly in inpatient behavioral health. Using a retrospective quantitative design, we assessed 142 behavioral health organizations' quality data submitted to the Hospital-Based Inpatient Psychiatric Services and Inpatient Psychiatric Facility Quality Reporting programs from 2017 to 2018 and tested relationships between compliance on 16 quality measures and symptom improvement on patient self-report outcomes (SROs) at the facility level. Performance on many quality measures was negatively skewed (at least four have almost no room for improvement on average), and there was high interrelatedness between most quality measures. Nine of the assessed measures correlated with patient SROs but not in clear groupings. Findings indicate that an underlying organizational construct may be driving compliance rates on quality measures, but the measures are not linked to treatment outcomes as expected. We encourage an expansion of the current framework of behavioral health quality measurement beyond process and organization and suggest the addition of patient outcomes such as SROs as quality measures to directly assess patient improvement.

Reliability and Validity of the Child and Adolescent Behavior Assessment (CABA): A Brief Structured Scale.

Use of valid, affordable, accessible, and brief measures facilitates the assessment of mental health outcomes. The Child and Adolescent Behavior Assessment Scale, a brief, structured scale, assesses problem behavior through patient and/or informant report. The purpose of this paper is to illustrate the scale's psychometric properties. In the cross-sectional study presented, a large national sample of youth (aged 5-18) admitted for psychiatric treatment (N = 32,689) was examined. The two major domains of problem behavior assessed were Internalizing and Externalizing. Reliability was good to excellent with alpha levels ranging from 0.874 to 0.917. Additional items measured Risk Behavior (α = 0.648). Subscale total scores correlated well with the Brief Psychiatric Rating Scale for Children, 9-item version (BPRS-C-9). Exploratory and confirmatory factor analyses supported the three-factor, multidimensional model of problem behavior as satisfactory for child and adolescent use, although further research is required to refine some items for clarity and improved model fit.