New Atlas Fills Need for Measuring Integrated Behavioral Health Care

As greater numbers of primary care organizations implement integrated behavioral health services, there is a growing need to measure the extent to which integrated behavioral health care is being provided. The 2013 Atlas of Integrated Behavioral Health Care Quality Measures helps primary care organizations and researchers identify and assess quality measures for integrating behavioral health care. It was developed by AHRQ’s Academy for Integrating Behavioral Health and Primary Care and features nine core measures that describe specific characteristics, actions, and selected outcomes of integrated care. All measures were chosen based on criteria established by a panel of experts. New measures will be added as they become available.

Atlas of Integrated Behavioral Health Care Quality Measures

Purpose

Integrated behavioral health care is an emerging field with the potential to improve health outcomes for patients and health care delivery within practices. Integrated behavioral health care can systematically enhance a primary care practice’s ability to effectively address behavioral health issues that naturally emerge in the primary care, prevent fragmentation between behavioral health and medical care, and create effective relationships with mental health specialists outside the primary care setting.
As greater numbers of primary care practices and health systems begin to design and implement integrated behavioral health services, there is a growing need for quality measures that are rigorous and appropriate to the specific characteristics of different approaches to integration.
The Atlas of Integrated Behavioral Health Care Quality Measures (the IBHC Measures Atlas) aims to support the field of integrated behavioral health care measurement by:

Presenting a framework for understanding measurement of integrated care;
Providing a list of existing measures relevant to integrated behavioral health care; and
Organizing the measures by the framework and by user goals to facilitate selection of measures.

Intended Audience

The IBHC Measures Atlas was developed for practices and teams that wish to understand if they are providing high-quality integrated behavioral health care or are preparing to implement integrated care. Individuals in clinical, administrative, accounting, policy, or patient advocacy roles may each find concepts and measures of interest in the IBHC Measures Atlas. Researchers and measurement experts can use the Atlas to identify appropriate measures for integration research and may find the IBHC Measures Atlas useful to identify where there are gaps in available measures and development efforts are needed.

Scope of the IBHC Measures Atlas

The IBHC Measures Atlas focuses on the components of integration (e.g., local care teams, coordinated workflows) that are within the influence of practices or teams. Broader health system changes that may impact integrated care, such as payment reform, are excluded from the IBHC Measures Atlas.
During this initial phase of IBHC Measures Atlas development, the scope of outcomes measures was limited to patient experience. Additional outcomes domains, such as provider experience, system experience, clinical outcomes, and financial outcomes, may be considered for inclusion in subsequent releases of the IBHC Measures Atlas and on the Academy website. Additional scope considerations for the search and selection of measures are described in the “Overview of Measures” section and the Methodological Details .

Quick Start Guide

Find a Measure: Users can search for measures by the name, functional domain (e.g., care team expertise, patient satisfaction), or measurement goal (e.g., build an integrated care team, improve quality).
What is Integrated Behavioral Health Care? The IBHC Measures Atlas is based on a consensus definition for integrated behavioral health care. The definition is presented with guidance on how to interpret the definition and a discussion of how integrated care fits into the broader landscape of high-quality, coordinated care, in general.
A Framework for Measuring Integration of Behavioral Health and Primary Care The Integration Framework adds further specificity to the definition of integrated behavioral health care. The framework includes functional domains and observable measurement constructs, which can guide the measurement of integrated behavioral health care.
Overview of Measures in the IBHC Measures Atlas This section describes the processes used to identify measures and map the measures to the Integration Framework.
Core Measures: Core measures align closely with the Integration Framework. Some of these measures (C2, C6-8) were designed specifically to assess integrated care, while others were designed to measure coordinated care in general and can be adapted to measure integrated care.
Additional Measures: These measures contain selected items that align with the Integration Framework. Measures in this category may have been designed for a specific population or condition or have only a few relevant items within a lengthy instrument.
Guide to Using the IBHC Measures Atlas This guide is designed to help users find measures that are applicable to their goals. The guide shows users how to locate measures in one of three ways: by searching for a specific measure, by matching to Integration Framework functional domains, or by using the “Guide Me to a Measure” tool.
Methodological Details Methodological Details describes the detailed methodology used in the environmental scan for measures and the process to map the measures to the Integration Framework.

About the Atlas

Prepared By

Neil Korsen, M.D., M.Sc.¹; Vasudha Narayanan, M.A., M.B.A., M.S.²; Lauren Mercincavage, M.H.S.²; Joshua Noda, M.P.P.²; C. J. Peek, Ph.D.³; Benjamin F. Miller, Psy.D.⁴; Jürgen Unützer, M.D., M.A., M.P.H.⁵; Garrett Moran, Ph.D.², Kitty Christensen, M.P.H.⁵

Acknowledgments

We thank Charlotte Mullican M.P.H., Agency for Healthcare Research and Quality, for her support, insightful comments, and guidance.
We thank members of our advisory panels and the National Integration Academy Council (NIAC) for sharing their time and expertise to improve this work: Macaran Baird⁶, Gale Bataille⁷, Alexander Blount⁸, Teresa Chapa⁹, Jennifer Clancy⁷, David deBronkart¹⁰, Frank Verloin deGruy⁴, Meena Dyak¹¹, Michael Hogan¹², Sherrie Kaplan¹³, Roger Kathol¹⁴, Parinda Khatri¹⁵, Elizabeth Lin¹⁶, Kathy McDonald¹⁷, Stephen Melek¹⁸, Cynthia Mulrow¹⁹, Kavita Patel²⁰, Leif Solberg²¹, and Steven Waldren²². We thank Shandra Brown Levey⁴ and Idalia Massa⁴ for their thoughtful review of the measures. We thank Kenneth Marshall⁵ and Diane Powers⁵ for their assistance with coordination, and we thank Elaine Swift²³ for her contributions to this work.
Affiliations
¹MaineHealth, Portland, ME
²Westat, Rockville, MD
³University of Minnesota Medical School, Minneapolis, MN
⁴University of Colorado Denver School of Medicine, Denver, CO
⁵University of Washington, Seattle, WA
⁶University of Minnesota Department of Family Medicine and Community Health, Minneapolis, MN
⁷California Institute for Mental Health, Sacramento, CA
⁸University of Massachusetts Medical School, Worcester, MA,
⁹US Department of Health and Human Services, Office of Minority Health, Rockville, MD
¹⁰ePatientDave.com, Nashua, NH
¹¹National Council for Community Behavioral Healthcare, Washington, DC
¹²Hogan Health Solutions LLC, Delmar, NY
¹³University of California Irvine School of Medicine, Irvine, CA
¹⁴Cartesian Solutions, Inc., Burnsville, MN
¹⁵Cherokee Health Systems, Knoxville, TN
¹⁶Group Health Research Institute, Seattle, WA
¹⁷Stanford University, Stanford, CA
¹⁸Milliman, Denver, CO
¹⁹The University of Texas Health Science Center at San Antonio, San Antonio, TX
²⁰Engelberg Center for Health Care Reform at the Brookings Institution, Washington, DC
²¹HealthPartners Research Foundation, Minneapolis, MN
²²American Academy of Family Physicians, Leawood, KS
²³NORC at the University of Chicago, Bethesda, MD

Internet Citation

Korsen N, Narayanan V, Mercincavage L, et al. Atlas of Integrated Behavioral Health Care Quality Measures. Agency for Healthcare Research and Quality, Rockville, MD. June 2013. AHRQ Publication No. 13-IP002-EF Available at: http://integrationacademy.ahrq.gov/atlas.