2019 MBHR Measure: Anxiety Response at 6-months

QCDR Name: MBHR Mental and Behavioral Health Registry

Measure Title Anxiety Response at 6-months
NQS Domain Effective Clinical Care
Measure ID MBHR2
NQF ID N/A
Measure Type Patient Reported Outcome (PRO)
High Priority? Yes
Description The percentage of adult patients (18 years of age or older) with an anxiety disorder (generalized anxiety disorder, social anxiety disorder, post-traumatic stress disorder, or panic disorder) who demonstrated a response to treatment at six months (+/- 60 days) after an index visit
Denominator Adult patients (18 years of age or older) with an anxiety disorder (generalized anxiety disorder, social anxiety disorder, post-traumatic stress disorder, or panic disorder) and an initial (index) GAD-7 score of 8 or higher.

Denominator Exclusions: Patients who die, are a permanent resident of a nursing home or are enrolled in hospice are excluded from this measure. Additionally, patients who have a diagnosis of schizophrenia or psychotic disorder.

Denominator Exceptions: None

Numerator The number of patients in the denominator who demonstrated a response to treatment, with a GAD-7 result that is reduced by 25% or greater from the index GAD-7 score, six months (+/- 60 days) after an index visit

Numerator Exclusions: None

Data Source Claims, EHR, Paper Medical Record, Registry
Meaningful Measure Area Prevention, Treatment, and Management of Mental Health
Meaningful Measure Rationale Measuring anxiety response in treatment will promote interventions and best practices that are effective at reducing symptoms and improve functional status and quality of life.
Inverse Measure? No
Proportional Measure? Yes
Continuous Variable Measure? No
Ratio Measure No
Number of Performance Rates 1
Risk Adjusted Yes
Preferred Specialty mental and behavioral health
Applicable Specialties Family Practice, Internal Medicine, Geriatric Medicine, Psychiatry, Behavioral Health

Measure Justification

Anxiety disorders are highly prevalent mental health problems, affecting approximately 18% of the adult population in the United States1. Although as common as depression, anxiety disorders have received less attention, leading to under-detection and lack of treatment, particularly in primary care settings2. Anxiety disorders can be disabling, having a substantial impact on patient functioning, work productivity, and health care utilization3. Moreover, anxiety disorders cost the United States an estimated $42 billion dollars per year4. Accordingly, a need to assess for anxiety symptoms rapidly in diverse treatment settings is essential to address the mental health needs of the public.

While originally developed to screen for generalized anxiety disorder, the GAD-7 is likely better characterized as an assessment of anxiety disorders generally rather than one of generalized anxiety disorder in particular. Studies have found that the GAD-7 is good at screening for panic disorder, social anxiety disorder and post-traumatic stress disorder3. Based on large and diverse sample (N=5223), a cut-off score of 8 was recommended for sensitivity to anxiety disorder diagnoses in general and generalized anxiety disorder5.

The psychometric properties of the GAD-7 have been examined in several different populations. Multiple studies have established internal consistency for the GAD-76,7,8, including finding that alpha reliability was consistent across all four diagnostic categories (generalized anxiety disorder, posttraumatic stress disorder, social anxiety disorder, and panic disorder)9. Good convergent validity with measures of depression, anxiety, general stress, and worry has also been established6,7,9,10.

The GAD-7 has also been found to be sensitive to treatment effects9. Specifically, as scores on the GAD-7 improved, there was lower severity observed for depression and anxiety, and improved well-being at posttreatment. Further, in a sample of N=1104, improvement on the GAD-7, regardless of diagnosis, was associated with improvements in depression scores after treatment specifically for either disorder or with a more general transdiagnostic treatment program11.

  1. Kessler, R.C., Chiu, W.T., Dernier, O., & Walters, E.E. (2005). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62, 617-627.
  2. Kessler, D., Lloyd, Lewis, G., & Gray, D. P. (1999). Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care. BMJ, 318, 436-439.
  3. Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O., & Lowe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, Comorbidity, and detection. Annals of Internal Medicine, 146, 317-325.
  4. Greenberg, P. E., Sisitsky, T., Kessler, R. C., Finkelstein, S.N., Berndt, E. R., Davidson, J. R., et al. (1999). The economic burden of anxiety disorders in the 1990s. Journal of Clinical Psychiatry, 60, 427-435.
  5. Plummer, F., Manea, L., Trapel, D., & McMillan, D. (2016). Screening for anxiety disorders with the GAD-7 and GAD-2: A systematic review and diagnostic metaanalysis. General Hospital Psychiatry, 39, 1-29.
  6. Ryan, T.A., Bailey, A., Fearon, P., & King, J. (2013). Factorial invariance of the Patient Health Questionnaire and Generalized Anxiety Disorder Questionnaire. British Journal of Clinical Psychology, 52, 438-449.
  7. Kertz, S., Bidga-Peyton, J., & Bjorgvinsson, T. (2013). Validity of the Generalized Anxiety Disorder-7 Scale in an acult psychiatric sample. Clinical Psychology & Psychotherapy, 20, 456-464.
  8. Schalet, B.D., Cook, K.F., Choi, S.W., & Cella, D. (2014). Establishing a common metric for self-reported anxiety: Linking the MASQ, PANAS, and GAD-7 to PROMIS Anxiety. Journal of Anxiety Disorders, 28, 88-96.
  9. Beard, C., & Bjorgvinnson, T. (2014). Beyond generalized anxiety disorder: Psychometric properties of the GAD-7 in a heterogeneous psychiatric sample. Journal of Anxiety Disorders, 28, 547-552.
  10. Rutter, L.A., & Brown, T.A. (2017). Psychometric properties of the Generalized Anxiety Disorder Scale-7 (GAD-7) in outpatients with anxiety and mood disorders. Journal of Psychopathology and Behavioral Assessment, 39, 140-146.
  11. Newby, J.M., Mewton, L., & Andrews, G. (2017). Transdiagnostic versus disorder-specific internet-delivered cognitive behaviour therapy for anxiety and depression in primary care. Journal of Anxiety Disorders, 46, 25-34.