2020 MBHR Measure: Posttraumatic Stress Disorder (PTSD) Screening and Outcome Assessment

QCDR Name: MBHR Mental and Behavioral Health Registry

Measure Title Posttraumatic Stress Disorder (PTSD) Screening and Outcome Assessment
NQS Domain Effective Clinical Care
Measure ID MBHR7
Measure Type Patient Reported Outcome (PRO)
High Priority? Yes
Description The percentage of patients with a history of a traumatic event (i.e., an experience that was unusually or especially frightening, horrible, or traumatic) who report symptoms consistent with PTSD for at least one month following the traumatic event AND with documentation of a standardized symptom monitor (PCL-5 for adults, CATS for child/adolescent) AND demonstrated a response to treatment at three months (+/- 60 days) after the index visit.

This measure is a multi-strata measure, which addresses symptom monitoring for both child and adult patients being treated for post-traumatic stress symptoms. Assessment instruments monitoring severity of symptoms for PTSD are validated either for adult or child populations. Thus, while the measurement structure will be similar for both populations, the specified instruments for symptom monitoring will be different.

Denominator Adult patients (18 years of age or older) with one of the PTSD related diagnoses (see Diagnostic list) and a validated symptom measure (PCL-5) for PTSD at the index visit.

Child/adolescent patients (7-17 years of age) with one of the PTSD related diagnoses (see Diagnostic list) and a validated symptom measure (CATS) for PTSD at the index visit.

Denominator Exclusion Death
Denominator Exception Patient refuses to participate or is unable to complete the questionnaire.
Numerator The number of patients in the denominator who demonstrated a response to treatment, using the identified validated PTSD self-report symptom monitor for the patient’s age group with a demonstrated change score indicating improvement.

For adults (age 18 and older), the instrument is the PCL-5, and a score reflecting symptom improvement is decrease of 5 or more on the total score from baseline administration, or a total score below 33.

For children and adolescents, age 7-17, a CATS, score decrease of 12 or more in the total score OR going below a total score of 15 on the follow-up administration.

Data Source Claims, EHR, Paper Medical Record, Registry
Meaningful Measure Area Prevention, Treatment, and Management of Mental Health
Meaningful Measure Rationale Screening for PTSD in children, adolescents, and adults will promote interventions and best practices that are effective at reducing symptoms and improve functional status and quality of life by identifying and addressing appropriate treatment needs. This provides a standardized way to communicate status which will improve both quality of treatment and efficient use of resources
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

PTSD is a disorder that may develop in response to high magnitude stressors such as natural disasters, serious accidents, critical medical conditions, sexual assault, violence, war, and terrorism (American Psychiatric Association [APA], 2000; Institute of Medicine, 2006; World Health Organization [WHO], 2004). Symptoms of PTSD include re-experiencing of the traumatic event, often in the form of intrusive memories, nightmares or flashbacks; avoidance; hyperarousal and hypervigilance, to include difficulty with sleep, concentration, and anger problems; negative alterations in mood and thinking, emotional numbing, dissociation, emotional dysregulation, interpersonal difficulties or problems in relationships, and negative self-perception (APA, 2000, NICE, 2018).

Symptoms can be enduring and patients with unrecognized PTSD are often treated in clinical practice for a variety of other mental and physical health problems (Keane, Weathers, & Foa, 2000). PTSD is a growing public health burden that brings a significant economic cost (Kessler, 2000; WHO, 2004).

Many patients with PTSD experience persistent impairment in critical life domains, such as work or school performance, social and family relationships, and lessened quality of life. (Schnurr, Lunney, Bovin, & Marx, 2009).

A number of psychological and medication based interventions have demonstrated effectiveness in treating PTSD; thus evaluating outcomes of treatment is critical to ensuring the most effective treatment approach is being utilized.