2021 MBHR Measure: Posttraumatic Stress Disorder (PTSD) Outcome Assessment for Adults and Children

QCDR Name: MBHR Mental and Behavioral Health Registry

Measure Title Posttraumatic Stress Disorder (PTSD) Outcome Assessment for Adults and Children
NQS Domain Effective Clinical Care
Measure ID MBHR7
NQF ID N/A
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 six months (+/- 120 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. To see additional details, please view the workflow diagram for this measure: View diagram

INCLUDES TELEHEALTH?  YES

Denominator 1. Adult patients (18 years of age or older) with one of the PTSD related diagnoses (see Diagnostic list)
2. Child/adolescent patients (7-17 years of age) with one of the PTSD related diagnoses (see Diagnostic list)
Denominator Criteria (Eligible cases):
Patients (identified as either in the adult category–aged 18 years or older OR child category–aged 7-17)ANDPatients self-reported symptoms for a duration of at least one month (adults patients) or two weeks (child patients) following a traumatic event indicated by:
Diagnosis for PTSD:
F43.10 PTSD, Unspecified
F43.11 PTSD, Acute
F43.12 PTSD, Chronic

AND

Patient encounter during the denominator identification period (CPT or HCPCS):
0362T, 0373T, 90785, 90791, 90792, 90832,90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90849, 90853, 90863, 90875, 90876, 96110, 96112, 96113, 96116, 96121, 96127, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146, 96156, 96158, 96159, 96164, 96165, 96167, 96170, 96171, 96178, 97129, 97130, 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 98966, 98967, 98968, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215,99354, 99355, 99406, 99407, 99408, 99409, 99446, 99447, 99448, 99449, 99484, 99492, 99493, 99494, G2011, G2061, G2062, G2063, G0396, G0397, G0402, G0438, G0439

AND

An Index Visit where the PTSD symptom assessment was completed with a PCL-5 score of 33 or more for an adult patient OR self-reported CATS 7-17 score of 15 or more for a child/adolescent patient.

Denominator Exclusion • Patients who die OR
• Are enrolled in hospice in the measurement year OR
• Are unable to complete the required assessment measure at follow-up due to cognitive deficit, visual deficit, motor deficit, language barrier, or low reading level, AND a suitable recorder (e.g., advocate) is not available
Denominator Exception • Ongoing care not indicated (e.g., referred to another provider or facility, consultation only) OR
• Patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) OR
• Medical reasons (e.g., scheduled for surgery or hospitalized)
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.

1. 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.
2. For children and adolescents, age 7-17, a CATS, score decrease of 12 or more in the total score OR a score <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 No
Preferred Specialty mental and behavioral health
Applicable Specialties Family Practice, Internal Medicine, Geriatric Medicine, Psychiatry, Behavioral Health
Care Settings Ambulatory Care: Hospital; Inpatient; Rehabilitation Facility; Nursing Home; Outpatient Services; Long Term Care

Clinical Recommendation Statement

Numerous organizations have issued guidelines for the assessment and treatment of Post-Traumatic Stress Disorder (VA/DoD Clinical Guidelines; American Psychological Association; International Society for Traumatic Stress Studies, NICE Guidelines). Exposure to trauma can lead to a variety of psychophysiological responses that can range from mild to completely debilitating. A number of co-morbidities, including substance use, depression, sleep dysfunction, family and relationship stress, anger, violence and self-harm are associated with PTSD. Structured psychological treatment has been demonstrated as being effective in treating symptoms associated with traumatic stress reactions, and a number of professional organization guidelines recommend use of these psychotherapies as well as medication-based treatments as being effective for PTSD.

Measure Rationale

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.