2021 MBHR Measure: Social Role Functioning Outcome utilizing PROMIS

QCDR Name: MBHR Mental and Behavioral Health Registry

Measure Title Social Role Functioning Outcome utilizing PROMIS
NQS Domain Effective Clinical Care
Measure ID MBHR4
Measure Type Patient Reported Outcome (PRO)
High Priority? Yes
Description The percentage of adult patients (18 years of age or older) with a mood or anxiety disorder who report concerns related to their psychosocial function and demonstrated a response to treatment six months (+/- 120 days) after the index visit. To see additional details, please view the workflow diagram for this measure: View diagram
Denominator Patients aged ≥ 18 years


Diagnosis for mood disorders (ICD-10-CM): F31.0, F31.1, F31.2, F31.3, F31.4, F31.5, F31.6, F31.7, F31.8, F31.9, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.8, F32.9, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.42, F33.8, F33.9, F34.0, F34.1, F34.8, F34.9


Diagnosis for anxiety disorders: F40.1 Social phobias; F40.10 Social phobia, unspecified; F40.11 Social phobia, generalized; F41.0 Panic disorder without agoraphobia; F41.1 Generalized anxiety disorder; F41.3 other mixed anxiety disorders; F41.8 other specified anxiety disorders; F41.9 anxiety disorder unspecified; F43.1 Post-traumatic stress disorder (PTSD); F43.10 Post-traumatic stress disorder, unspecified; F43.11 Post-traumatic stress disorder, acute; F43.12 Post-traumatic stress disorder, chronic


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


Index Event Date: Assessment utilizing the PROMIS adult Ability to Participate in Social Roles and Activities scale with a T-score of 40 or less documented during the twelve-month denominator identification period


Denominator Exceptions:

• 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)

Denominator Exclusions • Patients who die OR
• Are enrolled in hospice in the measurement year OR
• Are unable to complete the PROMIS adult Ability to Participate in Social Roles and Activities 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
Numerator The number of patients in the denominator who demonstrated a response to treatment, with a PROMIS adult Ability to Participate in Social Roles and Activities T score increase of 5 or greater from the index score, six months (+/- 120 days) after the index visit.

Numerator Exclusions: None

Data Source Claims, EHR, Paper Medical Record, Registry
Meaningful Measure Area Functional Outcomes
Meaningful Measure Rationale The PROMIS adult Ability to Participate in Social Roles and Activities item bank is a patient-reported outcome measure developed by NIH used to assess the perceived ability to perform one’s usual social roles and activities, and overall functioning.
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, Physical Therapy, Occupational Therapy, Neurology, Anesthesiology, Endocrinology, Hematology & Oncology, Neurology, Rehabilitation Medicine
Care Settings Ambulatory Care: Hospital; Inpatient; Rehabilitation Facility; Nursing Home; Outpatient Services; Long Term Care

Measure Justification

The World Health Organization has defined health as “a state of physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1948). While the importance of social support to overall health outcomes has been well established (Broadhead et al., 1983; Bruhn & Philips, 1984; McDowell, 2006; Mitchell, Billings, & Moos, 1982), social health has been a domain that historically has lacked agreed definitions and measures for clinical populations (Hahn, Cella, Bode, & Hanrahan, 2010). Few measures have been developed that effectively measure outcomes across clinical disorders, or that focus on individual, non-clinical factors influencing outcomes (McQuaid, Marx, Rosen, Bufka, Tenhula, Cook & Keane, 2012)

Transdiagnostic measures – that is measures that are intended to be relevant to any patient regardless of mental health diagnosis or setting – represent an important avenue for assessing quality of care beyond simply diagnostic remission. One such measure is functional impairment, which typically refers to the loss of individual’s ability to function on multiple levels (i.e., physical, cognitive, occupational, social) as a result of injury or illness, and can result in enormous monetary costs for both individuals (e.g., being out of work) and society (e.g., national disability benefit programs) (Mueller et al., 2017). Functional impairment is a complex, multifaceted construct, making measurement challenging. It plays a significant role in health care quality and outcomes (den Boer et al., 2006), yet has largely been overlooked within the current health care system (Mueller et al., 2017).

  • Hahn EA, Cella D, Bode RK, Hanrahan RT. Measuring Social Well-being in People with Chronic Illness. Social Indicators Research. 2010;96(3):381–401.
  • Broadhead WE, Kaplan BH, James SA, Wagner EH, Schoenbach VJ, Grimson R, Heyden S, Tibblin G, Gehlbach SH. The epidemiologic evidence for a relationship between social support and health. Am J Epidemiol. 1983 May; 117(5):521-37.
  • Bode RK, Hahn EA, DeVellis R, Cella D. Measuring Participation: The Patient-Reported Outcomes Measurement Information System Experience. Archives Physical Medicine Rehabilitation. 2010; 90 (9 0): S60-S65.
  • McQuaid JR, Marx BP, Rosen MI, Bufka LF, Tenhula W, Cook H, Keane TM. Mental Health Assessment in Rehabilitation Research. Journal of Rehabilitation Research & Development. 2012; 49 (1)
  • Mueller, K., Konicki, D., Larson, P., Hudson, T. W., Yarborough, C., & the ACOEM Expert
  • Panel on Functional Outcomes. (2017). Advancing value-based medicine: Why integrating functional outcomes with clinical measures is critical to our health care future. Journal of Occupational and Environmental Medicine, 59, e57-e62.
  • den Boer, J. J., Oostendorp, R. A., Beems, T., Munneke, M., Oerlemans, M., & Evers, A. W. (2006).

Clinical Recommendation Statement

The World Health Organization (WHO) [1] developed a framework for health and disability in part based on the findings that studies show that diagnosis alone does not predict service needs, length of hospitalization, level of care or functional outcomes. Nor is the presence of a disease or disorder an accurate predictor of receipt of disability benefits, work performance, return to work potential, or likelihood of social integration. Therefore, it is critical to go beyond the use of medical classification of diagnoses alone for health planning and management purposes. There is a lack of data about levels of functioning and disability, including the overall health of populations, the prevalence and incidence of non-fatal health outcomes, and the health care needs and the performance and effectiveness of health care systems, resulting in a need for reliable and comparable data on the health of individuals and populations. [1]

Further, many have argued for promoting the assessment of role functioning in daily clinical practice for both medical [2] and mental health conditions [3], and for including it as an important treatment outcome within clinical practice guidelines for various psychosocial treatments. [4] Yet there appears to be a disconnect between research and practice. For example, APA’s PTSD Clinical Practice Guideline found that important “patient-centered” outcomes, such as quality of life and functional impairment were infrequently studied or reported. They recommended that future investigations might include remission or loss of diagnosis as a critical outcome and also systematically evaluate patient-centered outcomes such as functionality and life quality. [4] But in order for this to happen, these measures need to be included in value-based payment models.

What guidelines do exist are from other countries (i.e., Australia) and are not focused specifically on health care. For example, The Impairment Assessment Guidelines (the Guidelines) were published under subsection 22(3) of the Return to Work Act 2014 (the Act) for the purpose of assessing the degree of whole person impairment arising from a work injury.

1. World Health Organization. (2002). Towards a common language for functioning, disability, and health: ICF. WHO: Geneva.
2. Gamper et al. Development of an item bank for the EORTC Role Functioning Computer Adaptive Test (EORTC RF-CAT). Health and Quality of Life Outcomes (2016) 14:72
3. Barbara A. Cornblatt, Andrea M. Auther, Tara Niendam, Christopher W. Smith, Jamie Zinberg, Carrie E. Bearden, and Tyrone D. Cannon. Preliminary Findings for Two New Measures of Social and Role Functioning in the Prodromal Phase of Schizophrenia. Schizophrenia Bulletin vol. 33 no. 3 pp. 688–702, 2007 doi:10.1093/schbul/sbm029
4. American Psychological Association, Guideline Development Panel for the Treatment of PTSD in Adults. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. Retrieved from http://www.apa.org/ptsd-guideline/ptsd.pdf