A framework for measuring quality and promoting accountability across silos: the case of mental disorders and co-occurring conditions.
BACKGROUND
Quality measures can be effective tools for improving delivery of care and patient outcomes. Co-occurring conditions (COCs), including general medical conditions and substance use disorders, are the rule rather than the exception in patients with serious mental health disorders and lead to substantial morbidity and mortality burden. COCs among persons with mental health disorders are often treated by separate systems ("silos") in the US healthcare system, making it difficult to establish expectations for performance, assign accountability for measure results and ultimately improve quality of care for this group.


OBJECTIVE
A framework for measuring quality of care for COCs is proposed by reviewing the current state of quality for COCs and examples of quality measures based on the Donabedian model.
The framework will also be applied to better define which providers are accountable for quality improvement, to ultimately ensure that quality measures have an impact on improving care for COCs.
Department of Psychiatry, VA Ann Arbor National Serious Mental Illness Treatment Research and Evaluation Center, University of Michigan School of Medicine, Ann Arbor, Michigan, USA. amykilbo@umich.edu
A M
AM
Kilbourne
C
C
Fullerton
D
D
Dausey
H A
HA
Pincus
R C
RC
Hermann
D015897:Comorbidity; D006801:Humans; D001523:Mental Disorders / Q000150:complications / Q000628:therapy*; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012941:Social Responsibility; D019966:Substance-Related Disorders / Q000150:complications / Q000628:therapy