Reports From the Field

Implementing the Quadruple Aim in Behavioral Health Care


 

References

Self-Reported Health and Well-Being. This CD asks patients to rate their current physical and mental health status, as well as their overall quality of life.

Brief review and suggested item(s): Self-rated physical health. Premature mortality among individuals with behavioral health issues appears to be due, in large part, to their increased vulnerability to the development of medical comorbidities.16,21 A single self-rating question has demonstrated considerable sensitivity to premature mortality,22,23 with predictive properties up to a decade prior to death.24,25 Further, self-rated health has been associated with subsequent functional decline,26,27 acute service utilization,28,29 and overall health care costs.28

Brief review and suggested item(s): Self-rated mental health. Mental health disorders are associated with significant disability worldwide,30 and comorbid mental health issues can exacerbate the course of other medical problems. For example, depression is associated with increased rates of mortality among individuals with diabetes and31 cardiovascular disease,32 as well as with rates of overall mortality,33 and psychiatric comorbidity is associated with longer lengths of stay and higher costs among patients hospitalized for medical problems.34 Research has found that a single-item measure of self-rated mental health is associated with the presence of psychiatric diagnoses, psychiatric symptoms, and subsequent depression and serious mental illness up to 1 year post-assessment.35,36 There is even evidence that self-rated mental health may be more strongly associated with self-ratings of overall health than self-ratings of physical health.37

Brief review and suggested item(s): Self-rated quality of life. Quality of life is a critical component of the recovery journey and overall health.38 For example, the County Health Rankings & Roadmaps lists “quality of life” as 1 of its key “health outcomes” in its County Health Rankings.13 As some authors have noted, quality of life is often inferred from other “objective” recovery domains, such as employment, health status, or housing status. However, there is evidence that these objective domains are functionally distinct from the inherently subjective construct of quality of life.39 This has led other authors to conclude that these domains should be assessed separately when evaluating outcomes.40 Single-item quality of life assessments have been used in research with individuals with cancer,41 adults with disabilities,42 patients with cystic fibrosis,43 and children with epilepsy.44 For this effort, BHD selected the first global quality of life item from the World Health Organization’s WHOQOL-BREF quality of life assessment,45 an item used in other quality of life research.46

Health Factors

Substance Use. This CD is a composite of 4 different types of substance use, any recent heavy alcohol use (defined as 5 or more drinks in one sitting), any recent drug use, any recent prescription drug abuse, and any recent tobacco use.

Pages

Recommended Reading

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AAP issues new guidelines for diagnosing, managing eating disorders
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Heavy drinking by teens may affect white-matter integrity
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HHS will drop buprenorphine waiver rule for most physicians
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Repeated ketamine infusions linked to rapid relief of PTSD
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National spike in methamphetamine overdose deaths
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