Research Brief
Supporting Readiness: Assessing and Improving the Quality of Care for Service Members with PTSD and Depression
Aug 7, 2017
Final Report
Does not include Appendixes
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The U.S. Department of Defense (DoD) strives to maintain a physically and psychologically healthy, mission-ready force, and the care provided by the Military Health System (MHS) is critical to meeting this goal. Attention has been directed to ensuring the quality and availability of programs and services for posttraumatic stress disorder (PTSD) and depression. This report is a comprehensive assessment of the quality of care delivered by the MHS in 2013–2014 for over 38,000 active-component service members with PTSD or depression. The assessment includes performance on 30 quality measures to evaluate the receipt of recommended assessments and treatments. These measures draw on multiple data sources including administrative encounter data, medical record review data, and patient self-reported outcome monitoring data. The assessment identified strengths and areas for improvement for the MHS. In particular, the MHS excels at screening for suicide risk and substance use, but rates of appropriate follow-up for service members with suicide risk are lower. Most service members received at least some psychotherapy, but less than half of psychotherapy delivered was evidence-based. In analyses focused on Army soldiers, outcome monitoring increased notably over time, yet preliminary analyses suggest that more work is needed to ensure that services are effective in reducing symptoms. When comparing performance between 2012–2013 and 2013–2014, most measures demonstrated slight improvement, but targeted efforts will be needed to support further improvements. RAND provides recommendations for strategies to improve the quality of care delivered for these conditions.
Chapter One
Introduction
Chapter Two
Methods
Chapter Three
Characteristics of Service Members in PTSD and Depression Cohorts, and Their Care Settings and Treatments
Chapter Four
Quality of Care for PTSD
Chapter Five
Quality of Care for Depression
Chapter Six
Use of Symptom Questionnaires and Relationship Between Evidence-Based Care and Symptom Scores
Chapter Seven
Summary and Recommendations
This research was sponsored by the Department of Defense's Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.
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