Research Brief
A Shared Definition of High-Quality Care Can Help Veterans Combat Invisible Wounds
Oct 22, 2020
Defining High-Quality Care for Posttraumatic Stress Disorder and Mild Traumatic Brain Injury
Proposed Definition and Next Steps for the Veteran Wellness Alliance
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Research Questions
- What does quality mean in the context of health care?
- What defines high-quality care for post-9/11 veterans with PTSD and TBI?
- What is required to monitor, implement, and disseminate standards for high-quality care?
Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) — sometimes referred to as "invisible wounds" — can have significant negative effects on veterans' mental and physical health, yet many veterans have difficulty accessing high-quality care for these conditions. The Veteran Wellness Alliance, an initiative of the George W. Bush Institute, is a coalition of veteran peer network and clinical provider organizations that aims to improve access to high-quality care for post-9/11 veterans, specifically those with PTSD and TBI. Although the Veteran Wellness Alliance and other veteran-serving organizations have a common goal to improve access to high-quality care for invisible wounds, there has been no shared definition of high-quality care to guide these improvement efforts. RAND researchers conducted a literature review and interviews with Veteran Wellness Alliance partner organizations to identify standards for high-quality care, develop an initial definition, and make recommendations for implementing, refining, and disseminating the definition and its associated metrics.
Establishing a clear standard for high-quality care will help the Veteran Wellness Alliance offer meaningful guidance to its clinical partners and peer networks and will guide the broader veteran-serving community in providing the highest level of support for post-9/11 veterans who are living with the effects of these conditions.
Key Findings
High-quality care for invisible wounds should be veteran-centered, accessible, and evidence-based, and it should include outcome monitoring
- Veteran-centered care requires cultural competence (and understanding of veteran experiences and identity), ongoing assessment of veterans' care experiences, shared decisionmaking between the veteran and provider, and family/caregiver involvement in care.
- Accessibility indicates that veterans can get the care they need in a timely manner and requires reducing geographic, financial, sociocultural, and other barriers to care.
- Evidence-based care incorporates treatments and practices that are backed by the best available research.
- Outcome monitoring involves using validated instruments to regularly assess veterans' clinical outcomes and changes to functioning, well-being, relationships, and life satisfaction.
Recommendations
- Continue to refine the definition of high-quality care for veterans with PTSD and TBI through ongoing research and by monitoring developments in the evidence base.
- Ensure that data needed to implement the definition of high-quality care — including data to monitor quality and track veteran outcomes — are available and feasible to collect.
- Develop an implementation plan for the definition that takes into account how partner organizations will use the proposed definition and associated quality measures.
- Develop a dissemination plan for the definition, promoting it throughout the veteran-serving community and setting the standard for high-quality care for PTSD and TBI.
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This research was funded by the George W. Bush Institute and carried out within the Quality Measurement and Improvement Program in RAND Health Care.
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