Cover: Defining High-Quality Care for Posttraumatic Stress Disorder and Mild Traumatic Brain Injury

Defining High-Quality Care for Posttraumatic Stress Disorder and Mild Traumatic Brain Injury

Proposed Definition and Next Steps for the Veteran Wellness Alliance

Published Oct 22, 2020

by Carrie M. Farmer, Lu Dong


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Research Questions

  1. What does quality mean in the context of health care?
  2. What defines high-quality care for post-9/11 veterans with PTSD and TBI?
  3. 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.


  • 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.

Research conducted by

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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