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## Complete Summary

#### TITLE

Post-traumatic stress disorder (PTSD): percent of eligible patients
screened at required intervals for PTSD and if positive PC-PTSD result,
who have Suicide Ideation/Behavioral Evaluation completed within 24
hours.

#### SOURCE(S)

Office of Quality and Performance (10Q). FY 2008, Q1 technical manual
for the VHA performance measurement system. Washington (DC): Washington
(DC); 2007 Oct 31. 315 p.

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percent of eligible patients screened
at required intervals for post-traumatic stress disorder (PTSD) and if
positive primary care PTSD (PC-PTSD) result, who have Suicide
Ideation/Behavioral Evaluation completed within 24 hours.

#### RATIONALE

A positive response to the primary care post-traumatic stress disorder
(PC-PTSD) screen does not necessarily indicate that a patient has
post-traumatic stress disorder. However, a positive response does
indicate that a patient may have PTSD or trauma-related problems and
further investigation of trauma symptoms by a mental-health professional
may be warranted. Those screening positive with the PC-PTSD 4 item
screen should then be assessed as part of a structured interview for
PTSD. The PTSD 17-item Checklist (PCL) may aid in this assessment and
**is optional**. This strategy increases a provider\'s ability to detect
PTSD and to initiate appropriate referral.

Patients who screen positive for PTSD should be explicitly screened for
suicidal ideation as well. Prompt assessment of potentially suicidal
patients by individual clinicians is imperative and requires knowledge
of the following: risk factors for suicide, skill in establishing a
rapport with an extremely distressed patient, and clinical experience in
assessing the degree of risk. After an evaluation of screening results
and a discussion with the patient, the provider can decide whether the
patient may benefit from further specialized mental-health evaluations.
Patients with positive screens may be referred, depending on
availability, to specialized PTSD treatment, behavioral medicine, or
more general mental-health services for further evaluation and possible
treatment.

#### PRIMARY CLINICAL COMPONENT

Post-traumatic stress disorder (PTSD); suicide ideation; behavior
evaluation

#### DENOMINATOR DESCRIPTION

Patients from the NEXUS cohort screened at required intervals for
post-traumatic stress disorder (PTSD) and have item-wise recording of
item responses, total score, and positive result of the PTSD primary
care screen in the medical record (see the related \"Denominator
Inclusions/Exclusions\" field in the Complete Summary)

#### NUMERATOR DESCRIPTION

Patients screened at required intervals for post-traumatic stress
disorder (PTSD) and have item-wise recording of item responses, total
score, and positive result of the PTSD Primary Care Screen in the
medical record who have Suicide Ideation/Behavioral Evaluation completed
within 24 hours (see the related \"Numerator Inclusions/Exclusions\"
field in the Complete Summary)

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

-   One or more research studies published in a National Library of
    Medicine (NLM) indexed, peer-reviewed journal

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [Practice guideline for the assessment and treatment of patients
    with suicidal
    behaviors.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=4529)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Unspecified

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

External oversight/Veterans Health Administration\
Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Ambulatory Care\
Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Advanced Practice Nurses\
Physician Assistants\
Physicians\
Psychologists/Non-physician Behavioral Health Clinicians\
Social Workers

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Single Health Care Delivery Organizations

#### TARGET POPULATION AGE

Unspecified

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Living with Illness\
Staying Healthy

#### IOM DOMAIN

Effectiveness\
Timeliness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Patients from the NEXUS cohort\* screened at required intervals for
post-traumatic stress disorder (PTSD) and have item-wise recording of
item responses, total score, and positive result of the PTSD primary
care screen in the medical record

\*Refer to the original measure documentation for patient cohort
description.

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients from the NEXUS cohort screened at required intervals for
post-traumatic stress disorder (PTSD) and have item-wise recording of
item responses, total score, and positive\* result of the PTSD primary
care screen in the medical record

\**Positive PC-PTSD screening*: If 3 or 4 of the 4 questions are
answered in the affirmative, the score is deemed a positive score. Refer
to the original measure documentation for additional detail.

**Exclusions**\
Unspecified

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Diagnostic Evaluation\
Encounter

#### DENOMINATOR TIME WINDOW

Time window precedes index event

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients screened at required intervals for post-traumatic stress
disorder (PTSD) and have item-wise recording of item responses, total
score, and positive result of the PTSD Primary Care Screen in the
medical record who have Suicide Ideation/Behavioral Evaluation\*
completed within 24 hours

\***Note**:

-   *Suicidal Ideation/Behavior Evaluation*: This evaluation requires
    knowledge of the following: risk factors for suicide, skill in
    establishing a rapport with an extremely distressed patient, and
    clinical experience in assessing the degree of risk. There is no
    standardized tool required for this evaluation. However, the
    provider must document an evaluation of the patient\'s suicide risk
    by assessing the patient\'s subjective experience (ideation, wish,
    plan, and intent) and behaviors (warning signs). Determination of
    ideations and behaviors can be assessed using guidance/tool (refer
    to Pocket Card Content in original measure documentation) developed
    by the Veterans Health Administration (VHA) Clinical Guidelines
    group which is consistent with the American Psychiatric Association
    Practice Guideline for the Assessment and Treatment of Patients with
    Suicidal Behaviors.

-   Suicide ideation/behavior evaluation when required is best done
    immediately upon completion of screening, as part of a seamless
    process. Completion within 24 hours is desired but for measurement
    purposes completion by the end of the next calendar day will be
    accepted.

Refer to the original measure documentation for additional details.

**Exclusions**\
Unspecified

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Fixed time period

#### DATA SOURCE

Administrative data\
Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Primary Care Post-traumatic Stress Disorder (PC-PTSD) Screen

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Prescriptive standard

#### PRESCRIPTIVE STANDARD

Fiscal Year (FY) 2008 targets for suicide ideation/behavioral evaluation
for patients screened for post-traumatic stress disorder (PTSD) (NEXUS
Clinics):

-   Facility Floor: ??

-   Meets Target: ??

-   Exceeds Target: ??

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Suicide ideation/behavioral evaluation after positive PC-PTSD screen.

#### MEASURE COLLECTION

[Fiscal Year (FY) 2008: Veterans Health Administration (VHA) Performance
Measurement
System](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=3&doc=10202)

#### MEASURE SET NAME

[Mission Critical
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=3&doc=12145)

#### MEASURE SUBSET NAME

[Appropriate
Screening](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=3&doc=9224)

#### DEVELOPER

Veterans Health Administration

#### FUNDING SOURCE(S)

Unspecified

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

Unspecified

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

Unspecified

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2007 Oct

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

Office of Quality and Performance (10Q). FY 2008, Q1 technical manual
for the VHA performance measurement system. Washington (DC): Washington
(DC); 2007 Oct 31. 315 p.

#### MEASURE AVAILABILITY

The individual measure, \"Suicide Ideation/Behavior Evaluation After
Positive PC-PTSD Screen,\" is published in \"FY 2008 VHA Performance
Measurement System: Technical Manual.\"

For more information contact:

Department of Veterans Affairs\
Office of Quality and Performance (10Q)\
ATTN: Lynnette Nilan, E-mail: <lynnette.nilan@va.gov> or\
Tammy Czarnecki, E-mail: <tammy.czarnecki2@va.gov>

#### NQMC STATUS

This NQMC summary was completed by ECRI Institute on May 9, 2008. The
information was not verified by the measure developer.

#### COPYRIGHT STATEMENT

No copyright restrictions apply.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008