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## Complete Summary

#### TITLE

Mental health: percent of eligible patients screened at required
intervals for PTSD.

#### 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 regular intervals for post-traumatic stress disorder (PTSD).

#### RATIONALE

The Veterans Administration (VA) requires regular screening for
post-traumatic stress disorder (PTSD) because PTSD is the mental health
disorder most commonly associated with combat and is central to VA\'s
mission. Screening for PTSD is the first and most essential step in
identifying and engaging Veterans with PTSD. Given the challenge of a
new generation of combat Veterans of OEF/OIF, it is crucially important
that VA be proactive in identifying new PTSD early and intervening early
in order to prevent chronic PTSD and its complicating disorders and
functional problems whenever possible. These include major depression,
suicidality, substance abuse, family violence and homelessness. It is of
the utmost importance for VA to be able to identify individual patients
with PTSD for treatment purposes and to track aggregate populations for
planning purposes. It is equally important to know the prevalence of
PTSD among veterans of previous deployments, among veterans affected by
local, regional or national disasters or terrorist attacks, and among
veterans with history of Military Sexual Trauma who have developed PTSD
so that we can meet the real needs of the veteran population.

The Primary Care PTSD Screen (PC-PTSD) is the required standardized PTSD
tool given its selection for general use in the *Joint VA/DoD Clinical
Practice Guideline for PTSD*. In addition, the PC-PTSD was incorporated
into DoD\'s Post Deployment Screening Tool (DD Form 2796, April 2003),
which is administered to every deployed service man and woman. Developed
by the National Center for PTSD, it was designed for use in primary care
and other medical settings. The PC-PTSD is brief and problem-focused.
The screen does not include a list of potentially traumatic events.
There are two reasons for this: (1) studies on trauma and health in both
male and female patients suggest that the active mechanism linking
trauma and physical health is the diagnosis of PTSD. In other words, the
relationship between trauma and health appears to be mediated through a
current PTSD diagnosis; (2) a symptom-driven screen, rather than a
trauma-focused screen, is attractive to primary care staff who may not
be able to address a patient\'s entire trauma history during their visit
with the patient. Such a trauma inquiry might be especially problematic
with a VA population where the average number of traumatic events
meeting criterion A for PTSD is over four.

#### PRIMARY CLINICAL COMPONENT

Mental health; post-traumatic stress disorder (PTSD); screening; Primary
Care PTSD Screen (PC-PTSD)

#### DENOMINATOR DESCRIPTION

Patients from the NEXUS Clinic cohort eligible for post-traumatic stress
disorder (PTSD) screening (see the related \"Denominator
Inclusions/Exclusions\" field in the Complete Summary)

#### NUMERATOR DESCRIPTION

Patients screened at required intervals for post-traumatic stress
disorder (PTSD) with item-wise recording of item responses, total score,
and positive or negative result of the PTSD Primary Care Screen in the
medical record (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

-   [VA/DoD clinical practice guideline for the management of
    post-traumatic
    stress.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=5187)

### 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\
Behavioral Health Care

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

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

#### 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

Getting Better\
Staying Healthy

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Patients from the NEXUS Clinic cohort\*

\*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 Clinic cohort\* eligible for post-traumatic
stress disorder (PTSD) screening\*\*

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

\*\**Patient eligible for PTSD screening if they are both*:

-   Patients in the NEXUS cohort minus PTSD exclusions\
    AND

-   Patients whose screen is due after October 1, 2007.

**Exclusions**\
Patients are excluded:

-   Recognized diagnosis of PTSD in the past 12 months as evidenced by
    at least one clinical encounter where PTSD was identified as the
    primary or secondary reason for the encounter. ICD9-CM code 309.81
    will be used to identify PTSD encounters.\
    **OR**

-   With documented moderate or severe cognitive impairment. Documented
    cognitive impairment can be established by:

    -   Screening using a standardized tool validated as identifying
        cognitive impairment with provider administration of the exam,
        the score, and interpretation of the score recorded in the
        medical record:

        -   If the Blessed Orientation-Memory-Concentration test (BOMC)
            is used, a score of greater than 10 is required to establish
            moderate or severe cognitive impairment.

        -   If the Mini-Mental State Exam (MMSE) test is used, a score
            of 17 or less is required to establish moderate or severe
            cognitive impairment.

> If the Blessed Information-Memory-Concentration (BIMC) test is used, a
> score of 14 or greater is required to establish moderate or severe
> cognitive impairment.
>
> **OR**

-   Provider documentation that the patient is moderately impaired or
    severely impaired or chronically severely impaired or too
    cognitively impaired to participate in screening.

Refer to the original measure documentation for additional details.

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

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

#### DENOMINATOR (INDEX) EVENT 

Encounter

#### DENOMINATOR TIME WINDOW

Time window precedes index event

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients screened at required intervals for post-traumatic stress
disorder (PTSD) with item-wise recording of item responses, total score,
and positive or negative result of the PTSD Primary Care Screen in the
medical record\*

\***Note**:

-   *Screened at regular intervals*: Screening must be accomplished
    annually for the first five years after most recent date of service
    separation and then every five years after the first five years. If
    the service separation date cannot be established, annual screening
    will be required.

-   *Date of service separation*: Most recent date of separation from
    active military duty. If the veteran has more than one tour of duty,
    the most recent date is used.

-   *Acceptable screening for PTSD*: For the patient to be considered
    \"screened\", PTSD screening must be accomplished using the standard
    four-question Primary Care PTSD Screen with item-wise recording of
    responses to all four questions, summary score, and
    positive/negative results must be recorded in the medical record.

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

Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

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

-   Blessed Orientation-Memory-Concentration test (BOMC)

-   Mini-Mental State Exam (MMSE)

-   Blessed Information-Memory-Concentration (BIMC)

### 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

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

PTSD screening with PC-PTSD.

#### 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

2006 Oct

#### REVISION 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, \"PTSD Screening With PC-PTSD,\" 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 March 7, 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