News Release

Quality measures don't match patient-reported outcomes in inpatient behavioral health

Peer-Reviewed Publication

Wolters Kluwer Health

November 10, 2021At psychiatric hospitals and other inpatient behavioral health facilities, good performance on routine quality measures does not necessarily lead to improvement in symptoms and other patient self-reported outcomes (SROs), reports a study in the November/December issue of the Journal for Healthcare Quality (JHQ), the peer-reviewed journal of the National Association for Healthcare Quality (NAHQ). The journal is published in the Lippincott portfolio by Wolters Kluwer.

"[O]ur analyses suggest there is a gap in the data regarding the quality of patient experience and symptom improvement, with little supporting evidence that the current measures directly relate to such constructs," according to the research by Rachel B. Nowlin, MS, and colleagues of Mental Health Outcomes, LLC (MHO), in Lewisville, Texas. They believe that quality assessment in behavioral inpatient care "has room for increased value return" – particularly by adding SROs or other direct measures of patient improvement.

Researchers call for adding SROs to quality assessment in behavioral healthcare

Quality measurement is a major focus for healthcare organizations, with the idea that improving performance on routine care measures will lead to improved patient outcomes. Compared to medical and surgical care, behavioral healthcare has lagged in establishing evidence-based quality measures and quality improvement.

How well does the current quality measurement framework reflect patient outcomes in inpatient behavioral health settings? Ms. Nowlin and colleagues analyzed quality data submitted by 142 US psychiatric hospitals or departments to the Centers for Medicare and Medicaid Services and The Joint Commission. The 16 measures reflected assessment, screening, treatment, and transition steps considered to be important indicators of the quality of inpatient mental and behavioral healthcare.

Performance on quality measures was evaluated for association with improvement in SROs, reflecting outcomes reported by patients themselves. The study included widely used assessments of behavioral health functioning and depression symptoms, as well as assessments targeting children and adolescents and older adults.

Scores on most of the quality measures were closely interrelated with each other: facilities that performed well on some measures tended to perform well on others. Four of the 16 measures – particularly those related to routine screening at admission and screening for alcohol and tobacco use – had reported rates of 90 percent or higher, with little room for improvement.

For 9 of the 16 measures, higher scores for quality of care were significantly associated with patient improvement on SROs. However, the correlations ranged from weak to moderate and did not fall into clear groupings. The single quality measure with the greatest impact on patient-rated improvement was providing medication or offering referrals for further treatment for substance use disorders at discharge.

The remaining 7 measures were unrelated to improvement in SROs. For most of these quality indicators – for example, routine admission assessments, influenza vaccinations, or recordkeeping steps at discharge – it is "difficult to discern" a direct link to improvement in patient-reported outcomes.

The researchers liken the current approach to quality measurement in behavioral healthcare to "a stool with two legs: Organizational and procedural measures are present, but outcome measurement is missing." Ms. Nowlin and coauthors conclude: "We encourage an expansion of the current framework of behavioral health quality measurement beyond process and organization and suggest the addition of patient outcomes such as SROs as quality measures to directly assess patient improvement."

Click here to read “Quality Measurement and Patient Outcomes in Inpatient Behavioral Health: Assessing the Current Framework”

DOI: 10.1097/JHQ.0000000000000319


About the Journal for Healthcare Quality

JHQ, a peer-reviewed journal, is an official publication of the National Association for Healthcare Quality (NAHQ). JHQ is a professional forum that continuously advances healthcare quality practice in a diverse and changing environment, and is the first choice for creative and scientific solutions in the pursuit of healthcare quality. The mission of JHQ is to advance the art and science of healthcare quality. Its audience is professionals dedicated to promoting healthcare treatment and services that are safe, effective, patient-centered, timely, efficient, equitable, and evidence-based across the continuum of care. 

The Journal publishes scholarly articles targeted to leaders of all healthcare settings, leveraging applied research and producing practice-focused, timely, and impactful evidence in healthcare system transformation. For more information about the Journal and author guidelines, please visit

About NAHQ

NAHQ is the leader in healthcare quality competencies. NAHQ provides a strategic advantage to healthcare professionals and the organizations they serve by developing and evolving competencies in healthcare quality that result in better patient and financial outcomes to support the goals of healthcare value. NAHQ offers the industry standard certification in healthcare quality, extensive educational programming, networking opportunities, and career resources to help healthcare professionals meet the challenges they face. Learn more about NAHQ at

About Wolters Kluwer

Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.

Wolters Kluwer reported 2020 annual revenues of €4.6 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,200 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit and follow us on LinkedIn and Twitter @WKHealth.

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