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A framework for measuring quality and promoting accountability across silos: the case of mental disorders and co-occurring conditions
  1. A M Kilbourne1,
  2. C Fullerton2,
  3. D Dausey3,
  4. H A Pincus4,
  5. R C Hermann5
  1. 1VA Ann Arbor National Serious Mental Illness Treatment Research and Evaluation Center, VA Ann Arbor HSR&D Center of Excellence, and Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
  2. 2Department of Health Care Policy, Harvard Medical School, and Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3Department of Public Policy and Management, Carnegie Mellon University H. John Heinz III School of Public Policy, Pittsburgh, Pennsylvania, USA
  4. 4College of Physicians and Surgeons, Columbia University, and New York Presbyterian Hospital and Irving Institute for Clinical and Translational Research, New York, New York, USA
  5. 5Center for Quality Assessment and Improvement in Mental Health (CQAIMH) at Tufts-New England Medical Center's Institute for Clinical Research & Health Policy Studies, Boston, Massachusetts, USA
  1. Correspondence to Dr Amy M Kilbourne, VA Ann Arbor SMITREC (11H), 2215 Fuller Road, Ann Arbor, MI 48105, USA; amykilbo{at}


Background Quality measures can be effective tools for improving delivery of care and patient outcomes. Co-occurring conditions (COCs), including general medical conditions and substance use disorders, are the rule rather than the exception in patients with serious mental health disorders and lead to substantial morbidity and mortality burden. COCs among persons with mental health disorders are often treated by separate systems (“silos”) in the US healthcare system, making it difficult to establish expectations for performance, assign accountability for measure results and ultimately improve quality of care for this group.

Objectives A framework for measuring quality of care for COCs is proposed by reviewing the current state of quality for COCs and examples of quality measures based on the Donabedian model.

Methods and framework The framework will also be applied to better define which providers are accountable for quality improvement, to ultimately ensure that quality measures have an impact on improving care for COCs.

  • Quality of care
  • mental disorders
  • substance use disorders
  • comorbidity
  • primary care
  • outcome
  • healthcare quality
  • substance use disorders

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  • Funding This work was supported by the Veterans Health Administration, Health Services Research and Development Service (IIR 02-283, IIR 07-115; AMK, PI), the Robert Wood Johnson Foundation Depression in Primary Care National Program (HAP, director), the Department of Veterans Affairs, the Robert Wood Johnson Foundation Substance Abuse Policy Research Program (DD) and the National Institute of Mental Health (CF). This work was also completed with the support of the Robert Wood Johnson Foundation Depression in Primary Care; Linking Clinical and System Strategies Program, the Irving Institute for Clinical and Translational Awards Grant Number UL1 RR024156 from the National Center for Research Resources, and the Mental Heath Therapeutics CERT at Rutgers, the State University of New Jersey, funded by the Agency for Healthcare Research and Quality (AHRQ) (5 U18 HS016097). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

  • Competing interests None.