Measurement-Based Care for Psychotic Disorders in the Veterans Health Administration: Current Practices and Future...

Measurement-based care (MBC) improves patient outcomes. However, there has been minimal focus on MBC for psychotic disorders. This study examines the use of patient-reported outcome measures (PROMs) in the Veterans Health Administration (VHA) to characterize their use among Veterans with psychotic disorders and to inform candidate measures for psychosis-related MBC.

Data on Veterans with and without ICD-10 psychotic disorders and at least 1 PROM during fiscal years (FYs) 2016-2019 (FY16-FY19) were collected. The sample included 3,935,504 PROM administrations among 1,192,897 Veterans. Included PROMs spanned multiple symptom and non-symptom domains. Percentages of total PROM administrations were calculated by aggregating across time and diagnosis. Facility-level statistics were also calculated. Absolute change in the percentage of unique Veterans administered a particular and repeated PROMs over time were calculated.

The core PROMs for VHA MBC (Patient Health Questionnaire-9 [PHQ-9], General Anxiety Disorder-7 Scale, PTSD Checklist-5, and Brief Addiction Monitor) accounted for the majority of PROMs for Veterans with (88.18%) and without (92.56%) psychotic disorders. The PHQ-9 accounted for the largest proportion (psychotic disorder: 45.89%; other diagnosis: 46.70%). The absolute changes in percentages of repeated PROM administration were similar over time across groups.

The use of PROMs in VHA mental health care increased during FY16-FY19 for Veterans with and without psychosis. The rates of PROM use were similar for both groups, and PROM use predominately consisted of the core measures. While the similar rates of PROM administration are encouraging, these findings highlight the need for psychosis-specific measures to tailor MBC for Veterans with these diagnoses.