Clinical Quality Measures: Process
Does not apply to this measure
This measure is used to assess the percentage of patients with bipolar disorder who receive a recommendation for an adjunctive psychosocial intervention, including evidence-based therapies, within 12 weeks of initiating treatment.
The Role of Psychosocial Interventions
- Psychotherapy is a critical component of bipolar disorder treatment in addition to pharmacotherapy.
- Evidence-based psychosocial interventions have been found to improve treatment adherence, reduce likelihood of recurrence and extend time to new episodes.
- Initially focusing on issues relating to medication adherence, psychosocial strategies are now recommended to include broader strategies to promote mood stability, address comorbid conditions, improve understanding in support of treatment adherence, recognition of relapse and collaborative self-management.
- Interventions that support return to role functioning and that address stressors and interpersonal communications are considered beneficial for remission and recovery.
Types of Psychosocial Interventions
- Evidence-based: family-focused therapy (FFT), cognitive behavioral therapy (CBT), formal psychoeducation, and interpersonal therapy (IPT) with or without a social rhythm component (IPSRT) have been supported through well developed clinical trials and are incorporated into guideline recommendations.
- Brief supportive and group psychotherapy are also suggested, as alternative strategies.
|Colom F, Vieta E, Martinez-Aran A, Reinares M, Goikolea JM, Benabarre A, Torrent C, Comes M, Corbella B, Parramon G, Corominas J. A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch Gen Psychiatry. 2003 Apr;60(4):402-7. PubMed|
|Colom F, Vieta E, Reinares M, Martinez-Aran A, Torrent C, Goikolea JM, Gasto C. Psychoeducation efficacy in bipolar disorders: beyond compliance enhancement. J Clin Psychiatry. 2003 Sep;64(9):1101-5. PubMed|
|Frank E, Kupfer DJ, Thase ME, Mallinger AG, Swartz HA, Fagiolini AM, Grochocinski V, Houck P, Scott J, Thompson W, Monk T. Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Arch Gen Psychiatry. 2005 Sep;62(9):996-1004. PubMed|
|Guideline watch: practice guideline for the treatment of patients with bipolar disorder. 2nd ed. Arlington (VA): American Psychiatric Association; 2006. 9 p.|
|Keck PE, Perlis R, Otto M, Carpenter D, Ross R, Docherty J. Treatment of bipolar disorder 2004. In: Expert consensus guideline series, postgraduate medicine - a special report. 2004 Dec.|
|Lam DH, Watkins ER, Hayward P, Bright J, Wright K, Kerr N, Parr-Davis G, Sham P. A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: outcome of the first year. Arch Gen Psychiatry. 2003 Feb;60(2):145-52. PubMed|
|Miklowitz DJ, George EL, Richards JA, Simoneau TL, Suddath RL. A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Arch Gen Psychiatry. 2003 Sep;60(9):904-12. PubMed|
|Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry. 2002 Apr;159(4 Suppl):1-50. [472 references] PubMed|
|Vieta E, Pacchiarotti I, Scott J, Sanchez-Moreno J, Di Marzo S, Colom F. Evidence-based research on the efficacy of psychologic interventions in bipolar disorders: a critical review. Curr Psychiatry Rep. 2005 Dec;7(6):449-55. [50 references] PubMed|
|Yatham LN, Kennedy SH, O'Donovan C, Parikh S, MacQueen G, McIntyre R, Sharma V, Silverstone P, Alda M, Baruch P, Beaulieu S, Daigneault A, Milev R, Young LT, Ravindran A, Schaffer A, Connolly M, Gorman CP. Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: consensus and controversies. Bipolar Disord. 2005;7 Suppl 3:5-69. PubMed|
Bipolar disorder; psychosocial intervention
Patients diagnosed and treated for bipolar disorder (see the related "Denominator Inclusions/Exclusions" field)
Patients with a recommendation for psychosocial intervention within 12 weeks of initiating treatment (see the related "Numerator Inclusions/Exclusions" field)
- A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
- A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
- One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal
- The STABLE measures were developed using the RAND Appropriateness Method and have been shown to have content validity and face validity.
- Data feasibility testing was performed to determine the availability of the data elements required in the measure numerator and denominator specifications.
- Inter-abstractor reliability testing was performed to assess the data collection strategy. The data collection strategy included data collection forms; data dictionary references and abstractor instructions.
- A field study was conducted to determine measure conformance in an appropriate convenience sample.
Refer to the references listed below for further information.
|STABLE performance measures: data feasibility testing & results. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. 2 p.|
|STABLE performance measures: development process & validity ratings. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. 3 p.|
|STABLE performance measures: field study process & conformance findings. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. 3 p.|
|STABLE performance measures: inter-abstractor reliability testing & results. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. 2 p.|
Behavioral Health Care
Advanced Practice Nurses
Psychologists/Non-physician Behavioral Health Clinicians
Individual Clinicians or Public Health Professionals
Age greater than or equal to 18 years
Either male or female
Prevention and Treatment of Leading Causes of Mortality
Patients associated with provider
Patient/Individual (Consumer) Characteristic
Does not apply to this measure
Patients 18 years of age or older with an initial or new episode of bipolar disorder
Documentation of a diagnosis involving bipolar disorder; to include at least one of the following:
- Codes 296.0x; 296.1x; 296.4x; 296.5x; 296.6x; 296.7; 296.80; 296.81; 296.82; 296.89; 301.13 documented in body of chart, such as a pre-printed form completed by a clinician and/or codes documented in chart notes/forms
- Diagnosis or impression documented in chart indicating bipolar disorder
- Use of a screening/assessment tool for bipolar disorder with a score or conclusion that patient has bipolar disorder and documentation that this information is used to establish or substantiate the diagnosis
Documentation of treatment for bipolar disorder with relevant pharmacotherapy; a mood stabilizing agent and/or an antipsychotic agent
Documentation that psychosocial interventions are (1) not indicated or (2) patients refuses to consider/discuss, or (3) source of referral for psychosocial practice not available in community.
Documentation that adjunctive psycho-social intervention(s) were recommended (Refer to the "Data Dictionary Reference" in the original measure documentation for specified psychosocial interventions.). Recommendation may include the following:
- Interventions provided at practice site
- Referral to psychologist/therapist or psychiatrist outside of practice site for psychosocial services
- Referral to a mental health clinic or hospital-based outpatient (OP) program for psychosocial services
- Referral to a support/advocacy provided community-based program for psychosocial services
Documentation of recommendation for adjunctive psychosocial intervention(s) should occur within 12 weeks of initiating treatment for bipolar disorder.
Fixed time period or point in time
Administrative clinical data
Paper medical record
Does not apply to this measure
Does not apply to this measure
Desired value is a higher score
Internal time comparison
Bipolar disorder: recommending adjunctive psychosocial interventions.
Standards for Bipolar Excellence (STABLE) Performance Measures
Center for Quality Assessment and Improvement in Mental Health - Clinical Specialty Collaboration
STABLE Project National Coordinating Council - Clinical Specialty Collaboration
AstraZeneca LLP, Wilmington, Delaware, provided financial sponsorship for the STABLE Project. They did not otherwise participate in the development of either the measures or toolkit.
The STABLE National Coordinating Council (NCC) was comprised of national experts in bipolar disorder, psychiatry, primary care, and performance improvement. The NCC guided and directed the STABLE Project. NCC members agreed to serve with the understanding that the STABLE Performance Measures and Resource Toolkit would be fully transparent and available without cost in the public domain.
EPI-Q, Inc. , is a consulting company providing practice-based outcomes research, pharmacoeconomic studies, and quality improvement services. EPI-Q managed the STABLE Project.
This measure was not adapted from another source.
This is the current release of the measure.
The measure developer reaffirmed the currency of this measure in September 2015.
|STABLE (STAndards for BipoLar Excellence) performance measures. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. various p.|
Source available from the Center for Quality Assessment and Improvement in Mental Health (CQAIMH) Web site .
The following is available:
- STABLE National Coordinating Council Resource Toolkit Workgroup. STABLE resource toolkit. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007 Mar. 67 p. This document is available in Portable Document Format (PDF) from the Center for Quality Assessment and Improvement in Mental Health (CQAIMH) Web site .
This NQMC summary was completed by ECRI Institute on January 10, 2008. The information was verified by the measure developer on April 14, 2008.
This NQMC summary was retrofitted into the new template on June 27, 2011.
The information was reaffirmed by the measure developer on September 30, 2015.
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