Improvement or Maintenance of Functioning for Individuals with a Mental and/or

Measure Specification

Mental and substance use disorders are among the 25 leading causes of years lived with disability and contribute significantly to the global burden of disease. Specifically, 19% of U.S. adults (46.6 million individuals aged 18 and older) have a mental illness and 7.6% (18.7 million individuals aged 18 and older) have a substance use disorder. Mental and substance use disorders often co-occur, with about 8.

5 million adults aged 18 and older in the U.S. having both conditions. Individuals with mental and/or substance use disorders are more likely to report severe impairment in functioning compared to those with chronic medical conditions. In fact, the level and pattern of functional impairment is described as the best indicator of service needs, treatment outcomes, and quality care, with greater level of functional impairment being a risk factor for poor prognosis for both mental and substance use disorders as well other medical conditions.

Improvement or maintaining functioning is strongly predictive of a positive outcome. Improvement or maintaining functioning is strongly predictive of a positive outcome.

WHO Disability Assessment Scale 2.0 (WHODAS 2.0) (Ustun et al., 2010) assesses change-over-time in functioning for all individuals with mental health and/or substance use disorders. The domains covered in the tool are communication and understanding, mobility, self-care, social functioning, life activities (work and home), and participation in society.

Response options include: (0) None, (1) Mild, (2) Moderate, (3) Severe, and (4) Extreme or Cannot Do. A 12-item and 36-item version of the WHODAS 2.0 are available. Summed scores on the 12-item and 36-item WHODAS 2.0 are converted to a summary scale from 0 to 100 (where 0 = no disability; 100 = full disability). There is no recommended cutoff score.

A higher score on the WHODAS 2.0 equates to a lower level of functioning. Available at: https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health/who- disability-assessment-schedule. Sheehan Disability Scale (SDS) (Sheehan et al., 2008) assesses change-over-time in functioning for individuals with mental health and/or substance use disorders.

The domains covered in the tool are work/school, social life/leisure activities, and family life/home responsibilities. Response options include: (0) Not at all, (1-3) Mildly, (4-6) Moderately, (7-9) Markedly, and (10) Extremely, regarding how current symptoms have disrupted activities in each of the domains covered by the assessment. The 3 items are summed into a single dimensional measure of global functioning from 0 to 30 (where 0 = unimpaired and 30 = highly impaired).

There is no recommended cutoff score. A higher score on the SDS equates to a lower level of functioning. Available at: https://harmresearch.org/about-us/david-v-sheehan-md- mba/sheehan-scales-and-structured-diagnostic-interviews/sheehan-disability-scale-sds.

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this patient-periodic measure is submitted a minimum of once per patient per timeframe specified by the measure during the performance period. The most advantageous quality data code will be used if the measure is submitted more than once.