0BPROJECT SUMMARY/ABSTRACT This project will create two complementary quality measures focused on pediatric anxiety. Pediatric anxiety disorders are the extremely prevalent and rates are rising rapidly. Without effective treatment, anxiety disorders can lead to more severe anxiety, depression, and substance use. Moreover, unresolved anxiety disorders can have profound effects on functioning into adulthood and increase the risk for depression, suicide, and chronic medical disorders. Although pediatric anxiety interventions, such as cognitive behavioral therapy and antidepressant medications, are highly efficacious, many clinicians are under-using these evidence-based treatments. An outcome-focused anxiety quality measure would provide a new tool for improving the quality of pediatric anxiety treatment. By comparing aggregate casemix-adjusted anxiety treatment outcomes among clinicians, clinics, and populations, organizations could identify opportunities for quality improvement. An obstacle to creating outcome-focused mental health measures in the United States has been the absence of a practical way to collect, aggregate, and report mental health symptoms/functioning on thousands of patients before and after treatment. We will develop and test two complementary casemix- adjusted pediatric anxiety outcome quality measures using the GAD-7: (1) a measure of whether patients are responding to treatment (treatment response), and (2) a whether patients’ anxiety remitted, which should be feasible to implement at scale. Our specific aims are as follows: Aim 1. Develop and test two complementary casemix-adjusted pediatric anxiety symptom quality measures. Aim 2. Assess whether there are differences in anxiety outcomes by race, ethnicity, and social risk factors. Aim 3. Determine how the measure will be implemented and used for quality improvement (feasibility and usability). Aim 4. Submit the quality measures for endorsement. The GAD-7 is a widely used seven-item anxiety questionnaire that is psychometrically reliable, valid, and responsive to change in pediatric and adult samples. Critically, the GAD-7 is easy for both specialty and primary care providers to incorporate into their daily workflow and captures the primary symptoms of most prevalent anxiety disorders, thus overcoming the main challenge to outcome-based mental health quality measures. Large mental health systems in England, and more recently in Norway, Australia, and Northern Ireland already use remission and response measures based on the GAD-7 to monitor outcomes on thousands of pediatric patients with anxiety to inform quality improvement efforts.

PROJECT NARRATIVE Anxiety disorders among youth are extremely common and without effective treatment can lead to depression, substance use, suicide, and deficits in functioning into adulthood. Although pediatric anxiety interventions, such as cognitive behavioral therapy and antidepressant medications, are highly efficacious, many clinicians are under-using these evidence-based treatments. We will develop and test two complementary casemix-adjusted pediatric anxiety outcome quality measures using the GAD-7 instrument: (1) a measure of whether patients are responding to treatment (treatment response) and (2) a whether patients’ anxiety remitted (remission), which will provide a critical tool for improving outcomes from anxiety treatment.