Open Access Highly Accessed Research

Performance measurement for co-occurring mental health and substance use disorders

David J Dausey12*, Harold A Pincus23 and James M Herrell4

Author Affiliations

1 Carnegie Mellon University, Pittsburgh PA 15213, USA

2 RAND Corporation, Pittsburgh PA 15213, USA

3 College of Physicians and Surgeons, Columbia University, and New York Presbyterian Hospital and Irving Center for Clinical and Translational Research, New York NY 10032, USA

4 Substance Abuse and Mental Health Services Administration (SAMHSA)/Center for Substance Abuse Treatment (CSAT), Rockville, MD 20850, USA

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Substance Abuse Treatment, Prevention, and Policy 2009, 4:18  doi:10.1186/1747-597X-4-18

Published: 14 October 2009



Co-occurring mental health and substance use disorders (COD) are the norm rather than the exception. It is therefore critical that performance measures are developed to assess the quality of care for individuals with COD irrespective of whether they seek care in mental health systems or substance abuse systems or both.


We convened an expert panel and asked them to rate a series of structure, process, and outcomes measures for COD using a structured evaluation tool with domains for importance, usefulness, validity, and practicality.


We chose twelve measures that demonstrated promise for future pilot testing and refinement. The criteria that we applied to select these measures included: balance across structure, process, and outcome measures, quantitative ratings from the panelists, narrative comments from the panelists, and evidence the measure had been tested in a similar form elsewhere.


To be successful performance measures need to be developed in such a way that they align with needs of administrators and providers. Policymakers need to work with all stakeholders to establish a concrete agenda for developing, piloting and implementing performance measures that include COD. Future research could begin to consider strategies that increase our ability to use administrative coding in mental health and substance use disorder systems to efficiently capture quality relevant clinical data.