This application proposes to identify, develop and test measures for the assessment of the quality of care for severe and persistent mental illness (SPMI). There are many proposed measures for mental health care, but the extent of their development and usefulness varies widely. This proposal represents a collaboration between researchers and public-private sector leaders responsible for the treatment of SPMI in Massachusetts (from the Department of Mental Health, the Division of Medical Assistance, and the managed care organization (MCO) contracted to administer the Medicaid mental health carve-out. The first specific aim of this proposal is to identify, inventory, and describe existing measures of the quality of mental health care for individuals with severe and persistent mental illness. Measures will be systematically collected from provider organizations, MCOs, accreditors, payers, researchers, and other groups. An inventory will be developed describing each measure and detailing its properties. Measures with adequate specifications will be entered into AHCPR's CONQUEST database to facilitate nationwide access. The second specific aim is to further develop selected measures and test their meaningfulness and feasibility. A stakeholder panel will work with the investigators to develop a conceptual framework for SPMI quality measurement and select a potentially feasible and meaningful subset of measures. These measures will be further developed, and then tested using clinical data (from administrative claims, medical records, and patient surveys) from several existing datasets. The panel will then rate and rank the meaningfulness and feasibility of each measure. The third specific aim is to implement selected measures as part of ongoing efforts to improve the quality of treatment provided to Medicaid and DMH clients with SPMI in Massachusetts. Several specific areas for implementation are described. The products of this research-an inventory of measures and their properties, and the results of our analyses-will also be disseminated nationally to organizations working toward the development of a core set of measures for mental health.