# Development and Testing of a Pediatric Anxiety Outcomes Quality Measure (PAO_QM Study)

> **NIH NIH R01** · RESEARCH TRIANGLE INSTITUTE · 2024 · $478,888

## Abstract

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.

## Key facts

- **NIH application ID:** 10943210
- **Project number:** 1R01MH137006-01
- **Recipient organization:** RESEARCH TRIANGLE INSTITUTE
- **Principal Investigator:** TAMI L MARK
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $478,888
- **Award type:** 1
- **Project period:** 2024-09-16 → 2028-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10943210

## Citation

> US National Institutes of Health, RePORTER application 10943210, Development and Testing of a Pediatric Anxiety Outcomes Quality Measure (PAO_QM Study) (1R01MH137006-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10943210. Licensed CC0.

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