# Anxiety diagnostic accuracy in VA primary care mental health integration settings: Identifying barriers and facilitators to inform a learning health care system

> **NIH VA I01** · MICHAEL E DEBAKEY VA MEDICAL CENTER · 2020 · —

## Abstract

Anticipated Impacts on Veteran's Healthcare: The provision of high quality healthcare requires accurate
and timely diagnosis. The National Academy of Medicine asserts that “Improving the diagnostic process is not
only possible, but also represents a moral, professional, and public health imperative.” Identifying factors
influencing diagnostic accuracy is essential to improving the diagnostic process. The proposed study will
identify factors associated with anxiety diagnostic errors in VHA primary care mental health integration
(PCMHI) and specialty mental health (MH) settings, and addresses HSR&D priority areas "Mental and
Behavioral Health” and “Health Care Systems Change” and the ORD-wide priority area “Learning Health Care
System”
Project Background: VHA has little information about specific determinants of current anxiety diagnostic
practices and the sociotechnical context in which diagnoses are made. Unspecified anxiety disorder is the
most common anxiety-related diagnosis in VHA but is often a diagnostic error. In FY2017, 408,250 Veterans
enrolled in the VHA carried an unspecified anxiety disorder diagnosis, and unspecified anxiety accounted for
70% of anxiety diagnoses in PCMHI that year. However, the majority of these diagnoses are erroneous as
fewer than 3% of Veterans diagnosed with unspecified anxiety meet DSM-5 criteria for this disorder. Accurate
diagnosis is foundational to evidence-based healthcare, and 77% of Veterans diagnosed with unspecified
anxiety meet diagnostic criteria for a specific anxiety or trauma-related disorder (generalized anxiety disorder
[GAD, 44%]; posttraumatic stress disorder [PTSD, 38%]; panic disorder, 20%; social anxiety disorder 20%).
Diagnostic accuracy is critical to accessing appropriate services. Only 32% of Veterans with unspecified
anxiety disorder received mental health services in the year following diagnosis, compared to Veterans
diagnosed with GAD (60%), panic disorder (67%), and social anxiety disorder (88%). Thus, an erroneous
diagnosis of unspecified anxiety disorder is a barrier to receipt of appropriate evidence-based care for specific
disorders such as PTSD, GAD, and panic disorder.
Project Objectives: The proposed, 3-year, multisite study will use mixed quantitative and qualitative methods,
informed by the Safer Dx framework, to identify system-, provider-, and patient-level factors associated with
anxiety diagnostic specificity in VHA PCMHI and specialty MH settings. Understanding how these factors
interact in the anxiety diagnostic process is crucial to identifying point(s) in the diagnostic process at which to
intervene.
Project Methods: The aims of the proposed project will be achieved through three major activities that will be
carried out using mixed, qualitative and quantitative, methods. Aim 1 will use administrative data from the
Corporate Data Warehouse (CDW) to identify system-, provider-, and patient-level factors associated with
anxiety diagnostic specificity in PCMHI and spec...

## Key facts

- **NIH application ID:** 9935909
- **Project number:** 5I01HX002504-02
- **Recipient organization:** MICHAEL E DEBAKEY VA MEDICAL CENTER
- **Principal Investigator:** Terri Lynn Fletcher
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-05-01 → 2022-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9935909

## Citation

> US National Institutes of Health, RePORTER application 9935909, Anxiety diagnostic accuracy in VA primary care mental health integration settings: Identifying barriers and facilitators to inform a learning health care system (5I01HX002504-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9935909. Licensed CC0.

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