PMID- 15812091
OWN - NLM
STAT- MEDLINE
DCOM- 20050810
LR  - 20191210
IS  - 1075-2730 (Print)
IS  - 1075-2730 (Linking)
VI  - 56
IP  - 4
DP  - 2005 Apr
TI  - Using the GAF as a national mental health outcome measure in the Department of 
      Veterans Affairs.
PG  - 420-6
AB  - OBJECTIVE: Data from the Veterans Health Administration (VHA) were used to 
      evaluate the strengths and weaknesses of the Global Assessment of Functioning 
      (GAF), a single-item mental health status measure, as an outcome measure for 
      large mental health care systems. METHODS: The sample consisted of VHA mental 
      health patients who had at least two GAF scores 45 days apart in 2002 
      (N=283,754). First, to evaluate the discriminant validity of the GAF change 
      measures, the authors examined the association of these measures with 
      sociodemographic and clinical characteristics. Facility-level risk-adjusted 
      measures of GAF change were then created in three different clinical samples at 
      more than 130 VHA medical centers, adjusting for patients' sociodemographic 
      characteristics and diagnoses. The internal consistency of the scale created by 
      using these items and their consistency across medical centers over time was 
      evaluated. RESULTS: The analysis supported the discriminant validity of the 
      GAF-derived measures. As expected, veterans who had a diagnosis of schizophrenia 
      or Alzheimer's disease or who had service-connected disability ratings above 50 
      percent had lower baseline GAF scores and showed less improvement. The overall 
      GAF performance measure had a high level of internal consistency (a standardized 
      alpha of .85) and was highly consistent across facilities over time. CONCLUSIONS: 
      The results of this study provide preliminary empirical support for cautious use 
      of a GAF-derived scale in monitoring changes in average facility-level outcomes 
      over time. However, because of the potential for gaming of the measures and 
      uncontrolled variation in the scale's administration across facilities, the scale 
      should not be used to compare outcomes across facilities.
FAU - Greenberg, Greg A
AU  - Greenberg GA
AD  - Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, 
      Connecticut, USA. ggreenberg@ssc.wisc.edu
FAU - Rosenheck, Robert A
AU  - Rosenheck RA
LA  - eng
PT  - Journal Article
PT  - Validation Study
PL  - United States
TA  - Psychiatr Serv
JT  - Psychiatric services (Washington, D.C.)
JID - 9502838
SB  - IM
MH  - Electronic Data Processing
MH  - Female
MH  - Humans
MH  - Male
MH  - Mental Disorders/*rehabilitation
MH  - Mental Health Services/*standards/statistics & numerical data
MH  - Middle Aged
MH  - Outcome Assessment, Health Care/*methods
MH  - Reproducibility of Results
MH  - Software
MH  - *Surveys and Questionnaires
MH  - United States
MH  - United States Department of Veterans Affairs
MH  - Veterans/*psychology
EDAT- 2005/04/07 09:00
MHDA- 2005/08/11 09:00
CRDT- 2005/04/07 09:00
PHST- 2005/04/07 09:00 [pubmed]
PHST- 2005/08/11 09:00 [medline]
PHST- 2005/04/07 09:00 [entrez]
AID - 56/4/420 [pii]
AID - 10.1176/appi.ps.56.4.420 [doi]
PST - ppublish
SO  - Psychiatr Serv. 2005 Apr;56(4):420-6. doi: 10.1176/appi.ps.56.4.420.