{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:53:29Z","timestamp":1782489209698,"version":"3.54.5"},"reference-count":42,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"unspecified","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["5R01MH137006"],"award-info":[{"award-number":["5R01MH137006"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,4,17]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Paediatric anxiety disorders are among the most common psychiatric disorders of childhood and adolescence, affecting between 15% and 30% of youth. Rates rose sharply during the COVID-19 pandemic, and untreated anxiety is associated with impaired functioning and increased risk of depression, suicidality and substance use in adulthood. Evidence-based treatments such as cognitive-behavioural therapy and selective serotonin reuptake inhibitors are highly effective yet remain underused, while non-recommended treatments, including benzodiazepines, are often prescribed. Despite the public health burden, there are currently no endorsed outcome-focused quality measures for paediatric anxiety. Developing such measures would allow health systems and providers to track outcomes, reduce disparities and drive quality improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This study will develop and test two complementary outcome-focused paediatric anxiety quality measures based on the seven-item Generalised Anxiety Disorder scale: (1) remission (clinically significant reduction in anxiety symptoms to below threshold) and (2) response (clinically significant improvement, even if remission is not achieved). Using electronic health record and claims data from Kaiser Permanente Northwest and Kaiser Permanente Southern California from 2017 to 2024, we will establish measure inclusion and exclusion criteria, evaluate the application of symptom weighting, test measure reliability and validity and implement casemix adjustment models. Analyses will examine disparities by race, ethnicity and social risk factors through linkage indices capturing local social determinants of health. Qualitative interviews with providers and electronic medical record vendors will be conducted to assess feasibility and usability. Measures will be prepared and submitted for endorsement by a national quality measurement body.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study has been reviewed and approved by the institutional review boards at RTI International and Kaiser Permanente. Findings will be disseminated through peer-reviewed publications, scientific conferences, stakeholder workshops and submissions to a national quality endorsement body.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-119157","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T16:00:20Z","timestamp":1777910420000},"page":"e119157","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Can the GAD-7 be used to create valid, reliable, feasible and actionable outcome-focused paediatric anxiety quality measures for use across specialty and paediatric treatment settings?"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5528-881X","authenticated-orcid":false,"given":"Tami L","family":"Mark","sequence":"first","affiliation":[{"name":"RTI International, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8880-0624","authenticated-orcid":false,"given":"Lissette M","family":"Saavedra","sequence":"additional","affiliation":[{"name":"RTI International, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4527-1910","authenticated-orcid":false,"given":"Sydney","family":"Kirsch","sequence":"additional","affiliation":[{"name":"RTI International, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0359-5877","authenticated-orcid":false,"given":"Ye Z","family":"Pogue","sequence":"additional","affiliation":[{"name":"RTI International, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0547-6812","authenticated-orcid":false,"given":"Frances L","family":"Lynch","sequence":"additional","affiliation":[{"name":"Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinna","family":"Koebnick","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA"},{"name":"Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science, Pasadena, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio A","family":"Morgan Lopez","sequence":"additional","affiliation":[{"name":"RTI International, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna C","family":"Yaros","sequence":"additional","affiliation":[{"name":"RTI International, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily K","family":"Juel","sequence":"additional","affiliation":[{"name":"The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"2026062608312509000_16.5.e119157.1","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1016\/j.jaac.2010.05.017","article-title":"Lifetime Prevalence of Mental Disorders in U.S. Adolescents: Results from the National Comorbidity Survey Replication\u2013Adolescent Supplement (NCS-A)","volume":"49","author":"Merikangas","year":"2010","journal-title":"Journal of the American Academy of Child & Adolescent Psychiatry"},{"key":"2026062608312509000_16.5.e119157.2","doi-asserted-by":"publisher","DOI":"10.1111\/jcpp.12381"},{"key":"2026062608312509000_16.5.e119157.3","doi-asserted-by":"crossref","first-page":"299","DOI":"10.4103\/indianjpsychiatry.indianjpsychiatry_700_21","article-title":"Epidemic of Depression and Anxiety in child and adolescent population during COVID-19 pandemic: A systematic review and meta analysis of the prevalence of depression and anxiety","volume":"65","author":"Maggu","year":"2023","journal-title":"Indian J Psychiatry"},{"key":"2026062608312509000_16.5.e119157.4","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1001\/jamapediatrics.2021.2482","article-title":"Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis","volume":"175","author":"Racine","year":"2021","journal-title":"JAMA Pediatr"},{"key":"2026062608312509000_16.5.e119157.5","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.38174","article-title":"Treatment Rates for Mental Disorders Among Children and Adolescents: A Systematic Review and Meta-Analysis","volume":"6","author":"Wang","year":"2023","journal-title":"JAMA Netw Open"},{"key":"2026062608312509000_16.5.e119157.6","doi-asserted-by":"publisher","DOI":"10.1007\/s10802-019-00550-5"},{"key":"2026062608312509000_16.5.e119157.7","doi-asserted-by":"crossref","DOI":"10.1002\/jcv2.12149","article-title":"The multifaceted consequences and economic costs of child anxiety problems: A systematic review and meta-analysis","volume":"3","author":"Pollard","year":"2023","journal-title":"JCPP Adv"},{"key":"2026062608312509000_16.5.e119157.8","doi-asserted-by":"publisher","DOI":"10.1007\/s10964-007-9224-0"},{"key":"2026062608312509000_16.5.e119157.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2013.09.017"},{"key":"2026062608312509000_16.5.e119157.10","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1097\/00004583-199207000-00003","article-title":"Chronic Course of Anxiety Disorders in Children and Adolescents","volume":"31","author":"Keller","year":"1992","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"2026062608312509000_16.5.e119157.11","first-page":"11","article-title":"The long-term clinical course of generalized anxiety disorder","volume":"63 Suppl 8","author":"Keller","year":"2002","journal-title":"J Clin Psychiatry"},{"key":"2026062608312509000_16.5.e119157.12","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7610.2010.02242.x"},{"key":"2026062608312509000_16.5.e119157.13","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1007\/s11121-022-01422-z","article-title":"Mitigating Multiple Sources of Bias in a Quasi-Experimental Integrative Data Analysis: Does Treating Childhood Anxiety Prevent Substance Use Disorders in Late Adolescence\/Young Adulthood?","volume":"24","author":"Saavedra","year":"2023","journal-title":"Prev Sci"},{"key":"2026062608312509000_16.5.e119157.14","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/978-3-031-57472-6_14","volume-title":"Pediatric psychopharmacology evidence","volume":"2024","author":"Ballard","year":"2024"},{"key":"2026062608312509000_16.5.e119157.15","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2019-3478","article-title":"Benzodiazepine Treatment and Fracture Risk in Young Persons With Anxiety Disorders","volume":"146","author":"Bushnell","year":"2020","journal-title":"Pediatrics"},{"key":"2026062608312509000_16.5.e119157.16","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1007\/s10567-024-00478-3","article-title":"Determinants of Exposure Therapy Implementation in Clinical Practice for the Treatment of Anxiety, OCD, and PTSD: A Systematic Review","volume":"27","author":"Racz","year":"2024","journal-title":"Clin Child Fam Psychol Rev"},{"key":"2026062608312509000_16.5.e119157.17","doi-asserted-by":"publisher","DOI":"10.1080\/15374416.2015.1046177"},{"key":"2026062608312509000_16.5.e119157.18","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.janxdis.2017.04.002","article-title":"Predictors of clinician use of exposure therapy in community mental health settings","volume":"49","author":"Becker-Haimes","year":"2017","journal-title":"J Anxiety Disord"},{"key":"2026062608312509000_16.5.e119157.19","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1037\/ser0000347","article-title":"Promoting measurement-based care and quality measure development: The APA mental and behavioral health registry initiative","volume":"17","author":"Wright","year":"2020","journal-title":"Psychol Serv"},{"key":"2026062608312509000_16.5.e119157.20","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.51.1.85"},{"key":"2026062608312509000_16.5.e119157.21","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"2026062608312509000_16.5.e119157.22","unstructured":"Centers for Medicare & Medicaid Services . 2024 MIPS quality measures list. 2024. Available: https:\/\/qpp-cm-prod-content.s3.amazonaws.com\/uploads\/2632\/2024%20MIPS%20Quality%20Measures%20List.xlsx"},{"key":"2026062608312509000_16.5.e119157.23","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"2026062608312509000_16.5.e119157.24","doi-asserted-by":"crossref","first-page":"241","DOI":"10.12788\/acp.0047","article-title":"Psychometric properties of the Generalized Anxiety Disorder 7-item scale in youth: Screening in a primary care sample","volume":"33","author":"Hughes","year":"2021","journal-title":"Ann Clin Psychiatry"},{"key":"2026062608312509000_16.5.e119157.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2020.01.032"},{"key":"2026062608312509000_16.5.e119157.26","unstructured":"Defense Health Agency . DHA-PM 6025.01: Procedures Manual (Primary Care Behavioral Health (PCBH) Standards). U.S. Department of Defense, 2019."},{"key":"2026062608312509000_16.5.e119157.27","doi-asserted-by":"crossref","first-page":"39","DOI":"10.7812\/TPP\/22.050","article-title":"Evaluating Implementation and Outcomes of the Achieving Depression and Anxiety Patient-Centered Treatment Collaborative Care Program in a Large, Integrated Health Care System: A Mixed Methods Observational Study Protocol","volume":"26","author":"Ridout","year":"2022","journal-title":"Perm J"},{"key":"2026062608312509000_16.5.e119157.28","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1176\/appi.ps.202000913","article-title":"Surveying the Landscape of Quality-of-Care Measures for Mental and Substance Use Disorders","volume":"73","author":"Schmidt","year":"2022","journal-title":"Psychiatr Serv"},{"key":"2026062608312509000_16.5.e119157.29","unstructured":"Department of Veterans Affairs . Behavioral Health Lab (BHL) privacy impact assessment: U.S. Department of Veterans Affairs. 2025."},{"key":"2026062608312509000_16.5.e119157.30","unstructured":"NHS England . NHS talking therapies manual (v7). 2025."},{"key":"2026062608312509000_16.5.e119157.31","doi-asserted-by":"crossref","first-page":"113792","DOI":"10.1016\/j.psychres.2021.113792","article-title":"Patient Health Questionnaire 9 (PHQ-9) and General Anxiety Disorder 7 (GAD-7) data contributed by 13,829 respondents to a national survey about COVID-19 restrictions in Australia","volume":"298","author":"Stocker","year":"2021","journal-title":"Psychiatry Res"},{"key":"2026062608312509000_16.5.e119157.32","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1177\/104012371702900404","article-title":"The Generalized Anxiety Disorder 7-item scale in adolescents with generalized anxiety disorder: Signal detection and validation","volume":"29","author":"Mossman","year":"2017","journal-title":"Ann Clin Psychiatry"},{"key":"2026062608312509000_16.5.e119157.33","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1037\/met0000077","article-title":"A more general model for testing measurement invariance and differential item functioning: Application to moderated nonlinear factor analysis","volume":"22","author":"Bauer","year":"2017","journal-title":"Psychol Methods"},{"key":"2026062608312509000_16.5.e119157.34","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.addbeh.2018.10.031","article-title":"Simplifying the implementation of modern scale scoring methods with an automated R package: Automated moderated nonlinear factor analysis (aMNLFA)","volume":"94","author":"Gottfredson","year":"2019","journal-title":"Addict Behav"},{"key":"2026062608312509000_16.5.e119157.35","doi-asserted-by":"crossref","DOI":"10.1002\/mpr.1963","article-title":"Differential symptom weighting in estimating empirical thresholds for underlying PTSD severity: Toward a \u201cplatinum\u201d standard for diagnosis?","volume":"32","author":"Morgan-L\u00f3pez","year":"2023","journal-title":"Int J Methods Psychiatr Res"},{"key":"2026062608312509000_16.5.e119157.36","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1080\/19012276.2023.2279904","article-title":"Can GAD-7 be used reliably to capture anxiety?: approaching evaluation of item quality using IRT","volume":"76","author":"Omarsdottir","year":"2024","journal-title":"Nord Psychol"},{"key":"2026062608312509000_16.5.e119157.37","unstructured":"Minnesota Community Measurement . Minnesota health care quality report, part 3: top performers (measurement year 2021). 2023."},{"key":"2026062608312509000_16.5.e119157.38","doi-asserted-by":"crossref","DOI":"10.1017\/S1754470X20000173","article-title":"Improvement in IAPT outcomes over time: are they driven by changes in clinical practice?","volume":"13","author":"Saunders","year":"2020","journal-title":"Cogn Behav Therap"},{"key":"2026062608312509000_16.5.e119157.39","doi-asserted-by":"publisher","DOI":"10.1177\/070674371005500903"},{"key":"2026062608312509000_16.5.e119157.40","unstructured":"HL7 International . Clinical quality language specification v1.5.3, 2025. Available: https:\/\/cql.hl7.org"},{"key":"2026062608312509000_16.5.e119157.41","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1176\/appi.ps.20230370","article-title":"The Hidden Psychometric Model Underlying the DSM: What Happens When It Fails to Fit Psychiatric Data","volume":"75","author":"Morgan-L\u00f3pez","year":"2024","journal-title":"Psychiatr Serv"},{"key":"2026062608312509000_16.5.e119157.42","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2014.0679"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-119157","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:39:52Z","timestamp":1782488392000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-119157"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":42,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,4]]},"published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1136\/bmjopen-2026-119157"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-119157","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}