CQAIMH - center for quality assessment and improvement in mental health



Bipolar Disorder: Monitoring change in level-of-functioning


This measure assesses the percentage of patients diagnosed and treated for bipolar disorder who are monitored for change in their level-of-functioning in response to treatment.

Clinical Rationale:

Recovery in Bipolar Disorder

  • Recovery includes remission of symptomatology, minimizing relapse or recurrence and maximizing functioning and improving quality of life (1)
  • Achieving treatment-related symptomatic improvement does not necessarily mean that the functional recovery is achieved (1)
  • Functional recovery involves the ability to sustain and maintain social, occupational, educational and independent living activities and relationships (1)

Bipolar Disorder & Response to Treatment

  • The 2002 APA Practice Guideline for the Treatment of Patients with Bipolar Disorder defines remission during the acute phase of treatment as “a complete return to baseline level of functioning and a virtual lack of symptoms”
  • The ability to function involves more than the presence or absence of symptoms as some patients with bipolar disorder function well despite having severe symptoms while others have few symptoms but can be dysfunctional (2)
  • Monitoring response to treatment in bipolar disorder should extend beyond symptom reduction to include a focus on a person’s improvement in level-of functioning (2)

Measuring Level-of-functioning

  • Level-of-functioning instruments measure a person’s ability to interact with others, form relationships and handle day-to-day tasks (3)
  • Self-report of level of functioning has been found to have an important role in treatment as it encourages patient participation and collaborative dialogue (3)

Denominator Population:

Patients diagnosed and treated for bipolar disorder

Data Sources:

  • Administrative data
  • Medical Record

Numerator Population:

Patients whose level of functioning was evaluated during the initial assessment and again within 12 weeks of initiating treatment

Data Source:

  • Medical Record

Initial Case-finding Guidance:

Patients with a diagnosis involving bipolar disorder
ICD9CM or DSM IV TR: 296.0x; 296.1x; 296.4x; 296.5x; 296.6x; 296.7; 296.80-82; 296.89; or 301.13

STABLE Resource Toolkit:

The following tools are recommended by the STABLE National Coordinating Council for use in assessing the risk of suicide.  The tools are available in the corresponding section of the STABLE Resource Toolkit.

  • Sheehan Disability Scale:  A brief self-report tool


  1. Harvey P, Defining and Achieving Recovery From Bipolar Disorder, J Clin Psychiatry 2006; 67 (suppl 9) 14-18
  2. Keck PE, Defining and Improving Response to Treatment in Patients With Bipolar Disorder; J Clin Psychiatry 2004; 65 (suppl 15) 25-29
  3. O’Malia L, McFarland B, et.al, A Level-of-Functioning Self-Report Measure for Consumers With Severe Mental Illness, Psychiatric Services, March 2002, Vol 53, No. 3 26-331

Copyright 2007 by the Center for Quality Assessment and Improvement in Mental Health