Measuring the Quality of Depression Care in a Large Integrated Health System

• Published in: Medical care 2003-05, Vol.41 (5), p.669-680
• Main Authors: Charbonneau, Andrea, Rosen, Amy K., Ash, Arlene S., Owen, Richard R., Kader, Boris, Spiro, Avron, Hankin, Cheryl, Herz, Lawrence R., Mary Jo V. Pugh, Kazis, Lewis, Miller, Donald R., Berlowitz, Dan R.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antidepressants; Antidepressive Agents - administration & dosage; Antidepressive Agents - therapeutic use; Bipolar disorder; Cohort Studies; Delivery of Health Care, Integrated - standards; Depressive Disorder - drug therapy; Depressive Disorder - ethnology; Depressive disorders; Dosage; Drug Utilization Review; Female; Health care process assessment; Health Services Research; Hospitals, Veterans - standards; Humans; Major depressive disorder; Male; Medications; Mental health outcomes; Middle Aged; New England; New York; Pharmacies; Practice Guidelines as Topic; Primary health care; Quality Assurance, Health Care - methods; Retrospective Studies; United States; United States Department of Veterans Affairs
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/01.MLR.0000062920.51692.B4

Background. Guideline-based depression process measures provide a powerful way to monitor depression care and target areas needing improvement. Objectives. To assess the adequacy of depression care in the Veterans Health Administration (VHA) using guideline-based process measures derived from administrative and centralized pharmacy records, and to identify patient and provider characteristics associated with adequate depression care. Research Design. This is a cohort study of patients from 14 VHA hospitals in the Northeastern United States which relied on existing databases. Subject eligibility criteria: at least one depression diagnosis during 1999, neither schizophrenia nor bipolar disease, and at least one antidepressant prescribed in the VHA during the period of depression care profiling (June 1, 1999 through August 31, 1999). Depression care was evaluated with process measures defined from the 1997 VHA depression guidelines: antidepressant dosage and duration adequacy. We used multivariable regression to identify patient and provider characteristics predicting adequate care. Subjects. There were 12,678 patients eligible for depression care profiling. Results. Adequate dosage was identified in 90%; 45% of patients had adequate duration of antidepressants. Significant patient and provider characteristics predicting inadequate depression care were younger age (