Comparing outcomes of routine care for depression: the dilemma of case-mix adjustment.
The purpose of this study was to formulate and test two case-mix models for depression treatment that permit comparisons of patient outcomes across diverse clinical settings. It assessed demographics; eight, diagnostic-specific, case-mix variables; and clinical status at baseline and follow-up for 187 patients. Regressions were performed to test two models for four dependent variables including depression severity and diagnosis. Individual treatment settings were then ranked based on a comparison of actual versus predicted outcomes using regression coefficients and predictor variables. A model inclusive of baseline physical health status and depression severity predicted depression severity, mental health, and physical health functioning at follow-up. A simpler model performed well in predicting depression remission. This study identifies variables to be included in case-mix adjustment models and demonstrates statistical methods to control for differences across settings when comparing depression outcomes.
Kramer
T L
TL
Centers for Mental Healthcare Research, Little Rock, AR 72204, USA. KramerTeresaL@exchange.uams.edu
Evans
R B
RB
Landes
R
R
Mancino
M
M
Booth
B M
BM
Smith
G R
GR
D000046:Academic Medical Centers; D000328:Adult; D000554:Ambulatory Care Facilities; D001131:Arkansas; D003627:Data Interpretation, Statistical; D003863:Depression / Q000175:diagnosis / Q000628:therapy*; D003953:Diagnosis-Related Groups; D005260:Female; D005500:Follow-Up Studies; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000592:standards* / Q000706:statistics & numerical data; D008875:Middle Aged; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D020379:Risk Adjustment