Measuring the quality of depression care in a large integrated health system.
BACKGROUND
Guideline-based depression process measures provide a powerful way to monitor depression care and target areas needing improvement.


OBJECTIVE
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.


METHODS
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.


METHODS
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 (<65), black race, and treatment exclusively in primary care.


CONCLUSIONS
Under-treatment of depression exists in the VHA, despite considerable mental health access and generous pharmacy benefits. Certain patient populations may be at higher risk for inadequate depression care. More work is needed to align current practice with best-practice guidelines and to identify optimal ways of using available data sources to monitor depression care quality.
Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts 01730, USA. acharb@bu.edu
Andrea
A
Charbonneau
Amy K
AK
Rosen
Arlene S
AS
Ash
Richard R
RR
Owen
Boris
B
Kader
Avron
A
Spiro
Cheryl
C
Hankin
Lawrence R
LR
Herz
Mary
M
Jo V  Pugh
Lewis
L
Kazis
Donald R
DR
Miller
Dan R
DR
Berlowitz
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated / Q000592:standards*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000208:ethnology; D017723:Drug Utilization Review; D005260:Female; D006302:Health Services Research; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009511:New England; D009518:New York; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000379:methods*; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs
D000928:Antidepressive Agents