Monitoring depression care: in search of an accurate quality indicator.
BACKGROUND
Linking process and outcomes is critical to accurately estimating healthcare quality and quantifying its benefits.


OBJECTIVE
The objective of this study was to explore the relationship of guideline-based depression process measures with subsequent overall and psychiatric hospitalizations.


METHODS
This is a retrospective cohort study during which we used administrative and centralized pharmacy records for sample identification, derivation of guideline-based process measures (antidepressant dosage and duration adequacy), and subsequent hospitalization ascertainment. Depression care was measured from June 1, 1999, through August 31, 1999. We used multivariable regression to evaluate the link between depression care and subsequent overall and psychiatric hospitalization, adjusting for patient age, race, sex, socioeconomic status, comorbid illness, and hospitalization in the prior 12 months.


METHODS
We studied a total of 12,678 patients from 14 Northeastern VHA hospitals.


RESULTS
We identified adequate antidepressant dosage in 90% and adequate duration in 45%. Those with adequate duration of antidepressants were less likely to be hospitalized in the subsequent 12 months than those with inadequate duration (odds ratio [OR],.90; 95% confidence interval [CI], .81-1.00). Those with adequate duration of antidepressants were less likely to have a psychiatric hospitalization in the subsequent 12 months than those with inadequate duration (OR, .82; 95% CI, .69-.96). We did not demonstrate a significant link between dosage adequacy and subsequent overall or psychiatric hospitalization.


CONCLUSIONS
Guideline-based depression process measures derived from centralized data sources offer an important method of depression care surveillance. Their accuracy in capturing depression care quality is supported by their link to healthcare utilization. Further work is needed to assess the effect of implementing these quality indicators on depression care.
Charbonneau
Andrea
A
Division of General and Geriatric Medicine, University of Kansas School of Medicine, Kansas City, KS 66160, USA. acharbonneau@kumc.edu
Rosen
Amy K
AK
Owen
Richard R
RR
Spiro
Avron
A
Ash
Arlene S
AS
Miller
Donald R
DR
Kazis
Lewis
L
Kader
Boris
B
Cunningham
Fran
F
Berlowitz
Dan R
DR
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy*; D017723:Drug Utilization Review; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006778:Hospitals, Psychiatric / Q000592:standards / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services / Q000592:standards* / Q000706:statistics & numerical data; D008875:Middle Aged; D009511:New England; D009518:New York; D010043:Outcome and Process Assessment, Health Care; D019984:Quality Indicators, Health Care; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards
D000928:Antidepressive Agents