title: The relationship of system-level quality improvement with quality of depression care.
abstract: OBJECTIVE
  To explore the relationship of systemwide continuous quality improvement (CQI) with depression care quality in the Veterans Health Administration (VHA).
  
  
  METHODS
  Observational study using data from 2 VHA studies.
  
  
  METHODS
  The Depression Care Quality Study (DCQS) was a retrospective cohort study of depression care quality in the northeastern United States involving 12 678 patients cared for at 14 VHA facilities; it used guideline-based process measures (ie, dosage and duration adequacy). The VHA CQI survey was a cross-sectional survey of systemwide CQI among a representative sample of VHA hospitals; it assessed CQI and organizational culture (OC) at 116 VHA hospitals nationwide and provided data on the 14 study facilities. We used analysis of variance to identify differences in the adequacy of depression care among these facilities. Pearson's correlation was used to identify the relationship of CQI and OC with facility-level depression care adequacy.
  
  
  RESULTS
  Mean depression care adequacy differed among the 14 DCQS facilities (P < .0001). Overall dosage adequacy was 90% (range: 87%-92%). Overall duration adequacy was 45% (range: 39%-64%). There was no correlation between CQI and either dosage adequacy (r= .004, P= .98) or duration adequacy (r= -.17, P= .55). Similarly, there was no correlation between OC and either dosage adequacy (r= -.35, P= .22) or duration adequacy (r= -.12, P= .68).
  
  
  CONCLUSIONS
  Although CQI may help bridge the healthcare quality gap, it may not be associated with higher disease-specific quality of care.
authors.affiliation: Division of General and Geriatric Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA. acharbonneau@kumc.edu
authors.forename: Andrea
authors.initials: A
authors.lastname: Charbonneau
authors.forename: Victoria
authors.initials: V
authors.lastname: Parker
authors.forename: Mark
authors.initials: M
authors.lastname: Meterko
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
authors.forename: Boris
authors.initials: B
authors.lastname: Kader
authors.forename: Richard R
authors.initials: RR
authors.lastname: Owen
authors.forename: Arlene S
authors.initials: AS
authors.lastname: Ash
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Whittle
authors.forename: Dan R
authors.initials: DR
authors.lastname: Berlowitz
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019985:Benchmarking; D015331:Cohort Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D038801:International Classification of Diseases; D008875:Middle Aged; D009511:New England; D009518:New York; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013597:Systems Analysis; D017749:Total Quality Management; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*
chemical_list: D000928:Antidepressive Agents