title: Conformance to Depression Process Measures of Medicare Part B Beneficiaries in Primary Care Settings.
abstract: OBJECTIVE
  To evaluate conformance to depression screening, management, and outcome quality indicators and to evaluate individual characteristics associated with conformance to these indicators.
  
  
  METHODS
  Cross-sectional study using electronic health record (EHR) data.
  
  
  METHODS
  Thirty-four clinics in one healthcare system.
  
  
  METHODS
  Medicare beneficiaries aged 65 and older with at least one primary care visit between September 2010 and August 2012 (N = 5,000).
  
  
  METHODS
  Seven measures, current as of 2013, were found for which all the necessary specifications were available in the EHR: general screening, screening within 4 months of diagnosis, screening after stroke, screening after heart disease, depression reassessment, depression response, and depression remission. Multilevel logistic regression analyses were used to determine factors associated with conformance.
  
  
  RESULTS
  Screening for depression in Medicare beneficiaries was low (17%). Conformance to measures varied from 10% for the depression response measure to 77% for the depression remission measure. In the adjusted regression analyses for the general screening (adjusted odds ratio (AOR) = 1.45, 95% confidence interval (CI) = 1.01-2.08), depression reassessment (AOR = 4.19, 95% CI = 1.16-15.19), and screening after heart disease (AOR = 5.57, 95% CI = 1.37-22.57) measures, black participants were more likely to be given care that conformed to the numerator criteria than white participants. A strong site effect was found, with 90% of the depression screens being administered at three sites.
  
  
  CONCLUSIONS
  Only a small proportion of Medicare beneficiaries received the recommended screening and follow-up care needed to conform to the quality measures for depression in the primary care setting. Further evaluation of measures of depression care should be conducted before these measures are implemented widely.
authors.affiliation: Division of General Internal Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland.|Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Pfoh
authors.affiliation: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Ramin
authors.initials: R
authors.lastname: Mojtabai
authors.affiliation: Johns Hopkins Community Physicians, Baltimore, Maryland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bailey
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Weiner
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Sydney M
authors.initials: SM
authors.lastname: Dy
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D004219:District of Columbia / Q000453:epidemiology; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008403:Mass Screening; D016345:Medicare Part B; D011320:Primary Health Care; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: Medicare; depression; quality assessment; screening