title: Depression Quality of Care: Measuring Quality over Time Using VA Electronic Medical Record Data.
abstract: BACKGROUND
  The Veterans Health Administration (VA) has invested substantially in evidence-based mental health care. Yet no electronic performance measures for assessing the level at which the population of Veterans with depression receive appropriate care have proven robust enough to support rigorous evaluation of the VA's depression initiatives.
  
  
  OBJECTIVE
  Our objectives were to develop prototype longitudinal electronic population-based measures of depression care quality, validate the measures using expert panel judgment by VA and non-VA experts, and examine detection, follow-up and treatment rates over a decade (2000-2010). We describe our development methodology and the challenges to creating measures that capture the longitudinal course of clinical care from detection to treatment.
  
  
  METHODS
  Data come from the National Patient Care Database and Pharmacy Benefits Management Database for primary care patients from 1999 to 2011, from nine Veteran Integrated Service Networks.
  
  
  METHODS
  We developed four population-based quality metrics for depression care that incorporate a 6-month look back and 1-year follow-up: detection of a new episode of depression, 84 and 180 day follow-up, and minimum appropriate treatment 1-year post detection. Expert panel techniques were used to evaluate the measure development methodology and results. Key challenges to creating valid longitudinal measures are discussed.
  
  
  RESULTS
  Over the decade, the rates for detection of new episodes of depression remained stable at 7-8 %. Follow-up at 84 and 180 days were 37 % and 45 % in 2000 and increased to 56 % and 63 % by 2010. Minimum appropriate treatment remained relatively stable over the decade (82-84 %).
  
  
  CONCLUSIONS
  The development of valid longitudinal, population-based quality measures for depression care is a complex process with numerous challenges. If the full spectrum of care from detection to follow-up and treatment is not captured, performance measures could actually mask the clinical areas in need of quality improvement efforts.
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street (152), Sepulveda, CA, 91343, USA. Melissa.Farmer@va.gov.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Farmer
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street (152), Sepulveda, CA, 91343, USA.|RAND, Santa Monica, CA, USA.|David Geffen School of Medicine and Fielding School of Public Health, University of California, Los Angeles, CA, USA.
authors.forename: Lisa V
authors.initials: LV
authors.lastname: Rubenstein
authors.affiliation: RAND, Santa Monica, CA, USA.
authors.forename: Cathy D
authors.initials: CD
authors.lastname: Sherbourne
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street (152), Sepulveda, CA, 91343, USA.
authors.forename: Alexis
authors.initials: A
authors.lastname: Huynh
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street (152), Sepulveda, CA, 91343, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Chu
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street (152), Sepulveda, CA, 91343, USA.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Lam
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street (152), Sepulveda, CA, 91343, USA.
authors.forename: Jacqueline J
authors.initials: JJ
authors.lastname: Fickel
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street (152), Sepulveda, CA, 91343, USA.|David Geffen School of Medicine and Fielding School of Public Health, University of California, Los Angeles, CA, USA.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Lee
authors.affiliation: VA Ann Arbor, HSR&D Center for Clinical Management Research, Ann Arbor, MI, USA.
authors.forename: Maureen E
authors.initials: ME
authors.lastname: Metzger
authors.affiliation: VA Ann Arbor, HSR&D Center for Clinical Management Research, Ann Arbor, MI, USA.
authors.forename: Lilia
authors.initials: L
authors.lastname: Verchinina
authors.affiliation: VA Ann Arbor, HSR&D Center for Clinical Management Research, Ann Arbor, MI, USA.|University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Post
authors.affiliation: University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Edmund F
authors.initials: EF
authors.lastname: Chaney
mesh_terms: D015331:Cohort Studies; D016208:Databases, Factual / Q000639:trends; D003663:Decision Trees; D003697:Delphi Technique; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D057286:Electronic Health Records / Q000592:standards / Q000639:trends*; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D011159:Population Surveillance / Q000379:methods; D011787:Quality of Health Care / Q000592:standards / Q000639:trends*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards / Q000639:trends*; D014728:Veterans
keywords: Veterans; depression; measurement; performance measurement; quality assessment