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    Monitoring depression care: in search of an accurate quality indicator

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    Authors
    Charbonneau, Andrea
    Rosen, Amy K.
    Owen, Richard R.
    Spiro, Avron III
    Ash, Arlene S.
    Miller, Donald R.
    Kazis, Lewis
    Kader, Boris
    Cunningham, Fran
    Berlowitz, Dan R.
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2004-05-29
    Keywords
    Adult
    Aged
    Antidepressive Agents
    Cohort Studies
    Comorbidity
    Depressive Disorder
    *Drug Utilization Review
    Female
    Hospitalization
    Hospitals, Psychiatric
    Hospitals, Veterans
    Humans
    Logistic Models
    Male
    Mental Health Services
    Middle Aged
    New England
    New York
    Outcome and Process Assessment (Health Care)
    *Quality Indicators, Health Care
    United States
    United States Department of Veterans Affairs
    Biostatistics
    Epidemiology
    Health Services Research
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    Link to Full Text
    http://journals.lww.com/lww-medicalcare/Abstract/2004/06000/Monitoring_Depression_Care__In_Search_of_an.4.aspx
    Abstract
    BACKGROUND: Linking process and outcomes is critical to accurately estimating healthcare quality and quantifying its benefits. OBJECTIVES: The objective of this study was to explore the relationship of guideline-based depression process measures with subsequent overall and psychiatric hospitalizations. RESEARCH DESIGN: 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. SUBJECTS: 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.
    Source
    Med Care. 2004 Jun;42(6):522-31. Link to article on publisher's site
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/47593
    PubMed ID
    15167320
    Related Resources
    Link to Article in PubMed
    Collections
    Population and Quantitative Health Sciences Publications

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