Clinical Quality Measures: Process
Does not apply to this measure
This measure is used to assess the percentage of patients with Bipolar I Disorder with depressive symptoms and behaviors who have evidence of use of a mood stabilizing or antimanic agent during the first 12 weeks of pharmacotherapy treatment.
Goals of Acute Treatment: Bipolar Disorder Depressive Episodes
- Remission of symptoms with a full return to usual levels of psychosocial functioning.
- Avoid mood destabilization and precipitating a manic or hypomanic episode.
Initial Treatment Considerations
- Treatment selection is dependent on illness severity, associated clinical features and patient preference.
- Treatment choice should also consider patient history, potential side effects and individual therapeutic response to specific pharmacotherapy agents.
Initial Treatment Recommendations
- Guidelines suggest lithium or lamotrigine alone or for patients refractory to monotherapy in combination with an atypical antipsychotic or lithium or lamotrigine alone or in combination, simultaneously, with an antidepressant.
- For patients refractory to the combinations above, guideline recommendations include the use of additional antimanic and antipsychotic agents.
- The use of antidepressants even in combination with a mood stabilizing or antimanic agent has been associated with some controversy over their potential to induce a mood switch.
|Guideline watch: practice guideline for the treatment of patients with bipolar disorder. 2nd ed. Arlington (VA): American Psychiatric Association; 2006. 9 p.|
|Keck PE, Perlis R, Otto M, Carpenter D, Ross R, Docherty J. Treatment of bipolar disorder 2004. In: Expert consensus guideline series, postgraduate medicine - a special report. 2004 Dec.|
|Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry. 2002 Apr;159(4 Suppl):1-50. [472 references] PubMed|
|Suppes T, Dennehy EB, Hirschfeld RM, Altshuler LL, Bowden CL, Calabrese JR, Crismon ML, Ketter TA, Sachs GS, Swann AC. The Texas implementation of medication algorithms: update to the algorithms for treatment of bipolar I disorder. J Clin Psychiatry. 2005 Jul;66(7):870-86. PubMed|
Bipolar I Disorder; depression; mood stabilizing agent; antimanic agent
Patients with Bipolar I Disorder with symptoms or episodes that involve depression (see the related "Denominator Inclusions/Exclusions" field)
Patients with evidence of use of a mood stabilizing or antimanic agent during the first 12 weeks of pharmacotherapy treatment (see the related "Numerator Inclusions/Exclusions" field)
- A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
- A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
- One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal
- The STABLE measures were developed using the RAND Appropriateness Method and have been shown to have content validity and face validity.
- Data feasibility testing was performed to determine the availability of the data elements required in the measure numerator and denominator specifications.
- Inter-abstractor reliability testing was performed to assess the data collection strategy. The data collection strategy included data collection forms; data dictionary references and abstractor instructions.
- A field study was conducted to determine measure conformance in an appropriate convenience sample.
Refer to the references listed below for further information.
|STABLE performance measures: data feasibility testing & results. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. 2 p.|
|STABLE performance measures: development process & validity ratings. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. 3 p.|
|STABLE performance measures: field study process & conformance findings. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. 3 p.|
|STABLE performance measures: inter-abstractor reliability testing & results. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. 2 p.|
Behavioral Health Care
Advanced Practice Nurses
Psychologists/Non-physician Behavioral Health Clinicians
Individual Clinicians or Public Health Professionals
Age greater than or equal to 18 years
Either male or female
Prevention and Treatment of Leading Causes of Mortality
Patients associated with provider
Patient/Individual (Consumer) Characteristic
Does not apply to this measure
Patients 18 years of age or older with an initial diagnosis or new presentation/episode of bipolar disorder
Documentation of Bipolar I Disorder with depressive symptoms, behaviors or episodes; to include at least one of the following:
- Code 296.5x documented in body of chart, such as a pre-printed form completed by a clinician and/or codes documented in chart notes/forms
- Diagnosis or impression documented in chart indicating Bipolar I Disorder with current depressive symptoms, behaviors or episodes
Exclude case from denominator population if numerator-required pharmacotherapy is not prescribed and the reason(s) for not prescribing is documented in chart, such as, not clinically indicated; not prescribed for related medical reasons (allergy, drug interaction); or not prescribed for patient reasons (patient refusal), etc.
Documented treatment with at least one pharmacotherapy agent with mood stabilizing or antimanic properties (Refer to the "Data Dictionary Reference" in the original measure documentation for specified medications.)
Documentation of the stated pharmacotherapy must be within the first 12 weeks of treatment.
Fixed time period or point in time
Administrative clinical data
Paper medical record
Does not apply to this measure
Does not apply to this measure
Desired value is a higher score
Internal time comparison
Bipolar disorder: use of mood stabilizing or antimanic agent in BD I with depression.
Standards for Bipolar Excellence (STABLE) Performance Measures
Center for Quality Assessment and Improvement in Mental Health - Clinical Specialty Collaboration
STABLE Project National Coordinating Council - Clinical Specialty Collaboration
AstraZeneca LLP, Wilmington, Delaware, provided financial sponsorship for the STABLE Project. They did not otherwise participate in the development of either the measures or toolkit.
The STABLE National Coordinating Council (NCC) was comprised of national experts in bipolar disorder, psychiatry, primary care, and performance improvement. The NCC guided and directed the STABLE Project. NCC members agreed to serve with the understanding that the STABLE Performance Measures and Resource Toolkit would be fully transparent and available without cost in the public domain.
EPI-Q, Inc. , is a consulting company providing practice-based outcomes research, pharmacoeconomic studies, and quality improvement services. EPI-Q managed the STABLE Project.
This measure was not adapted from another source.
This is the current release of the measure.
The measure developer reaffirmed the currency of this measure in September 2015.
|STABLE (STAndards for BipoLar Excellence) performance measures. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. various p.|
Source available from the Center for Quality Assessment and Improvement in Mental Health (CQAIMH) Web site .
The following is available:
- STABLE National Coordinating Council Resource Toolkit Workgroup. STABLE resource toolkit. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007 Mar. 67 p. This document is available in Portable Document Format (PDF) from the Center for Quality Assessment and Improvement in Mental Health (CQAIMH) Web site .
This NQMC summary was completed by ECRI Institute on January 10, 2008. The information was verified by the measure developer on April 14, 2008.
This NQMC summary was retrofitted into the new template on June 27, 2011.
The information was reaffirmed by the measure developer on September 30, 2015.
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