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  • Measure Summary
  • NQMC:001629
  • Jan 2005

Depression: percent of patients with a diagnosis of minor depression, depression not otherwise specified (NOS), or adjustment disorder (New Episode Patient Health Questionnaire [PHQ] less than 10) who are NOT on an antidepressant.

HDC topics: depression. [internet]. Rockville (MD): HRSA Health Disparities Collaboratives; 2005 [accessed 2005 Mar 31]. [9 p].

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in October 2015.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This population-based measure is used in primary care settings to assess the percent of patients with a diagnoses of minor depression, depression not otherwise stated (NOS), or adjustment disorder (New Episode Patient Health Questionnaire [PHQ]* less than 10) who are NOT on an antidepressant**.

It is recommended that this measure be used in conjunction with the related measure Patients with a diagnosis of major depression or dysthymia on an antidepressant at last visit.

This measure assesses evidence-based non-use of antidepressant medications for minor depression. Furthermore, most studies of the chronic care model have found effectiveness for major depression but not minor depression (Katon W, et al., JAMA 1995; Katon W, et al., Arch Gen Psychiatry 1996).

Efficacy studies of minor depression have provided only mixed support for a small to moderate benefit for antidepressant medications.

Better evidence is that antidepressants are helpful, if there is severe functional impairment. Selective serotonin receptor inhibitors (SSRIs) have been shown to be helpful for premenstrual dysphoric disorder.

*New Episode PHQ = The PHQ measurement item in PECS that is used to track the PHQ results at the beginning of a depressive episode

**For a list of specified antidepressants, see the "Numerator Inclusions/Exclusions" field in the Complete Summary.

Rationale

Depression is one of the most common chronic illnesses in the United States, with a one-year prevalence rate of 5-6 percent. Depression is twice as common in women as in men; it is estimated that 20 percent of women and 10 percent of men will have an episode of major depression at some point in their lives. Depression often takes a severe toll on the physical and social functioning of those who suffer from it. According to one study using the SF-36 quality-of-life measure, depression impaired social functioning more than any other chronic illness, including arthritis, diabetes, congestive heart failure (CHF), angina, and hypertension; and impaired physical functioning more than any other chronic condition except the cardiac illnesses.

Depression care in the United States is even more fragmented than care of other chronic illnesses, creating a major gap between the recommended guidelines for care and actual care. It is estimated that only 19 percent--fewer than 1 in 5--of people with depression who see their primary care provider receive appropriate, guideline-based care.

Improving depression care is not only a matter of meeting the typical challenges of providing good chronic illness care--following people over time rather than responding to acute episodes, providing systematic follow-up to ensure that patients adhere to treatment plans, and so on. In addition, depression care brings its own complex set of challenges, ranging from underdiagnosis to financial disincentives for providers to special treatment requirements because the underlying nature of the illness frequently undercuts patients' ability to be effective managers of their own care.

This measure is one of 8 additional recommended measures in the HRSA Health Disparities Collaborative for Depression; participants choose to track at least one of these measures. Participants also track 5 measures for the Depression Collaborative.

Evidence for Rationale

HDC topics: depression. [internet]. Rockville (MD): HRSA Health Disparities Collaboratives; 2005 [accessed 2005 Mar 31]. [9 p].

Institute for Healthcare Improvement. Health Disparities Collaboratives changing practice, changing lives: depression training manual. Cambridge (MA): Institute for Healthcare Improvement; 2002. 87 p.

Primary Health Components

Minor depression; depression not otherwise specified (NOS); adjustment disorder; antidepressant medication

Denominator Description

All patients with a diagnosis of minor depression, depression not otherwise specified (NOS), or adjustment disorder (last New Episode Patient Health Questionnaire [PHQ]* less than 10)

*New Episode PHQ = The PHQ measurement item that is used to track the PHQ results at the beginning of a depressive episode

Numerator Description

All patients with a diagnosis of minor depression, depression not otherwise specified (NOS), or adjustment disorder (last New Episode Patient Health Questionnaire [PHQ]* less than 10) NOT on an antidepressant (see the related "Numerator Inclusions/Exclusions" field in the Complete Summary)

*New Episode PHQ = The PHQ measurement item that is used to track the PHQ results at the beginning of a depressive episode

Type of Evidence Supporting the Criterion of Quality for the Measure

  • 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

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Collaborative inter-organizational quality improvement

Internal quality improvement

Measurement Setting

Ambulatory/Office-based Care

Behavioral Health Care

Community Health Care

Professionals Involved in Delivery of Health Services

Physicians

Psychologists/Non-physician Behavioral Health Clinicians

Least Aggregated Level of Services Delivery Addressed

Clinical Practice or Public Health Sites

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Person- and Family-centered Care
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Equity

Patient-centeredness

Case Finding Period

The last workday of the month

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Diagnostic Evaluation

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients with a diagnosis of minor depression, depression not otherwise specified (NOS), or adjustment disorder (last New Episode Patient Health Questionnaire [PHQ]* less than 10)

*New Episode PHQ = The PHQ measurement item that is used to track the PHQ results at the beginning of a depressive episode

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
All patients with a diagnosis of minor depression, depression not otherwise specified (NOS), or adjustment disorder (last New Episode Patient Health Questionnaire [PHQ]* less than 10) NOT on an antidepressant**

*New Episode PHQ = The PHQ measurement item that is used to track the PHQ results at the beginning of a depressive episode

**Antidepressants include the following:

Tricyclics

  • Amitriptyline (Elavil)
  • Desipramine (Norpramin)
  • Doxepine (Sinequan)
  • Imipramine (Tofranil)
  • Nortriptyline (Pamelor)

Selective serotonin receptor inhibitors (SSRIs)

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Paroxetine CR (Paxil)
  • Sertraline (Zoloft)

Other antidepressants

  • Bupropion SR (Wellbutrin)
  • Mirtazapine (Remeron)
  • Nefazodone (Serzone)
  • Venlafaxine XR (Effexor)

Exclusions
Unspecified

Numerator Search Strategy

Episode of care

Data Source

Registry data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Patient Health Questionnaire (PHQ)

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Prescriptive standard

Prescriptive Standard

Greater than 90%

Evidence for Prescriptive Standard

HDC topics: depression. [internet]. Rockville (MD): HRSA Health Disparities Collaboratives; 2005 [accessed 2005 Mar 31]. [9 p].

Original Title

Patients with diagnoses of minor depression, depression NOS, or adjustment disorder (PHQ less than 10) NOT on an antidepressant.

Measure Collection Name

HRSA Health Disparities Collaboratives (HDC) Measures

Measure Set Name

HRSA HDC Depression Collaborative Measures

Submitter

Health Resources and Services Administration - Federal Government Agency [U.S.]

Developer

HRSA Health Disparities Collaboratives: Depression Collaborative - Federal Government Agency [U.S.]

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Unspecified

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2005 Jan

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in October 2015.

Source(s)

HDC topics: depression. [internet]. Rockville (MD): HRSA Health Disparities Collaboratives; 2005 [accessed 2005 Mar 31]. [9 p].

Measure Availability

Source not available electronically.

For more information, contact the Health Resources and Services Administration at 5600 Fishers Lane, Room 7-100, Parklawn Building, Rockville, MD 20857; Phone: 888-275-4772.

Companion Documents

The following is available:

  • Institute for Healthcare Improvement. Health Disparities Collaboratives changing practice, changing lives: depression training manual. Cambridge (MA): Institute for Healthcare Improvement; 2002. 89 p.

NQMC Status

This NQMC summary was completed by ECRI on July 27, 2005. The information was verified by the measure developer on May 22, 2006.

This NQMC summary was retrofitted into the new template on July 11, 2011.

The information was reaffirmed by the measure developer on October 28, 2015.

Copyright Statement

No copyright restrictions apply.

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