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  • Measure Summary
  • NQMC:003490
  • Jan 2007

Depression: the percentage of patients presenting with depression who were assessed, prior to the initiation of treatment, for the presence of prior or current symptoms and/or behaviors associated with mania or hypomania.

STABLE (STAndards for BipoLar Excellence) performance measures. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. various p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

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

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients presenting with depression who were assessed, prior to the initiation of treatment, for the presence of prior or current symptoms and/or behaviors associated with mania or hypomania.

Rationale

Bipolar Disorder is an episodic illness with a variable course:

  • It is generally a lifetime condition associated with significant disability.
  • It is frequently unrecognized, underdiagnosed, and thus, not treated appropriately.

Recognition Considerations

  • Depressive episodes are the frequent presenting characteristics of both major depressive disorder and bipolar disorder.
  • Symptomatic bipolar disorder patients spend, on average, 33% of their time in a depressive phase compared to about 11% of their time in a manic/hypomanic phase.
  • Bipolar patients report considerable distress associated with their depressive symptoms and seek treatment for depression.
  • Bipolar depressive episodes are not only more numerous but, on average, also last longer than a patient's manic or hypomanic episodes.
  • Patients generally do not recognize or spontaneously report prior episodes of hypomania as these periods may be considered as normal happiness or well-being.
  • The most common incorrect diagnosis associated with bipolar disorder is unipolar depression.

Evidence for Rationale

Angst J. Do many patients with depression suffer from bipolar disorder. Can J Psychiatry. 2006 Jan;51(1):3-5. PubMed External Web Site Policy

Berk M, Dodd S. Bipolar II disorder: a review. Bipolar Disord. 2005 Feb;7(1):11-21. [151 references] PubMed External Web Site Policy

CME Institute of Physicians Postgraduate Press, Inc. Emerging therapies for bipolar depression. J Clin Psychiatry. 2006 Jul;67(7):1140-51. PubMed External Web Site Policy

Post RM, Calabrese JR. Bipolar depression: the role of atypical antipsychotics. Expert Rev Neurother. 2004 Nov;4(6 Suppl 2):S27-33. PubMed External Web Site Policy

STABLE (STAndards for BipoLar Excellence) performance measures. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. various p.

Thase ME. Bipolar depression: issues in diagnosis and treatment. Harv Rev Psychiatry. 2005 Sep-Oct;13(5):257-71. [152 references] PubMed External Web Site Policy

Primary Health Components

Unipolar depression; bipolar disorder; mania; hypomania; assessment

Denominator Description

Patients diagnosed and treated for unipolar depression (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Patients who receive an assessment, prior to treatment for unipolar depression, that includes consideration of current and/or prior manic or hypomanic symptoms or behaviors (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • 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

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

  • 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.

Evidence for Extent of Measure Testing

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.

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Ambulatory/Office-based Care

Behavioral Health Care

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Physicians

Psychologists/Non-physician Behavioral Health Clinicians

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

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

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Diagnostic Evaluation

Encounter

Patient/Individual (Consumer) Characteristic

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Patients 18 years of age or older with an initial diagnosis or new presentation/episode of depression

AND

Documentation of a diagnosis involving unipolar depression; to include at least one of the following:

  • Codes 296.2x; 296.3x. 300.4 or 311 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 "depression"
  • Use of a screening/assessment tool for depression with a documented score or conclusion that the patient is clinically depressed and indication that this information is used to establish or substantiate the diagnosis

AND

Documentation of treatment for depression, to include at least one of the following:

  • Antidepressant pharmacotherapy

    AND/OR

  • Psychotherapy and/or counseling for depression; provided at practice site or through referral

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Documentation of a screening or assessment that considers the presence or absence of current and/or prior symptoms or behaviors of mania or hypomania. Sources of this documentation may include the following:

  • Clinician statement in patient record regarding inquiry regarding the presence or absence of current or prior symptoms or behaviors associated with mania or hypomania
  • Use of a bipolar disorder screening or assessment tool for mania/hypomania symptoms or behaviors

AND

Timeframe:
Documentation of the screening or assessment for mania/hypomania must be present prior to, or concurrent with, the visit where the treatment plan for depression (pharmacotherapy and/or psychotherapy) is documented.

Exclusions
Unspecified

Numerator Search Strategy

Encounter

Data Source

Administrative clinical data

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

*Composite International Diagnostic Interview

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

Original Title

Depression: screening for bipolar mania/hypomania prior to treatment for depression.

Measure Collection Name

Standards for Bipolar Excellence (STABLE) Performance Measures

Submitter

Center for Quality Assessment and Improvement in Mental Health - Clinical Specialty Collaboration

Developer

STABLE Project National Coordinating Council - Clinical Specialty Collaboration

Funding Source(s)

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.

Composition of the Group that Developed the Measure

The STABLE National Coordinating Council (NCC) External Web Site Policy 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. External Web Site Policy, is a consulting company providing practice-based outcomes research, pharmacoeconomic studies, and quality improvement services. EPI-Q managed the STABLE Project.

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2007 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 September 2015.

Source(s)

STABLE (STAndards for BipoLar Excellence) performance measures. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. various p.

Measure Availability

Source available from the Center for Quality Assessment and Improvement in Mental Health (CQAIMH) Web site External Web Site Policy.

For more information, contact CQAIMH at E-mail: cqaimh@cqaimh.org; Web site: cqaimh.org/index.html External Web Site Policy.

Companion Documents

The following is available:

NQMC Status

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.

Copyright Statement

The STABLE materials published on this Web site are copyrighted by CQAIMH. They may be used for research, teaching, and quality measurement/improvement activities – provided the following:

  • The materials are not sold, distributed or licensed for commercial purposes.
  • CQAIMH's copyright is acknowledged in reproductions of these materials.
  • Modifications to the materials are not made without CQAIMH's permission.

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