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  • Measure Summary
  • NQMC:010196
  • Jan 2013

Major depressive disorder (MDD): percentage of patients aged 18 years and older with a diagnosis of MDD who received patient education at least once during the measurement period, regarding the minimum specified criteria.

American Psychiatric Association (APA), American Medical Association-convened Physician Consortium for Performance Improvement® (PCPI®). Adult major depressive disorder performance measurement set. Washington (DC): American Psychiatric Association (APA); 2013 Jan. 53 p. [32 references]

This is the current release of the measure.

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 aged 18 years and older with a diagnosis of major depressive disorder (MDD) who received patient education at least once during the measurement period, regarding, at a minimum:

  1. The symptoms and treatment of major depressive disorder, including somatic symptoms, potential side effects, suicidal thoughts and behaviors, and the importance of treatment adherence
  2. Its effects on functioning (including relationships, work, etc.)
  3. The effect of healthy behaviors on depression, such as exercise, good sleep hygiene, good nutrition, and decreased use of tobacco, alcohol, and other potentially deleterious substances

Rationale

Patient education regarding the symptoms and treatment of major depressive disorder (MDD), its effects on functioning (including relationships, work, etc.) and the effect of healthy behaviors on depression can greatly aid in a patient's understanding of their depression and their adherence to treatment. Patient education allows patients to become more knowledgeable and engaged with their treatment. Psychoeducational strategies should be incorporated into structured and organized treatment protocols, which entail systematic monitoring of treatment adherence and response and self-management strategies.

One of the key factors in nonadherence to MDD treatment is failure of patients to receive explanation of diagnosis and causes of illness. Ongoing patient education, whether verbal or written, is very important in improving treatment adherence for patients with MDD. At regular patient visits, clinicians should reinforce patient education, the need for continued MDD treatment, possible treatment modification, and assessment of adherence. In addition, clinicians should educate patients and their families to self-assess for symptoms and risk for recurrent MDD episodes.

The following evidence statements are quoted verbatim from the referenced clinical guidelines. Only selected portions of the clinical guidelines are quoted here; for more details, please refer to the full guideline.

Education about the symptoms and treatment of major depressive disorder should be provided in language that is readily understandable to the patient (American Psychiatric Association [APA], 2010).

With the patient's permission, family members and others involved in the patient's day-to-day life may also benefit from education about the illness, its effects on functioning (including family and other interpersonal relationships), and its treatment (APA, 2010).

Education about major depressive disorder should address the need for a full acute course of treatment, the risk of relapse, the early recognition of recurrent symptoms, and the need to seek treatment as early as possible to reduce the risk of complications or a full-blown episode of major depression (APA, 2010).

Patient education also includes general promotion of healthy behaviors such as exercise, good sleep hygiene, good nutrition, and decreased use of tobacco, alcohol, and other potentially deleterious substances (APA, 2010).

Educational tools such as books, pamphlets, and trusted web sites can augment the face-to-face education provided by the clinician (APA, 2010).

Psychoeducation should be provided for individuals with depression at all levels of severity and in all care settings and should be provided both verbally and with written educational materials (Management of MDD Working Group, 2009).

There should be education on the nature of depression and its treatment options (Management of MDD Working Group, 2009).

Education should incorporate principles of self-management and may include information and goals related to: Nutrition, Exercise, Bibliotherapy, Sleep hygiene, Tobacco use, Caffeine use, Alcohol use and abuse, and Pleasurable activities (Management of MDD Working Group, 2009).

Psychoeducational strategies should be incorporated into structured and organized treatment protocols, which entail structured systematic monitoring of treatment adherence and response and self-management strategies (Management of MDD Working Group, 2009).

Evidence for Rationale

American Psychiatric Association (APA), American Medical Association-convened Physician Consortium for Performance Improvement® (PCPI®). Adult major depressive disorder performance measurement set. Washington (DC): American Psychiatric Association (APA); 2013 Jan. 53 p. [32 references]

American Psychiatric Association (APA). Practice guideline for the treatment of patients with major depressive disorder. 3rd ed. Arlington (VA): American Psychiatric Association (APA); 2010 Oct. 152 p.

Management of MDD Working Group. VA/DoD clinical practice guideline for management of major depressive disorder (MDD). Washington (DC): Department of Veteran Affairs, Department of Defense; 2009 May. 203 p.

Primary Health Components

Major depressive disorder (MDD); patient education

Denominator Description

All patients aged 18 years and older with a diagnosis of major depressive disorder (MDD) (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Patients who received patient education at least once during the measurement period, regarding, at a minimum:

  1. The symptoms and treatment of major depressive disorder, including somatic symptoms, potential side effects, suicidal thoughts and behaviors, and the importance of treatment adherence
  2. Its effects on functioning (including relationships, work, etc.)
  3. The effect of healthy behaviors on depression, such as exercise, good sleep hygiene, good nutrition, and decreased use of tobacco, alcohol, and other potentially deleterious substances

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

Prevalence and Incidence

  • Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population aged 18 and older in a given year (National Institute of Mental Health [NIMH], 2010).
  • While major depressive disorder can develop at any age, the median age at onset is 32 (NIMH, 2010).
  • Major depressive disorder is more prevalent in women than in men (NIMH, 2010).
  • Depressive disorders are more common among persons with chronic conditions (e.g., obesity, cardiovascular disease, diabetes, asthma, arthritis, and cancer) and among those with unhealthy behaviors (e.g., smoking, physical inactivity, and binge drinking) (Centers for Disease Control and Prevention [CDC], 2010).

Disability

  • Major depressive disorder is the leading cause of disability in the U.S. for ages 15 to 44 (NIMH, 2010).

Suicide

  • Research has shown that more than 90% of people who kill themselves have depression or another diagnosable mental or substance abuse disorder (Conwell & Brent, 1995).
  • Depression is the cause of over two-thirds of the 30,000 reported suicides in the U.S. each year (Depression and Bipolar Support Alliance, 2010).
  • The suicide rate for older adults is more than 50% higher than the rate for the nation as a whole. Up to two-thirds of older adult suicides are attributed to untreated or misdiagnosed depression (Depression and Bipolar Support Alliance, 2010).

Disparities

  • Non-Hispanic blacks, Hispanics, and non-Hispanic persons of other races are more likely to report major depression than non-Hispanic whites, based on responses to the Patient Health Questionnaire 8 (PHQ-8), which covers eight of the nine criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) for diagnosis of major depressive disorder (CDC, 2010).
  • For individuals who experienced a depressive disorder in the past year, 63.7% of Latinos, 68.7% of Asians, and 58.8% of African Americans, compared with 40.2% of non-Latino whites, did not access any mental health treatment in the past year (Alegría et al., 2008).

Special Populations: Geriatrics

  • The rate of depression in adults older than 65 years of age ranges from 7% to 36% in medical outpatient clinics and increases to 40% in the hospitalized elderly (Institute for Clinical Systems Improvement [ICSI], 2010).
  • Comorbidities are more common in the elderly. The highest rates of depression are found in those with strokes (30% to 60%), coronary artery disease (up to 44%), cancer (up to 40%), Parkinson's disease (40%), and Alzheimer's disease (20% to 40%) (ICSI, 2010).
  • Similar to other groups, the elderly with depression are more likely than younger patients to underreport depressive symptoms (ICSI, 2010).

Evidence for Additional Information Supporting Need for the Measure

Alegría M, Chatterji P, Wells K, Cao Z, Chen CN, Takeuchi D, Jackson J, Meng XL. Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatr Serv. 2008 Nov;59(11):1264-72. PubMed External Web Site Policy

American Psychiatric Association (APA), American Medical Association-convened Physician Consortium for Performance Improvement® (PCPI®). Adult major depressive disorder performance measurement set. Washington (DC): American Psychiatric Association (APA); 2013 Jan. 53 p. [32 references]

Centers for Disease Control and Prevention (CDC). Current depression among adults---United States, 2006 and 2008. MMWR Morb Mortal Wkly Rep. 2010 Oct 1;59(38):1229-35. PubMed External Web Site Policy

Conwell Y, Brent D. Suicide and aging. I: Patterns of psychiatric diagnosis. Int Psychogeriatr. 1995 Summer;7(2):149-64. PubMed External Web Site Policy

Depression and Bipolar Support Alliance. Depression statistics. [internet]. Chicago (IL): Depression and Bipolar Support Alliance; [accessed 2010 Nov 22].

Institute for Clinical Systems Improvement (ICSI). Major depression in adults in primary care. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2010 May. 99 p. [246 references]

National Institute of Mental Health (NIMH). The numbers count: mental disorders in America. [internet]. Chicago (IL): National Institute of Mental Health (NIMH); [accessed 2010 Nov 22].

Extent of Measure Testing

This measure is being made available without any prior testing. The Physician Consortium for Performance Improvement (PCPI) recognizes the importance of testing all of its measures and encourages testing of the Adult Major Depressive Disorder measurement set by organizations or individuals positioned to do so. The Measure Testing Protocol was approved by the PCPI in 2010 and is available on the PCPI Web site (see Position Papers at http://www.ama-assn.org/ama/pub/physician-resources/physician-consortium-performance-improvement.page External Web Site Policy); interested parties are encouraged to review this document.

Evidence for Extent of Measure Testing

American Psychiatric Association (APA), American Medical Association-convened Physician Consortium for Performance Improvement® (PCPI®). Adult major depressive disorder performance measurement set. Washington (DC): American Psychiatric Association (APA); 2013 Jan. 53 p. [32 references]

National Guideline Clearinghouse Link

Practice guideline for the treatment of patients with major depressive disorder, third edition. External Web Site Policy

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

Physician Assistants

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

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

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Patient-centeredness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients aged 18 years and older with a diagnosis of major depressive disorder (MDD)

Exclusions
Unspecified

Exceptions
Documentation of patient reason(s) for not receiving patient education (e.g., patient unable or unwilling to receive patient education, other patient reasons)

Exclusions/Exceptions

Patient factors addressed

Numerator Inclusions/Exclusions

Inclusions
Patients who received patient education* at least once during the measurement period, regarding, at a minimum:

  1. The symptoms and treatment of major depressive disorder, including somatic symptoms, potential side effects, suicidal thoughts and behaviors, and the importance of treatment adherence
  2. Its effects on functioning (including relationships, work, etc.)
  3. The effect of healthy behaviors on depression, such as exercise, good sleep hygiene, good nutrition, and decreased use of tobacco, alcohol, and other potentially deleterious substances

*Patient education can include educational tools such as books, pamphlets, DVDs and other audiovisual materials, or trusted Web sites, and can be provided at face-to-face encounters or via teleconference or web conference.

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Electronic health/medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

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

Measure #3: patient education.

Measure Collection Name

Adult Major Depressive Disorder Performance Measurement Set

Submitter

American Psychiatric Association - Medical Specialty Society

Developer

American Psychiatric Association - Medical Specialty Society

Physician Consortium for Performance Improvement® - Clinical Specialty Collaboration

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Work Group Members: Richard Hellman, MD, FACP, FACE (Co-chair) (endocrinology, methodology); John S. McIntyre, MD, DFAPA, FACPsych (Co-chair) (psychiatry, methodology); Alan A. Axelson, MD (psychiatry); Stanley Borg, DO (family medicine); Andrea Bostrom, PhD, PMHCNS-BC (nursing, psychiatric nursing); Gwendolen Buhr, MD, MHS, CMD (geriatrics); Katherine A. Burson, MS, OTR/L, CPRP (occupational therapy); Mirean Coleman, MSW, LICSW, CT (social work); Thomas J. Craig, MD, MPH, DLFAPA, FACPM (psychiatry); Allen Doederlein (patient representative); William E. Golden, MD, FACP (internal medicine); Molly Finnerty, MD (psychiatry, methodology); Jerry Halverson, MD (psychiatry, methodology); Paul R. Keith, MD (health plan representative); Clifford K. Moy, MD (psychiatry); John M. Oldham, MD (psychiatry); Shaunte R. Pohl, PharmD, BCPS (pharmaceutical science); Mark A. Reinecke, PhD (psychology); Leslie H. Secrest, MD (psychiatry); Carl A. Sirio, MD (critical care medicine, methodology); Sharon S. Sweede, MD (family medicine); Roberta Waite, EdD, APRN, CNS-BC (psychiatric nursing, methodology)

Work Group Staff: Robert Plovnick, MD, MS (American Psychiatric Association); Robert Kunkle, MA; Samantha Shugarman (American Psychiatric Association); Mark Antman, DDS, MBA (American Medical Association); Katherine Ast, MSW, LCSW (American Medical Association); Keri Christensen, MS (American Medical Association); Kendra Hanley, MS (American Medical Association); Karen Kmetik, PhD (American Medical Association); Molly Siegel, MS (American Medical Association); David Marc Small, MS, MPP (American Medical Association); Kimberly Smuk, BS, RHIA (American Medical Association); Samantha Tierney, MPH (American Medical Association); Greg Wozniak, PhD (American Medical Association)

Financial Disclosures/Other Potential Conflicts of Interest

None of the members of the Adult Major Depressive Disorder Work Group had any disqualifying material interests under the Physician Consortium for Performance Improvement (PCPI) Conflict of Interest Policy. A summary of non-disqualifying interests disclosed on Work Group members' Material Interest Disclosure Statements (not including information concerning family member interests) is provided in the original measure documentation. Completed Material Interest Disclosure Statements are available upon request.

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2013 Jan

Measure Maintenance

The Physician Consortium for Performance Improvement (PCPI) stipulates a regular review of measures every 3 years or when there is a major change in scientific evidence, results from testing or other issues noted that materially affect the integrity of the measure.

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

Source(s)

American Psychiatric Association (APA), American Medical Association-convened Physician Consortium for Performance Improvement® (PCPI®). Adult major depressive disorder performance measurement set. Washington (DC): American Psychiatric Association (APA); 2013 Jan. 53 p. [32 references]

Measure Availability

Source not available electronically.

For more information, contact the American Psychiatric Association (APA) at 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209; Phone: 888-357-7924; E-mail: apa@psych.org; Web site: psychiatry.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on October 8, 2015. The information was verified by the measure developer on November 25, 2015.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

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