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## Complete Summary

#### TITLE

Depression: percent of clinically significant depression patients with a
Patient Health Questionnaire (PHQ) score less than 5, 4 months or longer
after their last New Episode PHQ.

#### SOURCE(S)

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

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Outcome

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This population-based measure is used in primary care settings to assess
the percent of clinically significant depression\* patients with a
Patient Health Questionnaire (PHQ) score less than 5, 4 months or longer
after their last New Episode PHQ\*\*.

This measure demonstrates 4-month remission rates and allows comparison
to published research outcomes (Wells KB et al., JAMA 2000; Katon et
al., J Gen Intern Med 2002; Unutzer J et al., JAMA 2002; Rost K et al.
BMJ 2002).

Patients who are less than 4 months into treatment would not be expected
to have a consistent response and are excluded from this measure.

**Note**: The universe of patients (denominator) for this measure is
limited to the last 12 months, This enables monitoring of changes in
performance in the last 12 calendar months on a continuing basis.

\*Clinically significant depression = Patient with a diagnosis of
depression and a New Episode PHQ of 10 or greater

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

#### 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.

#### PRIMARY CLINICAL COMPONENT

Clinically significant depression; symptom reduction; Patient Health
Questionnaire (PHQ)

#### DENOMINATOR DESCRIPTION

All patients with a diagnosis of clinically significant depression\* 4
months or longer after their last New Episode Patient Health
Questionnaire (PHQ)\*\*, and last New Episode PHQ is within the last 12
calendar months

\*Clinically significant depression = Patient with a diagnosis of
depression and a New Episode PHQ of 10 or greater

\*\*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 clinically significant depression\*
who, 4 months or longer after their last New Episode Patient Health
Questionnaire (PHQ)\*\* (occurring within the last 12 calendar months),
have a most recent PHQ score less than 5

\*Clinically significant depression = Patient with a diagnosis of
depression and a New Episode PHQ of 10 or greater

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

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A formal consensus procedure involving experts in relevant clinical,
    methodological, and organizational sciences

-   One or more research studies published in a National Library of
    Medicine (NLM) indexed, peer-reviewed journal

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Unspecified

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Collaborative inter-organizational quality improvement\
Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Ambulatory Care\
Behavioral Health Care\
Community Health Care

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians\
Psychologists/Non-physician Behavioral Health Clinicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Group Clinical Practices

#### TARGET POPULATION AGE

Age greater than or equal to 18 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

See \"Rationale\" field.

#### ASSOCIATION WITH VULNERABLE POPULATIONS

See \"Rationale\" field.

#### BURDEN OF ILLNESS

See \"Rationale\" field.

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better\
Living with Illness

#### IOM DOMAIN

Effectiveness\
Equity\
Patient-centeredness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

All patients with a diagnosis of clinically significant depression\* 4
months or longer after their last New Episode Patient Health
Questionnaire (PHQ)\*\*, and last New Episode PHQ is within the last 12
calendar months

\*Clinically significant depression = Patient with a diagnosis of
depression and a New Episode PHQ of 10 or greater

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

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All patients with a diagnosis of clinically significant depression\* 4
months or longer after their last New Episode Patient Health
Questionnaire (PHQ)\*\*, and last New Episode PHQ is within the last 12
calendar months

\*Clinically significant depression = Patient with a diagnosis of
depression and a New Episode PHQ of 10 or greater

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

**Exclusions**\
Patients who are less than 4 months into treatment would not be expected
to have a consistent response and are excluded from this measure.

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Diagnostic Evaluation

#### DENOMINATOR TIME WINDOW

Time window precedes index event

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All patients with a diagnosis of clinically significant depression\*
who, 4 months or longer after their last New Episode Patient Health
Questionnaire (PHQ)\*\* (occurring within the last 12 calendar months),
have a most recent PHQ score less than 5

\*Clinically significant depression = Patient with a diagnosis of
depression and a New Episode PHQ of 10 or greater

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

**Exclusions**\
Unspecified

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Fixed time period

#### DATA SOURCE

Special or unique data

#### LEVEL OF DETERMINATION OF QUALITY

Not Individual Case

#### OUTCOME TYPE

Clinical Outcome

#### PRE-EXISTING INSTRUMENT USED

Patient Health Questionnaire (PHQ)

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison\
Prescriptive standard

#### PRESCRIPTIVE STANDARD

Greater than 40%

#### EVIDENCE FOR PRESCRIPTIVE STANDARD

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

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

CSD patients with PHQ score less than 5 at least 4 months after last New
Episode PHQ.

#### MEASURE COLLECTION

[HRSA Health Disparities Collaboratives
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1726&doc=6877)

#### MEASURE SET NAME

[HRSA HDC Depression Collaborative
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1726&doc=6880)

#### SUBMITTER

Health Resources and Services Administration

#### DEVELOPER

HRSA Health Disparities Collaboratives: Depression Collaborative

#### FUNDING SOURCE(S)

Unspecified

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

Unspecified

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

Unspecified

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2002 Jan

#### REVISION DATE

2005 Jan

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

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

#### MEASURE AVAILABILITY

The individual measure \"CSD patients with PHQ score less than 5 at
least 4 months after last New Episode PHQ,\" is available from the
[Health Disparities Collaboratives Web
site](http://www.healthdisparities.net/hdc/html/collaboratives.topics.depression.aspx).

#### 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. This document is available in Portable
    Document Format (PDF) from the [Health Disparities Collaboratives
    Web
    site.](http://www.healthdisparities.net/hdc/content/Depression_Apr2002.pdf)
    See the related
    [QualityTools](http://www.innovations.ahrq.gov/content.aspx?id=1149)
    summary.

#### NQMC STATUS

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

#### COPYRIGHT STATEMENT

No copyright restrictions apply.

### Disclaimer

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/10/2008