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## Complete Summary

#### TITLE

Depression: percent of clinically significant depression patients who,
within one month of last New Episode Patient Health Questionnaire (PHQ),
are on an antidepressant and/or in psychotherapy.

#### SOURCE(S)

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

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

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 who, within
one month of last New Episode Patient Health Questionnaire (PHQ)\*\*,
are on an antidepressant\*\*\* and/or in psychotherapy\*\*\*\*.

This measure assesses use of evidence-based guidelines (medication
and/or psychotherapy) for treatment of clinically significant
depression.

Both medications and certain psychotherapies have been found to be
better than usual care (Schulberg HC et al., Arch Gen Psychiatry 1998;
Schulberg HC et al., Gen Hosp Psychiatry 2002).

**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

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

\*\*\*\*Refers to any type of psychotherapy for which an evidence base
exists in the literature for the treatment of acute major depression
(e.g., Cognitive-Behavioral Therapy \[CBT\], Interpersonal Psychotherapy
\[IPT\], or Problem-Solving Therapy \[PST\])

#### 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; antidepressant medication;
psychotherapy; Patient Health Questionnaire (PHQ)

#### DENOMINATOR DESCRIPTION

All clinically significant depression\* patients having a New Episode
Patient Health Questionnaire (PHQ)\*\* in the last 12 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 clinically significant depression patients with a New Episode
Patient Health Questionnaire (PHQ) in the last 12 months who were on an
antidepressant or in psychotherapy within one month of last New Episode
PHQ (see the related \"Numerator Inclusions/Exclusions\" field in the
Complete Summary)

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

-   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 clinically significant depression\* patients having a New Episode
Patient Health Questionnaire (PHQ)\*\* in the last 12 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 clinically significant depression\* patients having a New Episode
Patient Health Questionnaire (PHQ)\*\* in the last 12 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**\
Unspecified

#### 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 clinically significant depression\* patients with a New Episode
Patient Health Questionnaire (PHQ)\*\* in the last 12 months who were on
an antidepressant\*\*\* or in psychotherapy\*\*\*\* within one month of
last New Episode PHQ. The patient could have been on antidepressants
and/or in psychotherapy any time within 31 days after the last New
Episode PHQ (or even before).

\*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

\*\*\*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)

\*\*\*\*Refers to any type of psychotherapy for which an evidence base
exists in the literature for the treatment of acute major depression
(e.g., Cognitive-Behavioral Therapy \[CBT\], Interpersonal Psychotherapy
\[IPT\], or Problem-Solving Therapy \[PST\])

**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

Individual Case

#### 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 80%

#### 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

Percent of CSD patients on an antidepressant &/or in psychotherapy
within one month of 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 \"Percent of CSD patients on an antidepressant
&/or in psychotherapy within one month of 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: 11/3/2008