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## Complete Summary

#### TITLE

Mental health: the percentage of patients who were diagnosed with a new
episode of depression, and treated with antidepressant medication, and
who remained an antidepressant drugs for at least 84 treatment days (12
weeks) after the Index Prescription Date.

#### SOURCE(S)

Office of Quality and Performance (10Q). FY 2008, Q1 technical manual
for the VHA performance measurement system. Washington (DC): Washington
(DC); 2007 Oct 31. 315 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 measure is used to assess the percentage of patients who were
diagnosed with a new episode of depression, and treated with
antidepressant medication, and who remained on an antidepressant drug
for at least 84 treatment days (12 weeks) after the Index Prescription
Date.

#### RATIONALE

32.6 to 35.1 million adults in the United States \-- about 15 percent of
the population \-- will suffer from major depressive disorder in their
lifetime. In a given year, an estimated 18.8 million American adults
suffer from a depressive disorder or depression. Depressive disorders
are marked by a substantial and sustained disruption in a person\'s
mood, behavior, physical health and thoughts. There are three main
depressive disorders: major depression, dysthymia (chronic/mild
depression) and bipolar disorder (also known as manic-depressive
disorder).

Nearly 1 in 6 people with severe, untreated depression, commit suicide.
Depression affects people of all ages, but often first occurs in a
person\'s late twenties. Elderly people also suffer from high rates of
depression. Fortunately, many people can improve through treatment with
appropriate medications.

Antidepressant medication management can improve people\'s quality of
life:

-   Adults who are depressed are less physically healthy, less socially
    active and less satisfied with their lives than adults who are not
    depressed.

-   Depression may lead to appetite and sleep disturbances, anxiety,
    irritability, decreased concentration, and greatly increases risk of
    suicide.

And has important financial benefits:

-   Nearly 12 million days of lost productivity could be avoided
    nationally each year if workers with depression were treated at the
    rates seen in health plans at the 90th percentile.

-   Major depressive disorder is the leading cause of disability in the
    United States and in market economies worldwide.

-   Depression has the highest medical costs for all behavioral
    conditions and results in more days of disability than chronic
    medical conditions such as heart disease, hypertension, diabetes and
    lower back pain.

-   Workers with depression cost employers \$44.01 billion per year in
    lost productive time.

-   The overall health bills of employees who report depression are 70%
    higher than those of employees who do not.

#### PRIMARY CLINICAL COMPONENT

Mental health; depression; medication management

#### DENOMINATOR DESCRIPTION

Patients who were diagnosed with a new episode of depression and treated
with antidepressant medication (see the related \"Denominator
Inclusions/Exclusions\" field in the Complete Summary)

#### NUMERATOR DESCRIPTION

Patients diagnosed with a new episode of depression and treated with
antidepressant medication who have adequate medication for at least 84
treatment days (12 weeks)\* after the Index Prescription Date (see the
related \"Numerator Inclusions/Exclusions\" field in the Complete
Summary)

\***Note**: 30 gap days are allowed; therefore, 84 treatment days + 30
gap days = 114 days examined.

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

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

-   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

External oversight/Veterans Health Administration\
Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Ambulatory Care\
Behavioral Health Care

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Advanced Practice Nurses\
Physician Assistants\
Physicians\
Psychologists/Non-physician Behavioral Health Clinicians\
Social Workers

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Single Health Care Delivery Organizations

#### TARGET POPULATION AGE

Unspecified

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

See the \"Rationale\" field.

#### ASSOCIATION WITH VULNERABLE POPULATIONS

See the \"Rationale\" field.

#### BURDEN OF ILLNESS

See the \"Rationale\" field.

#### UTILIZATION

Unspecified

#### COSTS

See the \"Rationale\" field.

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better\
Living with Illness

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Patients who were diagnosed with a new episode of depression and treated
with antidepressant medication

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients who were diagnosed with a new episode of depression and treated
with antidepressant medication\*

\***Note**: The universe of patients for this measure includes patients
with qualifying diagnosis of major depression AND 120 day negative Major
Depression Diagnosis history prior to the qualifying diagnosis date also
known as the Index Diagnosis of Major Depression Date) **and**
antidepressant prescription filled 30 days prior to through 14 days on
or after the Index Diagnosis Date AND a 90 day negative antidepressant
prescription history (new or refill) on or before the Index Prescription
Date.

Refer to the original measure documentation for additional details.

**Exclusions**

-   Admissions to acute psychiatry during the 84 day acute phase of
    treatment.

-   Admissions to substance abuse during the 84 day acute phase of
    treatment.

-   Other institutional admissions such as to a nursing home care unit
    or domiciliary.

-   Deaths if the date of death is during the 84 day acute treatment
    phase.

-   Patients without at least one outpatient visit (anchoring visit)
    anywhere in the Veterans Health Administration (VHA) during the 13
    to 24 months prior to the qualifying period.

Refer to the original measure documentation for additional details.

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

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

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Therapeutic Intervention

#### DENOMINATOR TIME WINDOW

Time window brackets index event

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients diagnosed with a new episode of depression and treated with
antidepressant medication who have adequate medication for at least 84
treatment days (12 weeks)\* after the Index Prescription Date\*\*

**Effective acute phase antidepressant medication treatment**:
Continuity of treatment with antidepressant medications to cover at
least 84 days of 114 days following the Index Prescription Date. A
\'gap\' in antidepressant medications of no more than 30 days total is
allowed to accommodate the clinical practice of \'washing out\' one
medication before starting another if needed, and/or delay in
filling/picking up a prescription. Overlapping prescriptions of
different medications on the same day are not counted twice. To
determine the continuity of treatment, sum the number of gap days to the
number of treatment days for a maximum of 114 days from the Index
Prescription date. For all prescriptions filled within 114 days of the
Index Prescription Date, count until a total of 84 treatment days has
been established. Patients whose gap days exceed 30 or who do not have
84 treatment days within the 114 days after the Index Prescription Date
are not counted in the numerator.

\***Note**: 30 gap days are allowed; therefore, 84 treatment days + 30
gap days = 114 days examined.

\*\**Index Prescription Date*: The earliest prescription date for
antidepressants filled within a 44-day period as defined as 30 days
prior to through 14 days on or after the Index Episode Start Date.

Refer to the original measure documentation for additional details.

**Exclusions**\
Patients whose gap days exceed 30 or who do not have 84 treatment days
within the 114 days after the Index Prescription Date are not counted in
the numerator.

#### 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

Administrative data\
Pharmacy data

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### 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

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

New Dx of depression - medication coverage.

#### MEASURE COLLECTION

[Fiscal Year (FY) 2008: Veterans Health Administration (VHA) Performance
Measurement
System](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=3&doc=10202)

#### MEASURE SET NAME

[Health System
Indicators](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=3&doc=12147)

#### MEASURE SUBSET NAME

[Mental
Health](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=3&doc=9226)

#### DEVELOPER

Veterans Health Administration

#### FUNDING SOURCE(S)

Unspecified

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

Unspecified

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

Unspecified

#### ADAPTATION

Measure was adapted from another source.

#### PARENT MEASURE

Antidepressant Medication Management: Effective Acute Phase
Antidepressant Medication Treatment \[National Committee on Quality
Assurance (NCQA) Health Plan Employer Data and Information Set (HEDIS)\]

#### RELEASE DATE

2006 Oct

#### REVISION DATE

2007 Oct

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

Office of Quality and Performance (10Q). FY 2008, Q1 technical manual
for the VHA performance measurement system. Washington (DC): Washington
(DC); 2007 Oct 31. 315 p.

#### MEASURE AVAILABILITY

The individual measure, \"New Dx of Depression - Medication Coverage,\"
is published in \"FY 2008 VHA Performance Measurement System: Technical
Manual.\"

For more information contact:

Department of Veterans Affairs\
Office of Quality and Performance (10Q)\
ATTN: Lynnette Nilan, E-mail: <lynnette.nilan@va.gov> or\
Tammy Czarnecki, E-mail: <tammy.czarnecki2@va.gov>

#### NQMC STATUS

This NQMC summary was completed by ECRI Institute on March 7, 2008. The
information was not verified by the measure developer.

#### COPYRIGHT STATEMENT

No copyright restrictions apply.

### Disclaimer

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008