Targeting quality improvement activities for depression - Implications of using administrative data

BACKGROUND Large health care organizations may use administrative data to t arget primary care patients with depression for quality improvement (QI) ac tivities. However, little is known about the patients who would be identifi ed by these data or the types of QI activities they might need. We describe the clinical characteristics and outcomes of patients identified through a dministrative data in 2 family practice clinics. METHODS Patients with depression aged 18 to 65 years were identified throug h review of encounter/administrative data during a 16-month period. Patient s agreeing to participate (N=103) were interviewed with the Primary Care Ev aluation of Mental Disorders questionnaire and completed the Depression Out comes Modules (with an embedded Medical Outcomes Short Form-36 [SF-36]), Sy mptom Check List-25 (SCL-25), and Alcohol Use Disorders Identification Test . Follow-up assessments were completed by 83 patients at a median of 7 mont hs. RESULTS A large majority of identified patients (85%) met full criteria for a Diagnostic and Statistical Manual of Mental Disorders depressive disorde r; those not meeting criteria usually had high levels of symptoms on the SC L-25, Seventy seven percent of the patients reported recurrent episodes of depressed mood, and 60% reported chronic depression. Although most improved at follow-up, they continued to have substantial functional deficits on th e SF-36, and 60% still had high levels of depressive symptoms. CONCLUSIONS QI programs that use administrative data to identify primary ca re patients with depression will select a cohort with relatively severe, re current depressive disorders. Most of these patients will receive standard treatments without QI interventions and will continue to be symptomatic, QI programs targeting this population may need to offer intensive alternative s rather than monitor standard care.