The relationship between quality and outcomes in routine depression care

Objective: This longitudinal, nonexperimental study examined whether depres sion treatment provided in concordance with guidelines developed by the Age ncy for Healthcare Research and Quality (AHRQ) is associated with improved clinical outcomes. Methods: The medical, insurance, and pharmacy records of a community-based sample of 435 subjects who screened positive for current major depression were abstracted to ascertain whether depression treatment was received and whether it was provided in accordance with AHRQ guideline s. Regression analyses estimated the impact of guideline-concordant treatme nt on the change in depression severity and on mental and physical health o ver a six-month period. An instrumental variables analysis was used to chec k the sensitivity of the results to selection bias. Results: A total of 106 subjects were treated for depression by 105 different primary care and spe cialty providers. Sixty percent of the sample had current major depression, and about 40 percent had subthreshold depression. Only 29 percent of the p atients received guideline-concordant treatment. For patients with major de pression, guideline-concordant care was significantly and substantially ass ociated with improved depression severity but not with improvements in over all mental or physical health. The instrumental variables analysis indicate d that the standard regression analysis underestimated the treatment effect by 21 percent. For those with subthreshold depression, guideline-concordan t care was not associated with improved outcomes. Discussion and conclusion s: This community-based, nonexperimental study found a positive relationshi p between the quality of care for depression and clinical outcomes for pati ents with major depression in routine practice settings.