Abstract:
BACKGROUND:Linking process and outcomes is critical to accurately estimating healthcare quality and quantifying its benefits. OBJECTIVES:The objective of this study was to explore the relationship of guideline-based depression process measures with subsequent overall and psychiatric hospitalizations. RESEARCH DESIGN:This is a retrospective cohort study during which we used administrative and centralized pharmacy records for sample identification, derivation of guideline-based process measures (antidepressant dosage and duration adequacy), and subsequent hospitalization ascertainment. Depression care was measured from June 1, 1999, through August 31, 1999. We used multivariable regression to evaluate the link between depression care and subsequent overall and psychiatric hospitalization, adjusting for patient age, race, sex, socioeconomic status, comorbid illness, and hospitalization in the prior 12 months. SUBJECTS:We studied a total of 12,678 patients from 14 Northeastern VHA hospitals. RESULTS:We identified adequate antidepressant dosage in 90% and adequate duration in 45%. Those with adequate duration of antidepressants were less likely to be hospitalized in the subsequent 12 months than those with inadequate duration (odds ratio [OR],.90; 95% confidence interval [CI], .81-1.00). Those with adequate duration of antidepressants were less likely to have a psychiatric hospitalization in the subsequent 12 months than those with inadequate duration (OR, .82; 95% CI, .69-.96). We did not demonstrate a significant link between dosage adequacy and subsequent overall or psychiatric hospitalization. CONCLUSIONS:Guideline-based depression process measures derived from centralized data sources offer an important method of depression care surveillance. Their accuracy in capturing depression care quality is supported by their link to healthcare utilization. Further work is needed to assess the effect of implementing these quality indicators on depression care.
journal_name
Med Carejournal_title
Medical careauthors
Charbonneau A,Rosen AK,Owen RR,Spiro A 3rd,Ash AS,Miller DR,Kazis L,Kader B,Cunningham F,Berlowitz DRdoi
10.1097/01.mlr.0000127999.89246.a6keywords:
subject
Has Abstractpub_date
2004-06-01 00:00:00pages
522-31issue
6eissn
0025-7079issn
1537-1948pii
00005650-200406000-00004journal_volume
42pub_type
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