• Institute for Clinical Systems Improvement (ICSI). Major depression in adults in primary care. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); May 2008. 84 p. [244 references]

Does not apply to this measure

This measure is used to assess the percentage of patients who have reached remission at six months (+/- 30 days) after initiating treatment, i.e., have any PHQ-9 score less than five after six months (+/- 30 days).

The priority aim addressed by this measure is to improve the outcomes of treatment for major depression.

Major depression; remission; Patient Health Questionnaire (PHQ-9) score; Hamilton Rating Scale for Depression score

Number of adult patients older than 18 years with a new primary care diagnosis* of major depression who have remained under depression management within their primary care clinic for six months

Suggested International Classification of Diseases, Ninth Revision (ICD-9) codes include: 296.2x, 296.3x

*New diagnosis = no diagnosis in the six-month period prior to the target quarter.

Number of patients whose quantitative symptom assessment tool (Patient Health Questionnaire [PHQ-9]) administered six months (+/- 30 days) after initiating treatment, was less than 5 or (Hamilton Rating Scale) 7 or less

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

Unspecified

Current routine use

Internal quality improvement

Physician Group Practices/Clinics

Advanced Practice Nurses
Nurses
Physicians

Group Clinical Practices

Age greater than 18 years

Either male or female

Unspecified

In a national survey from the World Health Organization of more than 9,000 adults age 18 and over, the prevalence of major depression was 6.7 percent.

• Women (including pregnant and postpartum women). The rate of perinatal depression in the general population has been 10% to 15%. According to O'Hara, there is an increased incidence of perinatal depression as follows:
  • 25% - history of major depressive disorder
  • 35% - history of major depression during pregnancy
  • 50% - history of previous postpartum depression
  • 70% - history of both major depressive disorder and postpartum depression
• Depression in the elderly is widespread, often undiagnosed and usually untreated. The rate of depression in adults older than 65 years of age ranges from 7% to 36% in medical outpatient clinics and increases to 40% in the hospitalized elderly.

• Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G, Brody S, Miller WC. Perinatal depression: prevalence, screening accuracy, and screening outcomes: summary. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2005 Feb. 8 p. (Evidence report/technology assessment; no. 119). [77 references]



• Institute for Clinical Systems Improvement (ICSI). Major depression in adults in primary care. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); May 2008. 84 p. [244 references]



• O'Hara MW, Swain AM. Rates and risk of postpartum depression: a meta-analysis. Int Rev Psychiatry 1996 Mar;8(1):37-54.

• Major depression is a treatable cause of pain, suffering, disability and death.
• The estimate of the lifetime prevalence of suicide in those ever hospitalized for suicidality is 8.6%. The lifetime risk is 4% for affective disorder patients hospitalized without specification of suicidality.
• Cardiovascular disease, diabetes and chronic pain are common comorbidities in patients with depression.
• Major depression is associated with an increased risk of developing coronary artery disease, and has also been shown to increase the risk of mortality in patients after myocardial infarction by as much as four-fold. Moderate to severe depression before coronary artery bypass graft (CABG) surgery and/or persistent depression after surgery increases the risk of death after CABG more than two-fold compared to non-depressed patients.
• Depression earlier in life increases the risk of developing diabetes by twofold.
• In a national survey from the World Health Organization (WHO), major depression was second only to back and neck pain for having the greatest effect on disability days, at 386.6 million U.S. days per year. In another WHO study of more than 240,000 people across 60 countries, depression was shown to produce the greatest decrease in quality of health compared to several other chronic diseases. Health scores worsened when depression was a comorbid condition, and the most disability combination was depression and diabetes.

Unspecified

Work productivity is significantly decreased in employees with major depression with 8.4 hours lost on average per worker per week. This is estimated to cost employers $44 billion per year in lost productivity.

Getting Better
Living with Illness

Effectiveness

Users of care only

Adults older than 18 years with a new primary care diagnosis* of major depression

The primary source of data would be a registry. Other possible sources include claims or encounter data, scheduling information, and list of diagnosis codes.

The suggested time period for data collection is a calendar month.

*New diagnosis = no diagnosis in the six-month period prior to the target quarter.

Patients associated with provider

Inclusions
Number of adult patients older than 18 years with a new primary care diagnosis* of major depression who have remained under depression management within their primary care clinic for six months

Suggested International Classification of Diseases, Ninth Revision (ICD-9) codes include: 296.2x, 296.3x

*New diagnosis = no diagnosis in the six-month period prior to the target quarter.

Exclusions
Unspecified

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

Clinical Condition

Time window is a fixed period of time

Inclusions
Number of patients whose quantitative symptom assessment tool (Patient Health Questionnaire [PHQ-9]) administered six months (+/- 30 days) after initiating treatment, was less than 5 or (Hamilton Rating Scale) 7 or less

Exclusions
Unspecified

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Fixed time period

Administrative data
Registry data

Not Individual Case

Clinical Outcome

Patient Health Questionnaire (PHQ-9)

Hamilton Rating Scale for Depression

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV TR)

Rate

Better quality is associated with a higher score

Unspecified

Internal time comparison

Unspecified

Percentage of patients who have reached remission at six months (+/- 30 days) after initiating treatment, i.e., have any PHQ-9 score less than five after six months (+/- 30 days).

Institute for Clinical Systems Improvement

The following Minnesota health plans provide direct financial support: Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica, Metropolitan Health Plan, PreferredOne and UCare Minnesota. In-kind support is provided by the Institute for Clinical Systems Improvement's (ICSI) members.

Work Group Members: Mary Ellen Jaehne, LICSW (Work Group Leader) (Hamm Clinic) (Mental Health); Michael Trangle, MD (Work Group Leader) (HealthPartners/Regions Hospital) (Psychiatry); Craig Anderson, MD (SuperiorHealth Medical Group) (Family Medicine); Barbara Bank, MD (Fairview Health Services) (Family Medicine); Joel Haugen, MD (Dakota Clinic) (Family Medicine); Jay Mitchell, MD (Mayo Clinic) (Family Medicine); David Rossmiller, MD (Family HealthServices Minnesota) (Family Medicine; Bob Haight, PharmD, BCPP (Fairview Health Services) (Pharmacy); Cedric Skillon, MD (Park Nicollet Health Services) (Psychiatry); Amitabh Tipnis, MD (Hennepin County Medical Center) (Psychiatry); Jeffrey Boyd, PhD (Hennepin County Medical Center) (Psychology); Deb Rich, PhD (Fairview Health Services) (Psychology); Heidi Novak, WHNP (North Point Health & Wellness Center) (Women's Health OB/GYN); Nancy Jaeckels (Institute for Clinical Systems Improvement) (Measurement Advisor); Pam Pietruszewski, MA (Institute for Clinical Systems Improvement) (Facilitator)

ICSI has adopted a policy of transparency, disclosing potential conflict and competing interests of all individuals who participate in the development, revision and approval of ICSI documents (guidelines, order sets and protocols). This applies to all work groups (guidelines, order sets and protocols) and committees (Committee on Evidence-Based Practice, Cardiovascular Steering Committee, Women's Health Steering Committee, Preventive & Health Maintenance Steering Committee, Respiratory Steering Committee and the Patient Safety & Reliability Steering Committee).

Participants must disclose any potential conflict and competing interests they or their dependents (spouse, dependent children, or others claimed as dependents) may have with any organization with commercial, proprietary, or political interests relevant to the topics covered by ICSI documents. Such disclosures will be shared with all individuals who prepare, review and approve ICSI documents.

No work group members have potential conflicts of interest to disclose.

Measure was not adapted from another source.

2008 May

Please note: This measure has been updated. The National Quality Measures Clearinghouse is working to update this summary.

• Institute for Clinical Systems Improvement (ICSI). Major depression in adults in primary care. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); May 2008. 84 p. [244 references]

This NQMC summary was completed by ECRI Institute on June 30, 2008.

This NQMC summary (abstracted Institute for Clinical Systems Improvement [ICSI] Measure) is based on the original measure, which is subject to the measure developer's copyright restrictions.

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