Steven Cole MD and Colleagues Describe New Performance Measures for the Care of People with Depression

Steven Cole, MD

In a paper published in the Journal of Health Care for the Poor and Underserved, Professor of Psychiatry Steven Cole MD and colleagues reported on a set of newly-developed measures to guide improvements in the care for patients with clinically significant depression at community health centers throughout the United States.

Even though depression is a leading cause of disability among adults in the United States, most patients with depression never see a mental health professional, but seek help from their primary care providers. About half of people with depression are not diagnosed properly and more than three quarters of them are not appropriately treated. To help rectify this situation, the Health Resources and Services Administration created a series of Health Disparities Collaboratives designed to improve the care of depression in primary care centers. Dr. Cole co-chaired three collaboratives between 2002-2005 with Daniel Ford MD, MPH of Johns Hopkins School of Medicine. They reported outcomes after following 38,000 depressed patients for six years from 94 health centers in 47 states throughout the country.

In addition to the goal of improving care and outcomes for depression, Dr. Cole and his colleagues developed 10 population-based measures designed to provide objective documentation of these improvements over time.  The authors reported that one of the ten measures — the measure of early and sustained response (ESR) — “represents an entirely new concept in the measurement of chronic depression care” since it is “the first and only depression care measure… that documents a population of depressed patients’ long term outcome over time.” With respect to another measure which they developed (PHQ Reassessment), they reported that reassessing patients with the PHQ9 within 1 to 2 months after initiating treatment has a significant impact on outcomes, probably because it enables the clinician to adjust initial treatments based on the patient’s response.

Of the 94 health centers participating in the collaboratives, the authors completed a sub-study of the 7 highest performing centers to determine the factors leading to outcomes of excellence. The high performing centers were able to attain remarkably high rates of sustained response over many years, using active care management approaches.

The article, titled Improving Care for Depression: Performance Measures, Outcomes and Insights from the Health Disparities Collaboratives, was published in the August 2012 Supplement of the Journal of Health Care for the Poor and Underserved. Dr. Cole is Professor of Psychiatry in the Department of Psychiatry and Behavioral Science at Stony Brook University.