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 Improving Depression Care Starts with Quality Measures

A Leavitt Partners report released April 17 addresses the significant challenge for health care providers in treating Major Depressive Disorder (MDD), with experts pointing to the need for quality measurement to adequately detect, assess, or treat people with a disease affecting more than 16 million Americans.

For those providers in the long term and post-acute care profession, MDD is especially prevalent. The American Geriatrics Society estimates that approximately 40 percent of skilled nursing facility residents suffer from mild to chronic depression.

Despite the numbers with MDD, the health care system as a whole is not currently configured to detect, assess, or consistently treat MDD effectively, Leavitt said in its report, “Driving Depression Care Forward by Optimizing Quality Measures.”

“This is not just a problem for mental health specialists, but one requiring the attention and efforts of primary care providers, specialists, and others across the health and social services spectrum,” the report said.

To start, there needs to be a structural quality measure for MDD, since quality measurement can start to help identify, measure, and improve MDD diagnosis and treatment. Report authors said it is readily apparent that quality measures have helped improve other health conditions. A case in point is diabetes, which has been the focus of quality measurement for years.

“A national effort to develop a set of performance measures for diabetes led to the development of the Diabetes Quality Improvement Programs that were adopted for use in the Healthcare Effectiveness Data and Information Set and elsewhere,” the report said.

By assessing diabetes through measures, like monitoring A1C, blood pressure, and cholesterol levels, the number of people with diabetes who meet or exceed all three measures of diabetes management has significantly improved over time, Leavitt said.

Depression, however, poses certain difficulties in the crafting of a quality measure, given the nature of MDD and how it has been viewed by caregivers and patients alike. In the report, six challenges were listed, including the lack of attention to the serious nature of MDD, the lack of meaningful quality measures across the entire mental health spectrum of care, and issues with data collection and feedback.

Despite the prevalence of depression, it is not yet common practice for primary care practices to screen for the disease; research shows that only approximately 4 percent of Americans are screened for depression in a primary care setting each year,” the report said. Further, even when patients are diagnosed with severe depression, they do not always seek treatment.

Some recommendations in the report to change the status quo—which include development of a quality measure—are to create a system to ensure annual screenings for depression, follow up with people who screen positive to ensure referral and/or treatment occurs, and create a mechanism that reports back to patients and clinicians so they can make educated treatment decisions.

There are avenues in place to bolster quality measurement and care for MDD through ongoing multi-stakeholder initiatives, like the Healthy People 2030 initiative, the Interdepartmental Serious Mental Illness Coordinating Committee, the Centers for Medicare & Medicaid Services Innovation Center, Medicaid state-level innovation, and county behavioral health centers, the report said.

For more information on the Leavitt MDD report, go to

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