Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment (NQF 0105)

EMeasure Name Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment EMeasure Id F5210436-9B4D-45F6-B2A6-23718E16FFDF
Version number 1 Set Id 0DCFFB4C-21B6-4DF4-8023-53C60BDA7C4E
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward National Committee for Quality Assurance
Endorsed by National Quality Forum
Description The percentage of patients 18 years of age and older who were diagnosed with a new episode of major depression, treated with antidepressant medication, and who remained on an antidepressant medication treatment.
Copyright
© National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
This multi-component measure assesses different facets of the successful pharmacological management of depression.  Depression has a significant impact on patients’ quality of life which includes: interference with completing work responsibilities, lack of motivation, and difficulty in concentrating, discomfort, and dealing with coworkers. Depression contributes significantly to poor disease outcomes and premature death.  Studies have shown that increasing the intensity of depression treatment may be an important key to improvements in outcomes and cost-effectiveness and that appropriate therapy improves the daily functioning and overall health of patients with depression.

Clinical guidelines for depression stress the importance of effective clinical management in:  increasing patients’ medication compliance; monitoring treatment effectiveness by providers, and identifying and managing side effects. If pharmacological treatment is initiated, appropriate dosing and continuation of therapy through the acute and continuation phases decreases recurrence of depression. Thus, evaluation of length of treatment serves as an important indicator of success in promoting patient compliance with the establishment and maintenance of an effective medication regimen.
			
Clinical Recommendation Statement
American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 2000 revised, 2005 reviewed

Successful treatment of patients with major depressive disorder is promoted by a thorough assessment of the patient and close adherence to treatment plans.  Treatment consists of an acute phase, during which remission is induced; a continuation phase, during which remission is preserved; and a maintenance phase, during which the susceptible patient is protected against the recurrence of a subsequent major depressive episode.

When pharmacotherapy is part of the treatment plan, it must be integrated with psychiatric management and any other treatments that are being provided.  Patients who have started taking an antidepressant medication should be carefully monitored to assess their response to pharmacotherapy as well as the emergence of side effects, clinical condition and safety. (APA "I" Recommendation:    Recommended with substantial clinical confidence)

Factors to consider when determining the frequency of patient monitoring include the severity of illness, the patient’s cooperation with treatment, the availability of social supports, and the presence of co-morbid general medical problems.  Visits should be frequent enough to monitor and address suicidality and to promote treatment adherence.  In practice, the frequency of monitoring during the acute phase of pharmacotherapy can vary from once a week in routine cases to multiple times per week in more complex cases. Patients who have been treated with antidepressant medications in the acute phase should be maintained on these agents to prevent relapse. (APA "I" Recommendation: Recommended with substantial clinical confidence)

Reference: American Psychiatric Association practice guideline for the treatment of patients with major depressive disorder. Am J Psychiatry 2000 Apr;157(4 Suppl):1-45.
			
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
Definition
Guidance
Due to a lookback period, the measure identifies patients 18 years of age and older as of April 30th of the measurement year; this is equivalent to 224 months of age as of the end of the measurement year.
		
CUMULATIVE MEDICATION DURATION is the total number of days of a medication for an individual. Days of medication can be derived from number of doses per day divided by the frequency. The cumulative duration can be calculated as the sum of the number of medication dispensed days x number of medication refills over a set period of time, excluding any gaps during which a medication was not dispensed. For example, if a medication was prescribed for 30 days with 3 refills, then a gap of 3 month, then prescribed again for 60 days with 2 refills, the cumulative medication duration for would be (30 x 3) + (60 x 2) = 150 days over the 10 month period.

Table of Contents


Population criteria

Data criteria (QDS Data Elements)

Summary Calculation

Calculation is generic to all measures:



Measure set CLINICAL QUALITY MEASURE SET 2011-2012