The Value of Measuring Quality of Primary Care using Patient-Reported Depression Collected Through Electronic Health Records

Quality of care;depression screening;not listed

Pfoh, Elizabeth RoseMojtabai, Ramin ;

Johns Hopkins University

关键词: Quality of care;    depression screening;    not listed;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/39284/PFOH-DISSERTATION-2014.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Statement of the problem:Depression is a common condition that is often under-diagnosed and under-treated.Depression screening in primary care is both a Healthy People 2020 goal, and is being promoted through Medicare’s Annual Wellness Visit (AWV) benefit--a preventive care screening visit that is free for Medicare Part B beneficiaries.Methods: A secondary analysis of retrospectively collected electronic health record (EHR) data from 5,000 Medicare patients.Quota-random sampling was used so that half of the patients had an AWV and half of the patients had at least one primary care visit during the study period (2010-2012).Scores on the Patient Health Questionnaire, a validated patient-reported depression screening tool, were collected from structured fields in the EHR. Bivariate and multivariable logistic regressions were used to determine the odds of depression screening and meeting quality measures for depression. Results: Overall, depression screening was low, at 17%.In the cross-sectional analysis of the patients’ index visit, AWV patients were not more likely to receive depression screening at a statistically significant level in either the bivariate or the multivariable model, after accounting for clustering at the physician level(OR 1.28 95%CI:0.86-1.94; OR 1.33 95%CI:0.88-2.00, respectively). There was a clear clinic site effect of depression screening with one site screening 78% of AWV patients and 83% of non-AWV patients and six sites screening none of their patients.In the adjusted longitudinal analyses, having multi-morbidity was associated with decreased odds of receiving both depression and smoking status screenings compared to receiving neither or only smoking status screening by 28% after adjusting for race, age, and sex.(AOR: 0.72, 95%CI:0.52-1.0). Conclusions: Depression screening rates were low whether they were examined cross-sectionally or longitudinally.After adjusting for patient factors and clustering at the clinician and site level, the odds of depression screening were not significantly different between patients who received an AWV visit and those who did not.Our work shows that requiring depression screening as part of a Medicare benefit is not a strong enough incentive to increase depression screening.