2007 HSR&D National Meeting Abstract
1043 — VA Treatment for New Episodes of Depression: Does Dual-System Use Explain Poor Performance?
McCarthy JF (HSR&D / SMITREC; University of Michigan) , Bambauer KZ
(HSR&D / SMITREC; University of Michigan), Austin K
(SMITREC), Valenstein M
(HSR&D / SMITREC; University of Michigan)
Treatment guidelines recommend that patients with new episodes of major depression receive at least 3 outpatient follow-up visits and continuous antidepressant therapy during the 12-week acute treatment phase. HEDIS and VA performance measures are based on these recommendations. We assessed VA treatment for new episodes of depression and, among patients aged 65 or older, we determined whether patients also received Medicare-funded depression care. Substantial cross-system use could explain poor VA performance, while potentially complicating assessments of treatment quality.
Using the VA’s National Registry for Depression, we identified all 12,076 patients with new episodes of depression in the first quarter of FY03. Patients had to have received a depression diagnosis and an antidepressant prescription up to 30 days before or 14 days after the diagnosis. Further, they could have no depression diagnoses in the prior 120 days, nor antidepressant fills in the 90 days before their antidepressant start. We assessed receipt of adequate VA follow-up (>3 visits in the 12 weeks following diagnosis) and antidepressant coverage (>12 of the 16 weeks following diagnosis). Among patients aged 65 or older, we examined outpatient follow-up using VA data alone and when considering both VA and Medicare-funded depression treatment visits.
16.3% of patients received guideline-concordant VA follow-up visits. 64.9% had adequate antidepressant coverage. 12.4% received sufficient VA care for both measures. Among older patients (N=3567), only 333 (9.3%) received adequate VA outpatient contacts. Overall, 268 patients (2.2% of 12,076) received Medicare-funded depression-related visits during the acute treatment phase. 205 older patients (5.7% of 3567) received such visits. When considering both VA and Medicare utilization, 395 older patients (11.1%) met treatment guidelines for outpatient follow-up.
Despite ongoing performance assessments, VA treatment for new episodes of depression remains poor. Among older patients, consideration of Medicare services use only modestly increases the percentage of patients receiving guideline-concordant follow-up, from 9.3% to 11.1%. Dual system use (VA-Medicare) does not explain poor VA performance.
Research and service initiatives are urgently needed to improve VA treatment for new episodes of depression. Medicare use neither substantially supplements VA depression treatment, nor does it complicate assessments of VA depression treatment quality.