Psychiatric Practice Variations in the Diagnosis and Treatment of Major Depression

Kramer, Teresa L.; Daniels, Allen S.; Zieman, Gayle L.; Williams, Carla; Dewan, Naakesh A.

doi:10.1176/appi.ps.51.3.336

Cited by 25 publications

(12 citation statements)

References 29 publications

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“…[4][5][6]69,70 Although there was some overlap between standardized research and MR diagnoses of depression, 15 adolescents who met full criteria for the disorder, according to adolescent or parent DISC, were not diagnosed as such by clinicians throughout the treatment process. Consistent with previously established prevalence rates, 71,71-75 clinicians were more likely to diagnose females with a depressive disorder.…”

Section: Discussionmentioning

confidence: 99%

“…1 As noted in multiple studies, many adults with a depressive disorder do not receive care consistent with recommended treatment guidelines. [2][3][4][5][6][7] Poorer care has been associated with being African American, male, less educated, and younger than 30 or older than 59 years, and with lack of health care insurance. [6][7][8][9] Although there have been limited studies to date on the routine care of depressed youth, results suggest similar problems in the assessment, acute, and maintenance phases of treatment for this population as well.…”

Section: Introductionmentioning

confidence: 99%

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Quality of Mental Health Care for Depressed Adolescents

Kramer

Miller²,

Phillips

et al. 2008

Am J Med Qual

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Understanding the quality of routine care for adolescent depression constitutes the initial step in designing and implementing improvement strategies. This study assessed depression detection and type and duration of services for adolescents in mental health care settings. Medical record diagnosis and standardized research interview results were compared for youth seeking mental health treatment. The majority of depressed adolescents received care consistent with guidelines and evidence. However, only 51% received appropriate medication; fewer than half received at least 8 sessions of outpatient care or follow-up after hospitalization. Males received significantly fewer components of quality care compared with females. Depression diagnoses in routine care may be facilitated by using structured interviews or questionnaires. Quality monitoring and improvement initiatives may also increase rates of care components that are consistent with guidelines and evidence. Methods tested in this study may facilitate the evaluation of quality improvement initiatives for adolescent depression or other mental health disorders.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quality of Mental Health Care for Depressed Adolescents

Kramer

Miller²,

Phillips

et al. 2008

Am J Med Qual

Self Cite

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“…Psychiatric care is changing more rapidly than other areas of medicine [ 5 ]. Variations in the quality of psychiatric care, for example in depression treatment, have been described in psychiatric practice, including gaps between clinical practice and evidence-based guideline recommendations [ 6 , 7 ]. Clinical guidelines are useful tools to increase the use of EBM and to implement research findings [ 8 - 10 ].…”

Section: Introductionmentioning

confidence: 99%

An approach to measure compliance to clinical guidelines in psychiatric care

et al. 2008

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“…Large practice variation (eg, by 1.6 to 5.6 times) exists across different clinicians, health care facilities, and regions [ 13 , 27 , 32 - 37 ].…”

Section: Introductionmentioning

confidence: 99%

Using Computational Approaches to Improve Risk-Stratified Patient Management: Rationale and Methods

Luo¹,

Stone²,

Sakaguchi³

et al. 2015

JMIR Res Protoc

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BackgroundChronic diseases affect 52% of Americans and consume 86% of health care costs. A small portion of patients consume most health care resources and costs. More intensive patient management strategies, such as case management, are usually more effective at improving health outcomes, but are also more expensive. To use limited resources efficiently, risk stratification is commonly used in managing patients with chronic diseases, such as asthma, chronic obstructive pulmonary disease, diabetes, and heart disease. Patients are stratified based on predicted risk with patients at higher risk given more intensive care. The current risk-stratified patient management approach has 3 limitations resulting in many patients not receiving the most appropriate care, unnecessarily increased costs, and suboptimal health outcomes. First, using predictive models for health outcomes and costs is currently the best method for forecasting individual patient’s risk. Yet, accuracy of predictive models remains poor causing many patients to be misstratified. If an existing model were used to identify candidate patients for case management, enrollment would miss more than half of those who would benefit most, but include others unlikely to benefit, wasting limited resources. Existing models have been developed under the assumption that patient characteristics primarily influence outcomes and costs, leaving physician characteristics out of the models. In reality, both characteristics have an impact. Second, existing models usually give neither an explanation why a particular patient is predicted to be at high risk nor suggestions on interventions tailored to the patient’s specific case. As a result, many high-risk patients miss some suitable interventions. Third, thresholds for risk strata are suboptimal and determined heuristically with no quality guarantee.ObjectiveThe purpose of this study is to improve risk-stratified patient management so that more patients will receive the most appropriate care.MethodsThis study will (1) combine patient, physician profile, and environmental variable features to improve prediction accuracy of individual patient health outcomes and costs; (2) develop the first algorithm to explain prediction results and suggest tailored interventions; (3) develop the first algorithm to compute optimal thresholds for risk strata; and (4) conduct simulations to estimate outcomes of risk-stratified patient management for various configurations. The proposed techniques will be demonstrated on a test case of asthma patients.ResultsWe are currently in the process of extracting clinical and administrative data from an integrated health care system’s enterprise data warehouse. We plan to complete this study in approximately 5 years.ConclusionsMethods developed in this study will help transform risk-stratified patient management for better clinical outcomes, higher patient satisfaction and quality of life, reduced health care use, and lower costs.

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Psychiatric Practice Variations in the Diagnosis and Treatment of Major Depression

Abstract: Patient care varies considerably across psychiatric practices, a finding that is particularly relevant for developers of performance indicators and risk-adjustment strategies for mental health.

Cited by 25 publications

References 29 publications

Quality of Mental Health Care for Depressed Adolescents

Quality of Mental Health Care for Depressed Adolescents

An approach to measure compliance to clinical guidelines in psychiatric care

Using Computational Approaches to Improve Risk-Stratified Patient Management: Rationale and Methods

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