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Mental Health QUERI Initiative: Expert Ratings of Criteria to Assess Performance for Major Depressive Disorder and Schizophrenia

VA HSR&D Center for Mental Healthcare Outcomes Research (CeMHOR), Central Arkansas Veterans Healthcare System (152/NLR), 2200 Ft. Roots Drive, North Little Rock, AR 72114-1706 OwenRichardR{at}uams.edu; Department of Psychiatry and Behavioral Sciences

Dale Cannon, PhD

VA Salt Lake Heath Care System and the Department of Psychiatry, University of Utah

Carol R. Thrush, MA

VA HSR&D Center for Mental Healthcare and Outcomes Research (CeMHOR), Central Arkansas Veterans Healthcare System, Little Rock, AR, and the Centers for Mental Healthcare Research, Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, AR

The purpose of this study was to examine mental health care experts' opinions about performance measures and associated data elements that could serve as the basis of an information system for monitoring the implementation of clinical practice guidelines for major depressive disorder (MDD) and schizophrenia in the Veterans Health Administration (VHA). Nineteen mental health care experts rated the meaningfulness and validity of performance measures and automated data elements. For MDD, experts rated the following measures as very meaningful and valid: (a) the results of depression screening, (b) the occurrence and results of diagnostic assessment for MDD, (c) the provision of antidepressant medication or psychotherapy, and (d) whether antidepressant medications were prescribed within the therapeutic dose range recommended by practice guidelines. For schizophrenia, expert reviewers rated therapeutic doses of antipsychotic medication and assessment for antipsychotic medication side effects as being very meaningful and valid. Performance measures that evaluate clinically significant aspects of care using specific, valid data elements are the most meaningful. Translation efforts by the VHA's Mental Health Quality Enhancement Research Initiative program include additional studies of the validity of some of the proposed data elements and the development of national clinical reminders for performance measures judged to be meaningful.

Key Words: Clinical practice guidelines • depression • performance measurement • quality of care • schizophrenia

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