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2006 National Healthcare Quality Report

Effectiveness of Care: Mental Health and Substance Abuse

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Treatment of Depression
Adults diagnosed with a new episode of depression who had optimal practitioner contacts for medication management during the acute treatment phase
Adults diagnosed with a new episode of depression and initiated on an antidepressant drug who received a continuous trial of medication treatment during the acute treatment phase
Adults diagnosed with a new episode of depression and initiated on an antidepressant drug who remained on an antidepressant medication through the continuation phase of treatment
Deaths due to suicide per 100,000 population
Treatment of Serious Mental Illness
Adults age 18+ with a major depressive episode in the past year who received treatment for the depression in the past year
Persons age 12+ receiving mental health treatment and/or counseling for serious mental illness who experienced improvement
Treatment of Substance Abuse
People 12 and older who needed treatment at a specialty facility for illicit drug use and who received such treatment in the past year
People receiving illicit drug treatment who completed treatment


Treatment of Depression

Measure Title

Percent of adults diagnosed with a new episode of depression who had optimal practitioner contacts for medication management during the acute treatment phase.

Measure Source

National Committee for Quality Assurance, Health Plan Employer Data Information Set (HEDIS) measure.

Table

1.84. Adults diagnosed with a new episode of depression who had optimal practitioner contacts for medication management during the acute treatment phase, United States, 2001 and 2005.

Data Source

NCQA, HEDIS data.

Denominator

U.S. enrollees of Medicaid, Medicare or commercial health plans, age 18 and over, with a pharmacy benefit, diagnosed with a new episode of major depression (ICD-9-CM codes 296.2, 296.3, 298.0, 300.4, 309.1, 311).

Numerator

Subset of the denominator who had optimal practitioner contact: at least 3 follow-up office visits with a primary care or mental health provider in the 12-week acute treatment phase after a diagnosis of depression and prescription of antidepressant medication.

Comments

A new episode is defined as no prior diagnosis of depression of any magnitude (ICD-9-CM codes 296.2-296.9, 298.0, 300.4, 309.0, 309.1, 309.28, 311) within 120 days of the first episode occurring during the study year.

Refer to HEDIS technical specifications for a more thorough discussion of measure requirements.

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Treatment of Depression

Measure Title

Percent of adults diagnosed with a new episode of depression and initiated on an antidepressant drug who received a continuous trial of medication treatment during the acute treatment phase.

Measure Source

HEDIS data from the National Committee for Quality Assurance.

Table

1.85. Adults diagnosed with a new episode of depression and initiated on an antidepressant drug who received a continuous trial of medication treatment during the acute treatment phase, United States, 2001 and 2005.

Data Source

NCQA, HEDIS data.

Denominator

U.S. enrollees of Medicaid, Medicare or commercial health plans, age 18 and over, with a pharmacy benefit, diagnosed with a new episode of major depression (ICD-9-CM codes 296.2, 296.3, 298.0, 300.4, 309.1, 311) and initiated on an antidepressant drug.

Numerator

Subset of the denominator receiving a continuous trial of antidepressant medication treatment during the acute treatment phase (first 12 weeks following initial diagnosis).

Comments

A new episode is defined as no prior diagnosis of depression of any magnitude (ICD-9-CM codes 296.2-296.9, 298.0, 300.4, 309.0, 309.1, 309.28, 311) within 120 days of the first episode occurring during the study year.

Refer to HEDIS technical specifications for a more thorough discussion of measure requirements.

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Treatment of Depression

Measure Title

Percent of adults diagnosed with a new episode of depression and initiated on an antidepressant drug who remained on an antidepressant medication through the continuation phase of treatment.

Measure Source

NCQA Health Plan Employer Data Information Set (HEDIS) measure.

Table

1.86. Adults diagnosed with a new episode of depression and initiated on an antidepressant drug who remained on an antidepressant medication through the continuation phase of treatment, United States, 2001 and 2005.

Data Source

NCQA, HEDIS data.

Denominator

U.S. enrollees of Medicaid, Medicare or commercial health plans, age 18 and over, with a pharmacy benefit, diagnosed with a new episode of major depression (ICD-9-CM codes 296.2, 296.3, 298.0, 300.4, 309.1, 311) and initiated on an antidepressant drug.

Numerator

Subset of the denominator receiving antidepressant medication and remaining on medication throughout the continuation treatment phase (6 months following initial diagnosis).

Comments

A new episode is defined as no prior diagnosis of depression of any magnitude (ICD-9-CM codes 296.2-296.9, 298.0, 300.4, 309.0, 309.1, 309.28, 311) within 120 days of the first episode occurring during the study year.

Refer to HEDIS technical specifications for a more thorough discussion of measure requirements.

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Treatment of Depression

Measure Title

Deaths due to suicide per 100,000 population.

Measure Source

Healthy People 2010, measure 18-1.

Tables

1.87a. Suicide deaths per 100,000 population, United States, 1999 and 2003.

1.87b. Suicide deaths per 100,000 population, by State, 1999 and 2003.

Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Vital Statistics System—Mortality.

Denominator

U.S. population.

Numerator

Number of deaths due to suicide (ICD-10-CM codes X60-X84, Y87.0).

Comments

Suicides may be undercounted because of difficulty in the determination of suicidal intent by coroner or medical examiner.

Rates are age adjusted to the 2000 standard population.

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Treatment of Serious Mental Illness

Measure Title

Adults age 18 and over with a major depressive episode in the past year who received treatment for the depression in the past year.

Measure Source

Substance Abuse and Mental Health Services Administration (SAMHSA).

Table

1.88. Adults age 18 and over with past year major depressive episode who received treatment for the depression in the past year, United States, 2004.

Data Source

SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health (NSDUH).

Denominator

Persons age 18 or older with a major depressive episode in the past year.

Numerator

Subset of the denominator who received treatment or counseling in the past year.

Comments

Major depressive episode (MDE) is defined as a period of at least 2 weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had a majority of the symptoms for depression as described in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders DSM-IV. Respondents with unknown data for past year MDE measures were excluded.

Negative or poor refers to household incomes below the Federal poverty line; near poor/low, over the poverty line to just below 200 percent of the poverty line; middle, 200 percent to just below 400 percent of the poverty line; and high, 400 percent of the poverty line and over.

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Treatment of Serious Mental Illness

Measure Title

Persons age 12 and older receiving mental health treatment and/or counseling for serious mental illness who experienced improvement.

Measure Source

Substance Abuse and Mental Health Services Administration (SAMHSA).

Table

1.89. Perception of help received from treatment or counseling among persons age 12 and over with a past year major depressive episode, United States, 2004.

Data Source

SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health (NSDUH).

Denominator

Persons age 12 or older with serious mental illness who received mental health treatment or counseling in the past year.

Numerator

Subset of the denominator who experienced improvement.

Comments

Serious mental illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that meets criteria set forth in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and which resulted in functional impairment that significantly impeded 1 or more major life activities. For further information see Appendix B, Section B.4 of the Results from the 2003 National Survey on Drug Use and Health: National Findings available at http://www.oas.samhsa.gov.

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Treatment of Substance Abuse

Measure Title

People 12 and older who needed treatment at a specialty facility for illicit drug use and who received such treatment in the past year.

Measure Source

Substance Abuse and Mental Health Services Administration (SAMHSA).

Table

1.90. Persons age 12 or older who needed treatment for any illicit drug use and who received such treatment at a specialty facility in the past year, United States, 2003 and 2004.

Data Source

SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health (NSDUH).

Denominator

Persons age 12 or older who needed treatment for any illicit drug use.

Numerator

Subset of the denominator who received treatment for illicit drug use at a specialty facility in the past year.

Comments

Treatment at a specialty facility refers to inpatient hospital, inpatient or outpatient rehabilitation facility or mental health center treating drug use, or for treatment of medical problems associated with drug use.

Respondents were classified as needing treatment for an illicit drug problem if they met any of 3 criteria during the past year: (1) dependent on any illicit drug, (2) abuse of any illicit drug, or (3) received treatment for an illicit drug problem at a specialty facility. Illicit drugs include marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or nonmedical use of prescription psychotherapeutic drugs.

Estimates by family income are only available for persons age 18 or older. Negative or poor refers to household incomes below the Federal poverty line; near poor/low, over the poverty line to just below 200 percent of the poverty line; middle, 200 percent to just below 400 percent of the poverty line; and high, 400 percent of the poverty line and over. Estimates by education are only available for persons age 18 or older.

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Treatment of Substance Abuse

Measure Title

People receiving illicit drug treatment who completed treatment.

Measure Source

Substance Abuse and Mental Health Services Administration (SAMHSA).

Table

1.91. Persons age 12 or older who received substance abuse treatment who completed the treatment course, United States, 2002 and 2003.

Data Source

SAMHSA, Office of Applied Studies, Treatment Episode Data Set (TEDS).

Denominator

Persons receiving treatment for any illicit drug use at a State certified facility.

Numerator

Subset of the denominator who completed treatment.

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