VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
J Behav Health Serv Res. 2023 Jan;50(1):49-67. doi: 10.1007/s11414-022-09813-4. Epub 2022 Oct 7.
To inform the potential use of patient-reported depression symptom outcomes as measures of care quality, this study collected and analyzed longitudinal Patient Health Questionnaire (PHQ9) scores among 1,638 patients who screened positive for major depression according to a PHQ9 ≥ 10 across 29 Department of Veterans Affairs facilities. The study found baseline PHQ9, prior mental health visits, physical functioning, and treatment expectancy were consistently associated with subsequent PHQ9 outcomes. No facilities outperformed any others on PHQ9 scores at the 6-month primary endpoint, and the corresponding intra-class coefficient was ≤ .01 for the entire sample (n = 1,214) and 0.03 for the subgroup of patients with new depression episodes (n = 629). Measures of antidepressant receipt, psychotherapy, or treatment intensification were not associated with 6-month PHQ9 scores. PHQ9 outcomes are therefore unlikely to be useful as quality indicators for VA healthcare facilities due to low inter-facility variation, and new care process measures are needed to inform care for patients with chronic depression prevalent in this sample.
为了探究将患者报告的抑郁症状作为医疗质量衡量标准的潜在用途，本研究收集并分析了 29 家退伍军人事务部医疗机构中 1638 名 PHQ9 评分≥10 的重度抑郁症患者的纵向 PHQ9 评分。研究发现，基线 PHQ9、先前的心理健康就诊次数、身体功能和治疗预期与后续 PHQ9 结果始终相关。在 6 个月的主要终点时，没有任何一个机构在 PHQ9 评分上优于其他机构，整个样本（n=1214）的组内相关系数≤0.01，新出现抑郁发作患者亚组（n=629）的相应系数为 0.03。抗抑郁药的使用、心理治疗或治疗强化与 6 个月 PHQ9 评分均无相关性。因此，由于设施间差异较小，PHQ9 结果不太可能作为退伍军人事务部医疗保健设施的质量指标，需要新的护理流程措施来为该样本中常见的慢性抑郁症患者提供护理。
