Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT 06516, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States.
VA Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, DC 20420, United States.
Psychiatry Res. 2023 Jun;324:115196. doi: 10.1016/j.psychres.2023.115196. Epub 2023 Apr 10.
Healthcare Effectiveness Data and Information Set (HEDIS) quality measures for depression treatment aggregate Patient Health Questionnaire (PHQ)-9 data from routine clinical assessments recorded in electronic health records (EHR). To determine whether aggregated PHQ-9 data in US Veterans Health Administration (VHA) EHRs should be used to characterize the organization's performance, we compared rates for depression response and remission calculated from EHRs with rates calculated with data representing the underlying Veteran patient population estimated using Veterans Outcome Assessment (VOA) survey data. We analyzed data from initial assessments and 3-month follow-up for Veterans beginning treatment for depression. EHR data were available for only a minority of Veteran patients, and the group of Veterans with EHR data differed from the underlying Veteran patient population with respect to demographic and clinical characteristics. Aggregated rates of response and remission from EHR data were significantly different from estimates based on representative VOA data. The findings suggest that until patient-reported outcome from EHRs are available for a substantial majority of patients receiving care, aggregated measures of patient outcomes derived from these data cannot be assumed to be representative of the outcomes for the overall population, and they should not be used as outcome-based measures of quality or performance.
医疗保健效果数据和信息集（HEDIS）的抑郁症治疗质量措施汇总了电子健康记录（EHR）中常规临床评估记录的患者健康问卷（PHQ-9）数据。为了确定是否应该使用美国退伍军人事务部（VHA）EHR 中的汇总 PHQ-9 数据来描述组织的绩效，我们比较了从 EHR 计算得出的抑郁反应和缓解率，以及使用代表使用退伍军人结果评估（VOA）调查数据估计的基础退伍军人患者群体的数据计算得出的率。我们分析了开始接受抑郁症治疗的退伍军人的初始评估和 3 个月随访的数据。仅有少数退伍军人患者的 EHR 数据可用，并且具有 EHR 数据的退伍军人群体在人口统计学和临床特征方面与基础退伍军人患者群体有所不同。EHR 数据得出的反应和缓解率汇总结果与基于代表性 VOA 数据的估计值显著不同。这些发现表明，在接受护理的绝大多数患者的 EHR 中提供患者报告的结果之前，不能假定从这些数据得出的患者结果汇总指标能够代表总体人群的结果，并且不能将其用作基于结果的质量或绩效衡量标准。
