ACP finds only one of eight measures to be valid for management of major depressive disorder

The paper, published in Annals of Internal Medicine, presents a review of MDD performance measures and highlights opportunities to improve performance measures addressing MDD management.

Major depressive disorder is a severe mood disorder affecting at least 8.4% of the adult population in the United States. Characteristics of MDD include diminished interest in daily activities, persistent sadness, and a state of hopelessness.

The illness, if left untreated, may progress quickly and have devastating consequences. Eight performance measures are available to evaluate screening, diagnosis, and successful management of MDD. However, many performance measures fail to meet the criteria for reliability, validity, evidence, and meaningfulness. 

A January 2023 ACP clinical guideline recommends monotherapy with cognitive behavioral therapy (CBT) or with a second-generation antidepressant as an initial treatment in patients in the acute phase of moderate to severe MDD. There is strong evidence around appropriate treatment for MDD after an initial diagnosis, despite this, no performance measures currently exist to fill this gap. However, there are feasibility challenges with the data needed for such a performance measure, including but not limited to ICD-10 coding and capturing CBT recommendations.

The ACP's Performance Measurement Committee (PMC) reviews performance measures using a validated process to inform regulatory and accreditation bodies in an effort to recognize high-quality performance measures, address gaps and areas for improvement in performance measures, and help reduce reporting burden.

ACP’s PMC found that out of eight performance measures only one measure, Suicide Risk Assessment, was found to be valid at all levels of attribution. This performance measure evaluates the frequency of suicide risk assessment for patients with a new diagnosis of major depressive disorder. The performance measure is evidence-based, clinically sound, and tested appropriately with reliable and valid results.

“It is important to screen, diagnose, and provide timely treatment for MDD,” Omar T. Atiq, M.D., MACP, president, ACP, said in a press release. “Performance measures intend to encourage evidence-based care with results that will drive improvements in care. However, several feasibility barriers related to continuity of care and coding need addressing to measure appropriate management of MDD accurately."

There is a need for systemwide technological improvements to extract the necessary data and support proper coding for MDD management. The paper suggests that the need for data interoperability to improve reporting for performance measures that can move the quality needle and reduce the burden of performance measurement on group practices, physicians, and health systems.

Reference:

Qaseem A, Andrews RA, Campos K, Goldzweig CL, MacDonald S, McLean RM, Powell RE, Fitterman N; Performance Measurement Committee of the American College of Physicians*. Quality Indicators for Major Depressive Disorder in Adults: A Review of Performance Measures by the American College of Physicians. Ann Intern Med. 2024 Mar 5. doi: 10.7326/M23-3077. Epub ahead of print. PMID: 38437692.