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Challenging the quality of the quality indicator, "depression without treatment"
Marc H Zisselman1, Robert S Warren, Theresa Cutillo-Schmitter
1Temple Continuing Care Center, and Department of Psychiatry, Temple University, Philadelphia, Pennsylvania, USA.
Objective:
To assess the validity of the Minimum Data Set (MDS)-based quality indicator, "depression without treatment," and examine whether a nonphysician-based educational intervention can improve the accuracy of MDS questions regarding depression and its treatment.
Subjects:
All residents of a 538-bed urban, university affiliated, long-term-care (LTC) facility. Nursing and social work staff involved in completing the mood and behavior items on the MDS.
Design:
Two retrospective chart review of psychotropic medications, psychiatric diagnoses, mental health evaluation, and treatment of all residents who were identified as displaying the MDS quality indicator, depression without treatment, before and 2 months after an educational intervention. The education consisted of three 1 1/2-hour sessions led by a psychiatric clinical nurse specialist to educate registered nurse assessment coordinators and social workers about psychotropic medications, clinical characteristics of psychiatric diagnoses, chart review, and coordination of resident medical care.
Results:
The first MDS identified 66 residents as having depression without treatment. Clinical record review revealed that 11 of these residents were receiving an antidepressant. Twenty-two others were receiving a psychotropic medication consistent with their psychiatric diagnosis. Twenty-five of the remaining residents had not received mental health assessment for greater than 1 year. Two months after the educational intervention, 36 residents were identified as depression without treatment. Four of these residents were receiving an antidepressant; eight others were receiving a psychotropic medication consistent with their psychiatric diagnosis. Thirteen of the remaining residents had not received mental health assessment for greater than 1 year.
Conclusions:
This preliminary study reveals that the presence of the quality indicator, depression without treatment, may not accurately capture clinically depressed LTC residents in need of mental health intervention. An educational intervention may be able to assist staff in more accurately completing MDS questions regarding depression and its treatment.