Effectiveness and Outcomes in Health Care Proceedings of an Invitational Conference (1990) / Chapter Skim
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19 Studying Outcomes for Patients with Depression: Initial Findings from the Medical Outcomes Study
19 Studying Outcomes for Patients with Depression: Initial Findings from the Medical Outcomes Study
Pages 160-172
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From page 160... ...
Clinicians and patients were selected on the basis of the health care systems that they had chosen. As a result, there were likely to be differences in patient characteristics-for example, severity of the target condition, stage of treatment, and complicating comorbidities that could affect outcomes, independently of the quality of care received.
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From page 161... ...
health maintenance organizations (HMOs) , large health care organizations representing the major prepaid alternative to traditional private practice care; and (c)
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From page 162... ...
Taking all these points together, we can hypothesize that important differences exist across health care settings in the detection of depression and the subsequent quality of care provided to depressed patients. We may further hypothesize that such differences have important implications for patients and for society.
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From page 163... ...
As I mentioned earlier, to compare patient outcomes across different health care settings using an observational design, one must identify baseline patient characteristics that may affect the course of depression. In the baseline phase of the MOS, we comprehensively assessed factors that are believed to be of some prognostic significance in depression.
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From page 164... ...
We have arrived at estimates of the prevalence of depression among patients in these health care systems (17~. In practices of mental health specialists, about 25 percent of visiting patients on any given day currently had depression.
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From page 165... ...
The zero level on the vertical axis represents the average level of functioning and well-being of patients with no chronic medical or mental health conditions. Positive numbers along the vertical axis represent the extent to which patients with depression and chronic medical conditions have poorer functioning arid well-being than those with no chronic conditions.
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From page 166... ...
Second, we have identified a number of baseline patient characteristics, particularly severity of depression, which need to be included as case-mix adjustment factors in comparisons of health care settings. CONCLUSION I will end with a couple of thoughts.
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From page 167... ...
A second issue is whether, from a measurement perspective, we are ready to begin studying outcomes as a part of health care effectiveness studies. With respect to generic measures of functioning and well-being, I agree with John Ware that we are ready to begin using generic measures in large-scale efforts.2 There exist brief, patient-administered generic measures that have established reliability, that are responsive to changes in patient state, and that are responsive to differences across conditions.
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From page 168... ...
The Prevalence of Depression in General Medical and Mental Health Outpatient Practices in Three Health Care Systems. Santa Monica, CA: RAND Corporation, in preparation.
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From page 169... ...
Pp. 107-1 19 in Electiveness and Outcomes in Health Care.
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From page 171... ...
; (3) we must be able to interpret the results in a way that will be useful to those delivering and receiving health care services; and (4)
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From page 172... ...
172 EFFECTIVENESS AND OUTCOMES IN HEALTH CARE and management system at HCHP that attempts to measure and manage variations in clinical practice. Eugene C
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