Measurement Tool for Clinical Practice Guideline Implementation: Measures for Depression

Transcription

1 ment Tool for Clinical Practice Guideline : Establish process and clinical outcomes measures before implementing the Depression in the Long Term Care Setting Clinical Practice Guideline (CPG). As much as possible, identify measurable (quantitative) indicators. Process measures evaluate how well a facility is implementing related processes of care, e.g., number of patients admitted that are assessed for. Outcomes measures look at measurable changes in a patient s condition as a result of treatment or other interventions, e.g., number of patients with documented improvement in function. In the past, health care facilities mostly have relied on process measures. Recently, however, quality monitoring organizations have begun to demand outcomes measures. Both are important. Here are AMDA s suggested quantitative clinical process and clinical outcomes measures related to using the Depression CPG in a long-term care facility. These measures are based on the four components of the AMDA management process: Recognition, Assessment, Treatment, and Monitoring. Where noted, certain terms will require further definition by the facility. All clinical process and clinical outcomes measures should be defined using selected benchmarks, e.g., national norms or the facility s historical norms, if others are not available. General Process s Note: Documentation refers to whether a procedure/discussion was indicated/done or not indicated/not done. s (percentages) are obtained by multiplying each calculated fraction by 100 (for example, if 15 persons were assessed for out of 45 who should have been assessed, the rate is 15/45 x 100 or.333 x 100 = 33.3%). All measures marked with an asterisk (*) are applicable for practitioners only.

2 Clinical Process s Recognition % of patients identified for history of on admission % of patients screened for using a validated geriatric screening tool on admission and at a significant change % of patients identified for signs or symptoms of % of patents identified with risk factors for N = # of patients identified for history of on admission D = # of all patients N = # of patients screened for using a validated geriatric screening tool on admission and at a significant change D = # of all patients N = # of patients identified for signs or symptoms of D = # of all patients N = # of patents identified with risk factors for D = # of patients not identified with current

3 Assessment *% of patients deemed appropriate to have a medical workup performed for factors possibly contributing to signs and symptoms of possible *% of patients assessed for medications possibly causing or contributing to *% of patients who receive a medical evaluation to determine the extent to which underlying medical problems cause or contribute to depressive symptoms *% of patients whose type of depressive disorder has been clarified % of patients with persistently depressed mood or loss of interest or pleasure for at least 2 weeks for whom a health care practitioner has been consulted % of patients with who have been assessed for complications that may pose a risk to the patients or others % of patients with who have been assessed for suicide risk N = # of patients deemed appropriate to have a medical workup performed for factors possibly contributing to signs and symptoms of possible D = # of all patients with possible N = # of patients assessed for medications possibly causing or contributing to D = # of all patients with N = # of patients who receive a medical evaluation to determine the extent to which underlying medical problems cause or contribute to depressive symptoms D = # of all patients with N = # of patients whose type of depressive disorder has been clarified D = # of all patients with N = # of patients with persistently depressed mood or loss of interest or pleasure for at least 2 weeks for whom a health care practitioner has been consulted D = # of patients with persistently depressed mood or loss of interest or pleasure for at least 2 weeks N = # of patients with who have been assessed for complications that may pose a risk to the patient or others D = # of patients with N = # of patients with who have been assessed for suicide risk D = # of patients with

4 Treatment % of patients with who have an appropriate and evidence-based nonpharmacologic or complementary treatment plan implemented *% of patients receiving pharmacologic therapy for whose practitioner has discussed and documented the rationale for adding pharmacotherapy with team members as well as with the patient and his or her family % of patients with receiving appropriate adjunctive treatment N = # of patients with who have an appropriate and evidence-based nonpharmacologic or complementary treatment plan implemented D = # of patients with N = # of patients receiving pharmacologic therapy for whose practitioner has discussed and documented the rationale for adding pharmacotherapy with team members as well as with the patient and his or her family D = # of patients receiving pharmacologic therapy for N = # of patients with receiving appropriate adjunctive treatment D = # of patients with

5 Monitoring % of patients whose response to treatment for is monitored and documented % of patients with receiving pharmacotherapy treatment who are monitored at least one year beyond initiation for achieving full remission % of patients receiving antidepressants who are monitored for common side effects of treatment N = # of patients whose response to treatment for is monitored and documented D = # of patients with N = # of patients with receiving pharmacotherapy treatment who are monitored at least one year beyond initiation for achieving full remission D = # of patients receiving antidepressant medication N = # of patients receiving antidepressants who are monitored for common side effects of treatment D = # of patients receiving antidepressant medication

6 Clinical Outcome s that show resolution of signs and symptoms of that show improvement of scores on the validated screening tools that show improvement in attendance at and participation in usual activities that show improvement in sleep pattern that show resolution of signs and symptoms of that show improvement of scores on the validated screening tools that show improvement in attendance at and participation in usual activities that show improvement in sleep pattern