Does the Veterans Affairs depression performance measure predict quality care?

BACKGROUND: In 2000, the Department of Veterans Affairs (VA) instituted a performance measure to improve the quality of depression care. The measure evaluated adequacy of follow-up for depressed patients but was removed from clinic directors' performance plans in fiscal year (FY) 2009 because it had not been empirically validated. The VA depression performance measure was compared with an empirically validated model for assessing adherence to important depression treatment processes.

METHODS: VA medical centers (VAMCs) whose performance on the VA depression measure was in the top or bottom quartile nationally for all four quarters in FY2008 were selected for inclusion. A blinded interviewer attempted to contact clinical directors of both primary care and mental health at each VAMC and conducted telephone interviews using a protocol designed to employ the 3-Component Model (3CM) fidelity measure, which assesses domains of evidence-based depression care.

RESULTS: There were 9 sites in the "high-performing" group and 10 sites in the "low-performing" group. At least one interview was completed at 8 of the 9 sites in the high-performing group and 9 of the 10 sites in the low-performing group. There was a significant difference in the percentage of patients meeting the VA depression performance measure between the high- and low-performing groups (47.5% versus 14.7%; chi2 = 837.5, p < .001). The adapted version of the 3CM fidelity scale detected a significant difference in process of depression care between the high- and low-performing sites (82.3 versus 71.4; z = 2.4, p = .018).

CONCLUSIONS: The highest-performing sites on the VA depression performance measure adhered to important care processes more often than did the lowest-performing sites.