How well do automated performance measures assess guideline implementation for new-onset depression in the Veterans Health Administration?

BACKGROUND: Because most guidelines focus on patients with new episodes of depression, algorithms to identify such samples must be accurate. This study examined whether the Veterans Health Administration's (VHA's) electronic medical record database could identify valid cases of new-onset depression.
RESULTS: Of 109 individuals receiving outpatient care at one of three VHA medical centers who were identified with newly diagnosed depressive disorder, 39 (35.8%) actually had documentation of depression diagnosis and antidepressant prescription or other treatment within the previous six months. Good to excellent agreement was found between indicators of guideline-concordant care using automated and manual chart review methods. DISCUSSION: Electronic medical records can validly identify many cases of new-onset depression, although with a higher-than-anticipated rate of false-positives. Half of depressed veterans received care consistent with clinical guidelines for psychopharmacological intervention, regardless of data source.
SUMMARY: Clinical managers, administrators, and policy advocates must weigh the cost-benefit of administrative versus medical record reviews to assess quality.