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  • Measure Summary
  • NQMC:003492

Depression: the percentage of patients diagnosed with unipolar depression who receive an initial assessment that considers the risk of suicide.

STABLE (STAndards for BipoLar Excellence) performance measures. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. various p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

The STABLE Project National Coordinating Council reaffirmed the currency of this measure in November 2010.

Primary Measure Domain

Process

The validity of measures depends on how they are built. By examining the key building blocks of a measure, you can assess its validity for your purpose. For more information, visit the Measure Validity page.

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients diagnosed with unipolar depression, who receive an initial assessment that considers the risk or suicide. See the related National Quality Measures Clearinghouse (NQMC) summary of the STABLE Project National Coordinating Council measure Bipolar disorder: the percentage of patients diagnosed with bipolar disorder who receive an initial assessment that considers the risk of suicide.

Rationale

Bipolar Disorder and Risk of Suicide

  • Unipolar depression and bipolar disorder are associated with a significant risk of suicide. The risk of completed suicide is higher in bipolar disorder than in unipolar depression.
  • Patients with bipolar disorder are at high risk for suicide; rates as high as 80% of patients with bipolar disorder have been reported with either suicidal ideation or suicide attempts.
  • Suicide completion rates in patients with bipolar I disorder have been reported as high as 10-15% with some studies reporting higher rates in patients with bipolar II disorder.
  • Among the phases of bipolar disorder, depression is associated with the highest suicide risk, followed by mixed states and presence of psychotic symptoms with episodes of mania being least associated with suicide.
  • Data from a large study reporting systematic treatment enhancement program for bipolar disorder (STEP-BD) baseline data identified that of patients with bipolar disorder, 60% had a history of prior suicide attempts and that this finding was consistent with other large studies that show a strong association between prior history of suicide attempts and new attempts or completed suicide in patients with bipolar disorder.

Assessing Risk of Suicide

  • All patients should be asked about suicidal ideation, intention to act on these ideas, and extent of plans or preparation for suicide.

Primary Clinical Component

Unipolar depression; suicide risk assessment

Denominator Description

Patients diagnosed with unipolar depression (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Patients who receive an initial assessment for unipolar depression that includes an appraisal of the risk of suicide (see the related "Numerator Inclusions/Exclusions" field)

Evidence Supporting the Criterion of Quality

A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence

A formal consensus procedure involving experts in relevant clinical, methodological, and organizational sciences

One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Need for the Measure

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Care Setting

Ambulatory Care

Behavioral Health Care

Physician Group Practices/Clinics

Professionals Responsible for Health Care

Advanced Practice Nurses

Physicians

Psychologists/Non-physician Behavioral Health Clinicians

Lowest Level of Health Care Delivery Addressed

Individual Clinicians

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

Stratification by Vulnerable Populations

Unspecified

Source(s)

STABLE (STAndards for BipoLar Excellence) performance measures. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. various p.

Incidence/Prevalence

Unspecified

Association with Vulnerable Populations

Unspecified

Burden of Illness

See the "Rationale" field.

Utilization

Unspecified

Costs

Unspecified

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Case Finding

Users of care only

Description of Case Finding

Patients with a diagnosis involving unipolar depression: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or Diagnostic and Statistical Manual of Mental Disorders, Fourth Revision, Text Revision (DSM-IV-TR): 296.2x; 296.3x; 300.4 or 311

Denominator Sampling Frame

Patients associated with provider

Denominator Inclusions/Exclusions

Inclusions
Patients 18 years of age or older with an initial diagnosis or new presentation/episode of depression

AND

Documentation of a diagnosis involving unipolar depression; to include at least one of the following:

  • Codes 296.2x; 296.3x. 300.4 or 311 documented in body of chart, such as a pre-printed form completed by a clinician and/or codes documented in chart notes/forms
  • Diagnosis or impression documented in chart indicating "depression"
  • Use of a screening/assessment tool for depression with a documented score or conclusion that the patient is clinically depressed and that indication that this information is used to establish or substantiate the diagnosis

Exclusions
Unspecified

Relationship of Denominator to Numerator

All cases in the denominator are equally eligible to appear in the numerator

Denominator (Index) Event

Clinical Condition

Encounter

Denominator Time Window

Time window is a single point in time

Numerator Inclusions/Exclusions

Inclusions
Documentation of an assessment for risk of suicide; to include at least one of the following:

  • Documented clinician evaluation of the presence or absence of suicidal ideation or intention
  • Documented reference to comments the patient made that relate to the presence or absence of thoughts of suicide/death
  • Documented reference to use, or presence in the chart of, a screening tool or patient assessment form that addresses suicide

AND

Timeframe:
Documentation of the assessment for risk of suicide must be present prior to, or concurrent with, the visit where the diagnosis and/or treatment plan is first documented.

Exclusions
Unspecified

Measure Results Under Control of Health Care Professionals, Organizations and/or Policymakers

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Numerator Time Window

Encounter or point in time

Data Source

Administrative data

Medical record

Level of Determination of Quality

Individual Case

Pre-existing Instrument Used

Scoring

Rate

Interpretation of Score

Better quality is associated with a higher score

Allowance for Patient Factors

Unspecified

Standard of Comparison

Internal time comparison

Extent of Measure Testing

  • The STABLE measures were developed using the RAND Appropriateness Method and have been shown to have content validity and face validity.
  • Data feasibility testing was performed to determine the availability of the data elements required in the measure numerator and denominator specifications.
  • Inter-abstractor reliability testing was performed to assess the data collection strategy. The data collection strategy included data collection forms; data dictionary references and abstractor instructions.
  • A field study was conducted to determine measure conformance in an appropriate convenience sample.

Refer to the references listed below for further information.

Evidence for Reliability/Validity Testing

STABLE performance measures: data feasibility testing & results. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. 2 p.

STABLE performance measures: development process & validity ratings. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. 3 p.

STABLE performance measures: field study process & conformance findings. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. 3 p.

STABLE performance measures: inter-abstractor reliability testing & results. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. 2 p.

Original Title

Bipolar disorder or depression: assessment for risk of suicide.

Measure Collection Name

Standards for Bipolar Excellence (STABLE) Performance Measures

Submitter

Center for Quality Assessment and Improvement in Mental Health

Developer

STABLE Project National Coordinating Council

Funding Source(s)

AstraZeneca LLP, Wilmington, Delaware, provided financial sponsorship for the STABLE Project. They did not otherwise participate in the development of either the measures or toolkit.

Composition of the Group that Developed the Measure

The STABLE National Coordinating Council (NCC) External Web Site Policy was comprised of national experts in bipolar disorder, psychiatry, primary care, and performance improvement. The NCC guided and directed the STABLE Project. NCC members agreed to serve with the understanding that the STABLE Performance Measures and Resource Toolkit would be fully transparent and available without cost in the public domain.

EPI-Q, Inc. External Web Site Policy, is a consulting company providing practice-based outcomes research, pharmacoeconomic studies, and quality improvement services. EPI-Q managed the STABLE Project.

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

Measure was not adapted from another source.

Release Date

2007 Jan

Measure Status

This is the current release of the measure.

The STABLE Project National Coordinating Council reaffirmed the currency of this measure in November 2010.

Measure Availability

The individual measure, "Bipolar Disorder or Depression: Assessment for Risk of Suicide," is published in "STABLE (STAndards for BipoLar Excellence) Performance Measures." This document is available in Portable Document Format (PDF) from the Center for Quality Assessment and Improvement in Mental Health (CQAIMH) Web site External Web Site Policy.

Companion Documents

The following is available:

NQMC Status

This NQMC summary was completed by ECRI Institute on January 10, 2008. The information was verified by the measure developer on April 14, 2008. The information was reaffirmed by the measure developer on November 1, 2010.

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