Effectiveness of Care: Mental Health and Substance Abuse

2008 National Healthcare Quality and Disparities Reports

The National Healthcare Quality Report (NHQR) is a comprehensive national overview of quality of health care in the United States. It is organized around four dimensions of quality of care: effectiveness, patient safety, timeliness, and patient centeredness.

Treatment of Depression
Suicide deaths per 100,000 population
Adults diagnosed with a new episode of depression who had optimal practitioner contacts for medication management during the acute treatment phase
Adults diagnosed with a new episode of depression and initiated on an antidepressant drug who received a continuous trial of medication treatment during the acute treatment phase
Adults diagnosed with a new episode of depression and initiated on an antidepressant drug who remained on an antidepressant medication throughout the continuation phase of treatment
Adults with a major depressive episode in the last 12 months who received treatment for depression in the last 12 months
Children ages 12-17 with a major depressive episode in the last 12 months who received treatment for depression in the last 12 months
Adults treated for a major depressive episode who experienced improvement
Adults with a mood, anxiety, or impulse control disorder in the past year who received minimally adequate treatment

Treatment of Substance Abuse
People age 12 and over who needed treatment for illicit drug use and who received such treatment at a specialty facility in the last 12 months
People age 12 and over treated for substance abuse who completed treatment course
 


Treatment of Depression

Measure Title

Suicide deaths per 100,000 population.

Measure Source

Healthy People 2010.

National Tables

7_1_1.1 Suicide deaths per 100,000 population, United States, 1999 and 2005.

7_1_1.2 Suicide deaths per 100,000 population, United States, 2005, by:

  • Race.
  • Ethnicity.
  • Education.

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Vital Statistics System - Mortality (NVSS-M).

National Denominator

U.S. resident population.

National Numerator

Number of deaths due to suicide (International Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] codes X60-X84, Y87.0).

State Tables

7_1_1.3 Suicide deaths per 100,000 population, by State, 1999 and 2005.

State Data Source

CDC, NCHS, NVSS-M.

State Denominator

Resident population, by State.

State Numerator

Same as national.

Comments

Suicides may be undercounted because of difficulty a coroner or medical examiner may have in determining suicidal intent.

Rates are age adjusted to the 2000 standard population.

This measure is referred to as measure 18-1 in Healthy People 2010 documentation.

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Treatment of Depression

Measure Title

Adults diagnosed with a new episode of depression who had optimal practitioner contacts for medication management during the acute treatment phase.

Measure Source

National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS).

Table

Data table will not be presented this year.

Data Source

NCQA, HEDIS.

Denominator

U.S. enrollees of Medicaid, Medicare, or commercial health plans, age 18 and over, with a pharmacy benefit, diagnosed with a new episode of major depression (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 296.2, 296.3, 298.0, 300.4, 309.1, 311).

Numerator

Subset of the denominator who had optimal practitioner contact: at least 3 followup office visits with a primary care or mental health provider in the 12-week acute treatment phase after a diagnosis of depression and prescription of antidepressant medication.

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Treatment of Depression

Measure Title

Adults diagnosed with a new episode of depression and initiated on an antidepressant drug who received a continuous trial of medication treatment during the acute treatment phase.

Measure Source

National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS).

Tables

7_1_3.1 Adults diagnosed with a new episode of depression and initiated on an antidepressant drug who received a continuous trial of medication treatment during the acute treatment phase, United States, 2001 and 2007.

Data Source

NCQA, HEDIS.

Denominator

U.S. enrollees of Medicaid, Medicare, or commercial health plans, age 18 and over, with a pharmacy benefit, diagnosed with a new episode of major depression (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 296.20-296.25, 296.30-296.35, 298.0, 300.4, 309.1, 311) and initiated on an antidepressant drug.

Numerator

Subset of the denominator receiving a continuous trial of antidepressant medication treatment during the acute treatment phase (first 12 weeks following initial diagnosis).

Comments

A new episode is defined as no prior diagnosis of depression of any magnitude (ICD-9-CM codes 296.2-296.9, 298.0, 300.4, 309.0, 309.1, 309.28, 311) within 120 days of the first episode occurring during the study year.

Refer to HEDIS technical specifications for a more thorough discussion of measure requirements.

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Treatment of Depression

Measure Title

Adults diagnosed with a new episode of depression and initiated on an antidepressant drug who remained on an antidepressant medication throughout the continuation phase of treatment.

Measure Source

National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS).

Table

Data table will not be presented this year.

Data Source

NCQA, HEDIS.

Denominator

U.S. enrollees of Medicaid, Medicare, or commercial health plans, age 18 and over, with a pharmacy benefit, diagnosed with a new episode of major depression (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 296.2, 296.3, 298.0, 300.4, 309.1, 311) and initiated on an antidepressant drug.

Numerator

Subset of the denominator receiving antidepressant medication and remaining on medication throughout the continuation treatment phase (6 months following initial diagnosis).

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Treatment of Depression

Measure Title

Adults with a major depressive episode in the last 12 months who received treatment for depression in the last 12 months.

Measure Source

Substance Abuse and Mental Health Services Administration (SAMHSA).

Tables

7_1_5.1 Adults with a major depressive episode in the last 12 months who received treatment for depression in the last 12 months, United States, 2004 and 2006.

7_1_5.2 Adults with a major depressive episode in the last 12 months who received treatment for depression in the last 12 months, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health (NSDUH).

Denominator

Adults age 18 and over with a major depressive episode in the past year.

Numerator

Subset of the denominator who received treatment or counseling in the past year.

Comments

Major depressive episode (MDE) is defined as a period of at least 2 weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had a majority of the symptoms of depression described in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Respondents with unknown data for past year MDE measures were excluded.

Negative or poor refers to household incomes below the Federal poverty line; near poor/low, over the poverty line to just below 200 percent of the poverty line; middle, 200 percent to just below 400 percent of the poverty line; and high, 400 percent of the poverty line and over.

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Treatment of Depression

Measure Title

Children ages 12-17 with a major depressive episode in the last 12 months who received treatment for depression in the last 12 months.

Measure Source

Substance Abuse and Mental Health Services Administration (SAMHSA).

Tables

7_1_6.1 Children ages 12-17 with a major depressive episode in the last 12 months who received treatment for depression in the last 12 months, United States, 2004 and 2006.

7_1_6.2 Children ages 12-17 with a major depressive episode in the last 12 months who received treatment for depression in the last 12 months, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.

Data Source

SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health (NSDUH).

Denominator

Children ages 12-17 with a major depressive episode in the last 12 months.

Numerator

Subset of the denominator who received treatment.

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Treatment of Depression

Measure Title

Adults treated for a major depressive episode who experienced improvement.

Measure Source

Substance Abuse and Mental Health Services Administration (SAMHSA).

Tables

7_1_7.1 Perception of help received from treatment or counseling among people age 12 and over with a major depressive episode (MDE) in the last 12 months, United States, 2006.

7_1_7.2 Perception of help received from treatment or counseling among people age 12 and over with a major depressive episode (MDE) in the last 12 months, United States, 2004.

Data Source

SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health (NSDUH).

Denominator

People age 12 and over with a major depressive episode who received treatment or counseling for depression in the last 12 months.

Numerator

Subset of the denominator who experienced improvement.

Comments

Major depressive episode (MDE) is defined as a period of at least 2 weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had a majority of the symptoms of depression described in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Respondents with unknown data for past year MDE measures were excluded.

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Treatment of Depression

Measure Title

Adults with a mood, anxiety, or impulse control disorder in the past year who received minimally adequate treatment.

Measure Source

National Institutes of Health (NIH), National Institute of Mental Health (NIMH), Collaborative Psychiatric Epidemiology Surveys (CPES).

Tables

7_1_8.1 Adults age 18 and over with a mood, anxiety, or impulse control disorder in the past year who received minimally adequate treatment, United States, 2001-2003.

Data Source

NIH, NIMH, CPES.

Denominator

U.S. population age 18 and over who had a mood, anxiety, or impulse control disorder in the past year.

Numerator

Subset of the denominator who received minimally adequate treatment, defined as either of the following criteria: (1) at least 60 days of an appropriate medication and 4 visits to a physician; or (2) psychotherapy, including at least 8 visits to a health care or human services professional lasting an average of 30 or more minutes.

Comments

The Composite International Diagnostic Interview (CIDI) was used to make psychiatric diagnoses consistent with the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Minimally adequate treatment is defined as at least 60 days of an appropriate medication and 4 visits to a physician or at least 8 visits to a health care or human services professional lasting an average of 30 or more minutes in the past year.

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Treatment of Substance Abuse

Measure Title

People age 12 and over who needed treatment for illicit drug use and who received such treatment at a specialty facility in the last 12 months.

Measure Source

Substance Abuse and Mental Health Services Administration (SAMHSA).

Tables

7_2_1.1 People age 12 and over who needed treatment for illicit drug use and who received such treatment at a specialty facility in the last 12 months, United States, 2003 and 2006.

7_2_1.2 People age 12 and over who needed treatment for illicit drug use and who received such treatment at a specialty facility in the last 12 months, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health (NSDUH).

Denominator

People age 12 and over who needed treatment for any illicit drug use.

Numerator

Subset of the denominator who received treatment for illicit drug use at a specialty facility in the last 12 months.

Comments

Treatment at a specialty facility refers to an inpatient hospital or an inpatient or outpatient rehabilitation facility or mental health center treating drug use, or treatment of medical problems associated with drug use.

Respondents were classified as needing treatment for an illicit drug problem if they met any of three criteria during the past year: (1) dependence on any illicit drug, (2) abuse of any illicit drug, or (3) treatment at a specialty facility for an illicit drug problem. Illicit drugs include marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, and heroin and nonmedical use of prescription psychotherapeutic drugs.

Estimates by family income are provided only for adults age 18 and over. Negative or poor refers to household incomes below the Federal poverty line; near poor/low, over the poverty line to just below 200 percent of the poverty line; middle, 200 percent to just below 400 percent of the poverty line; and high, 400 percent of the poverty line and over.

Estimates by education are only available for adults age 18 and over.

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Treatment of Substance Abuse

Measure Title

People age 12 and over treated for substance abuse who completed treatment course.

Measure Source

Substance Abuse and Mental Health Services Administration (SAMHSA).

Tables

7_2_2.1 People age 12 and over treated for substance abuse who completed treatment course, United States, 2002 and 2005.

Data Source

SAMHSA, Office of Applied Studies, Substance Abuse Treatment Episode Data Set (TEDS).

Denominator

Discharges from substance abuse treatment from publicly funded substance abuse treatment facilities.

Numerator

Subset of the denominator who completed treatment.

Return to Measure Specifications

Current as of September 2009
Internet Citation: Effectiveness of Care: Mental Health and Substance Abuse: 2008 National Healthcare Quality and Disparities Reports. September 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr08/measurespec/mental_health_and_substance_abuse.html