The relationship of system-level quality improvement with quality of depression care

UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date


Document Type



Adult; Aged; Antidepressive Agents; Benchmarking; Cohort Studies; Depressive Disorder; Guideline Adherence; Hospitals, Veterans; Humans; International Classification of Diseases; Middle Aged; New England; New York; Practice Guidelines as Topic; *Process Assessment (Health Care); Questionnaires; Retrospective Studies; Systems Analysis; *Total Quality Management; United States; United States Department of Veterans Affairs; Veterans


Biostatistics | Epidemiology | Health Services Research


OBJECTIVE: To explore the relationship of systemwide continuous quality improvement (CQI) with depression care quality in the Veterans Health Administration (VHA).

STUDY DESIGN: Observational study using data from 2 VHA studies.

PATIENTS AND METHODS: The Depression Care Quality Study (DCQS) was a retrospective cohort study of depression care quality in the northeastern United States involving 12 678 patients cared for at 14 VHA facilities; it used guideline-based process measures (ie, dosage and duration adequacy). The VHA CQI survey was a cross-sectional survey of systemwide CQI among a representative sample of VHA hospitals; it assessed CQI and organizational culture (OC) at 116 VHA hospitals nationwide and provided data on the 14 study facilities. We used analysis of variance to identify differences in the adequacy of depression care among these facilities. Pearson's correlation was used to identify the relationship of CQI and OC with facility-level depression care adequacy.

RESULTS: Mean depression care adequacy differed among the 14 DCQS facilities (P < .0001). Overall dosage adequacy was 90% (range: 87%-92%). Overall duration adequacy was 45% (range: 39%-64%). There was no correlation between CQI and either dosage adequacy (r= .004, P= .98) or duration adequacy (r= -.17, P= .55). Similarly, there was no correlation between OC and either dosage adequacy (r= -.35, P= .22) or duration adequacy (r= -.12, P= .68).

CONCLUSION: Although CQI may help bridge the healthcare quality gap, it may not be associated with higher disease-specific quality of care.


Am J Manag Care. 2004 Nov;10(11 Pt 2):846-51. Link to article on publisher's site

Journal/Book/Conference Title

The American journal of managed care

PubMed ID


Related Resources

Link to Article in PubMed