Enhancing Electronic Health Record Measurement of Depression Severity and Suicide Ideation: A Distributed Ambulatory Research in Therapeutics Network (DARTNet) Study

from the Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences and the Department of Family Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, the American Academy of Family Physicians, Denver, CO
The Journal of the American Board of Family Medicine (Impact Factor: 1.98). 09/2012; 25(5):582-93. DOI: 10.3122/jabfm.2012.05.110053
Source: PubMed


Depression is a leading cause of morbidity worldwide. The majority of treatment for depression occurs in primary care, but effective care remains elusive. Clinical decision making and comparative studies of real-world antidepressant effectiveness are limited by the absence of clinical measures of severity of illness and suicidality.
The Distributed Ambulatory Research in Therapeutics Network (DARTNet) was engaged to systematically collect data using the 9-item Patient Health Questionnaire (PHQ-9) at the point of care. We used electronic health records (EHRs) and the PHQ-9 to capture, describe, and compare data on both baseline severity of illness and suicidality and response and suicidality after diagnosis for depressed patients in participating DARTNet practices.
EHR data were obtained for 81,028 episodes of depression (61,464 patients) from 14 clinical organizations. Over 9 months, data for 4900 PHQ-9s were collected from 2969 patients in DARTNet practices (this included 1892 PHQ-9s for 1019 adults and adolescents who had at least one depression diagnosis). Only 8.3% of episodes identified in our depression cohort had severity of illness information available in the EHR. For these episodes, considerable variation existed in both severity of illness (32.05% with no depression, 26.89% with minimal, 19.54% with mild, 12.04% with moderate, and 9.47% with severe depression) and suicidality (69.43% with a score of 0, 22.58% with a score of 1, 4.97% with a score of 2, and 3.02% with a score of 3 on item 9 of the PHQ-9). Patients with an EHR diagnosis of depression and a PHQ-9 (n = 1019) had similar severity but slightly higher suicidality levels compared with all patients for which PHQ-9 data were available. The PHQ-9 showed higher sensitivity for identifying depression response and emergent (after diagnosis) severity and suicidality; 25% to 30% of subjects had some degree of suicidal thought at some point in time according to the PHQ-9.
This study demonstrated the value of adding PHQ-9 data and prescription fulfillment data to EHRs to improve diagnosis and management of depression in primary care and to enable more robust comparative effectiveness research on antidepressants.

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Available from: Robert J Valuck,
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    • "A federated network of EHR data from eight organizations including large clinical practice sites, national research networks, and technical partners , DARTNet uses existing EHR data and point-of-care data collection techniques to supplement data from large administrative data sets enabling comparative effectiveness and safety research (Pace, West, Valuck, Cifuentes, & Staton, 2009). CER through DARTNet has conducted varied studies including the use of over-the-counter medications and herbs in treating hypoglycemia (Libby et al., 2010), and the value of adding depression severity and prescription fulfillment data to the EHR to improve diagnosis and management of depression in primary care (Valuck et al., 2012). Such data enable more robust CER on medications and other treatment approaches. "
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