Objective: Because depression is a common, treatable disorder that causes suffering, morbidity, and mortality in nursing home residents, improving the quality of its treatment can have a major impact on the lives of these vulnerable individuals.
Design: The Michigan Peer Review Organization (MPRO) initiated a quality improvement project in 14 nursing facilities to improve the accuracy of assessments, and the targeting and monitoring of care.
Materials and Methods: 14 skilled nursing facilities were evaluated, including for-profit and not-for-profit, government/county, and EdenTM homes. The data source for sampling was electronic MDS data for the 14 participating facilities. Medicare assessments performed at intervals of 5, 14, 30, and 60 days were requested. All residents with stays 30 days or longer were selected (n=637). An additional 208 residents were selected proportionately from each facility with an overall sample size of 845. Case listings with the names of sampled residents were sent to each facility to prepare them for medical record abstraction. Data abstraction used a tool developed by MPRO based on MedQuest™ to collect data from the medical record that was not captured in the MDS.
Results: Findings from the baseline phase of this study demonstrated that, according to medical and administrative records, 31% of newly admitted nursing home residents had a diagnosis of depression at admission and that an additional 13% were diagnosed early in their stay. 81% of residents with depression at admission were receiving treatment, and 79% of all residents with depression were treated by day 14 of their stay. Although treatment is far more common now than in the past, 7.9% of the residents had a diagnosis of depression without treatment.
Conclusion: The accuracy of the evaluation of depressive symptoms in nursing home residents could be improved if assessments using the federally mandated Resident Assessment Instrument, the Minimum Data Set, were supplemented for cognitively intact or mild-moderately impaired residents with self-reports using the Geriatric Depression Scale. In addition, there should be mechanisms to ensure that providers and facilities follow recommended practice guidelines. It is not enough to initiate treatment with antidepressant medications; it is also important to monitor residents during care to identify those who still have depressive symptoms and to modify or intensify their treatment.
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