Challenging the quality of the quality indicator, " XXXX without treatment".

@entity308 @entity10281 @entity146
OBJECTIVE: To assess the validity of the @entity10281 ( @entity10281 )-based quality indicator, " @entity308 without treatment," and examine whether a nonphysician-based educational intervention can improve the accuracy of @entity10281 questions regarding @entity308 and its treatment. SUBJECTS: All residents of a 538-bed urban, university affiliated, long-term-care (LTC) facility. Nursing and social work staff involved in completing the mood and behavior items on the @entity10281 . DESIGN: Two retrospective chart review of psychotropic medications, @entity146 diagnoses, mental health evaluation, and treatment of all residents who were identified as displaying the @entity10281 quality indicator, @entity308 without treatment, before and 2 months after an educational intervention. The education consisted of three 1 1/2-hour sessions led by a @entity146 clinical nurse specialist to educate registered nurse assessment coordinators and social workers about psychotropic medications, clinical characteristics of @entity146 diagnoses, chart review, and coordination of resident medical care. RESULTS: The first @entity10281 identified 66 residents as having @entity308 without treatment. Clinical record review revealed that 11 of these residents were receiving an antidepressant. Twenty-two others were receiving a psychotropic medication consistent with their @entity146 diagnosis. Twenty-five of the remaining residents had not received mental health assessment for greater than 1 year. Two months after the educational intervention, 36 residents were identified as @entity308 without treatment. Four of these residents were receiving an antidepressant; eight others were receiving a psychotropic medication consistent with their @entity146 diagnosis. Thirteen of the remaining residents had not received mental health assessment for greater than 1 year. CONCLUSIONS: This preliminary study reveals that the presence of the quality indicator, @entity308 without treatment, may not accurately capture clinically depressed LTC residents in need of mental health intervention. An educational intervention may be able to assist staff in more accurately completing @entity10281 questions regarding @entity308 and its treatment.
