Table 1.

Quality Measures Based on the 1993 Guidelines for Treatment of Major Depression by the Agency for Health Care Policy and Research

Measure	Data Source	Criteria	Guideline-Based Rationale
1. Follow-up (acute phase)	Administrative (claims/encounter)	Proportion of patients with at least 1 visit within 6 weeks of initial antidepressant medication	After initial diagnosis, patients should be seen frequently until symptoms resolve, then every 4 to 12 weeks.
2. Medication adherence (acute phase)	Pharmacy	Proportion of patients filling at least 90 days of therapy during the 118 days from the first antidepressant fill	Lack of adherence to medication is associated with worse outcomes. Physicians should promote patient adherence.
3. Medication adherence(chronic phase)	Pharmacy	Proportion of patients filling at least 120 days of therapy during the 155 days from the first antidepressant fill	Medication should be continued for 4 to 9 months after onset of remission.
4. Minimum medication dose (acute phase)	Pharmacy	Proportion of patients started on at least the minimum therapeutic dose approved by Federal Drug Administration	When prescribed, medication should be administered in dosages shown to alleviate symptoms.
5. Minimum medication dose (chronic phase)	Pharmacy	Proportion of patients continued on at least the minimum therapeutic dose approved by Federal Drug Administration	For continuation treatment, medication should be prescribed at the same dosage necessary to control symptoms in the acute phase.
6. Adequate trial before switching (either phase)	Pharmacy	Proportion of patients receiving a minimum 25-day trial of initial antidepressant before receiving new antidepressant exclusive of low dose tricyclic or trazadone added for insomnia	When prescribed, medication should be continued for a sufficient length of time to permit a reasonable assessment of response, generally 4 to 6 weeks.