Would you like proof that your treatment of major depression helps your patients? Do you want direct feedback from your patients about their progress and treatment compliance? Do your patients feel as if they are participants in their own treatment? Quality Care 2000 is answering these questions for psychiatrists who participate in the study.

The project, a collaborative effort between APA’s Office of Quality Improvement and Psychiatric Services and the University of Arkansas Center for Outcomes Research and Effectiveness (CORE), looks at the effectiveness of different types and combinations of psychopharmacologic and psychosocial treatments for major depression. It also provides psychiatrists with an "Internet-based depression outcomes system" that allows them to enter patient data from their own computers.

This system is available free to APA members on the Quality Care 2000 Web site at <www.netoutcomes.net>. Psychiatrists who enroll in the project can access the on-screen forms at this site with an ID number and password.

"As a researcher and a member of APA, I am delighted to be able to bring this new technology to fellow members of APA. This is one way that we can demonstrate that we are giving our patients good medical care," stated G. Richard Smith Jr., M.D., director for CORE and primary investigator for the project. Smith developed the tools to measure quality improvement in the late 1980s, but only recently has there been a vehicle to allow these tools to be used on a larger scale—the Internet.

Describing the project, research scientist Farifteh Duffy, Ph.D., explained that patients who meet criteria for major depressive disorder (MDD) and are interested in participating must first complete a baseline assessment form that gathers information about their symptoms, treatments, and diagnosis. Their psychiatrists complete the clinician baseline assessment for each patient. The form takes three to five minutes to complete.

Patients will then complete follow-up questionnaires using pencil and paper at three, six, nine, and 12 months after the initial visit, answering questions about their health, the treatments they are receiving, and the effect of the treatments on their depression. "Patients are usually enthusiastic about participating through the follow-up stages," noted C. Winston Brown, M.D., medical director of psychiatric services for CORE and user of the NetOutcomes system in his routine clinical practice. "Patients appreciate a doctor's interest in their well-being."

Not long after the baseline forms are completed and entered onto the computer, several types of reports become available—individual patient reports, cumulative patient reports, and provider reports.

The individual patient report can be downloaded as soon as the patient and clinician baseline assessments are completed and entered. This report highlights clinically relevant data on individual patients, including symptoms, functioning, suicidality, and general health status.

The cumulative patient reports are generated as the patient follow-up data are entered, highlighting the patient’s progress over time. The provider reports, which are available on a quarterly basis, portray aggregate information about all of the patients in the psychiatrist’s caseload. In addition, the provider report compares the aggregate patient information with that of all patients enrolled in Quality Care 2000 and with the NetOutcomes depression database. The database includes a larger pool of data on patients with major depressive disorder collected from a variety of practice settings from across the nation.

Brown finds the provider reports very helpful. Seeing his patients’ information highlighted, charted, and displayed quantitatively helped him to discover that substance abuse was much more prevalent in his patients than he first thought it to be, for example. He also found that overall, his patients had a much lower adherence to their medication regimens over time than he would have predicted. He and his colleagues "who have encountered the same information in their patients about medication nonadherence plan to design an efficient intervention to remind patients about the importance of continuing their medication," he told Psychiatric News.

Lloyd Sederer, M.D., director of clinical services at APA, believes that the study can address common concerns shared by psychiatrists treating patients with major depression.

"Why should a doctor spend his or her time on this study? The Quality Care study is an opportunity for the physician to prove that his or her care works. The study will monitor individual patient outcomes as well as aggregate data on groups of patients. APA members who participate will be able to use the patient self-reports as a means of building patient alliances by asking patients directly whether they think their treatment works. Participation in the study," he said, "is also a chance for psychiatrists to ask and actually find out from patients whether [their] treatments work as well as [they] think they do. If not, why not?"

Darrel Regier, M.D., M.P.H., the director of the American Psychiatric Institute for Research and Education, is also interested in the study's focus on treatments for people with MDD.

"The Quality Care 2000 system offers a powerful tool for both clinicians and researchers to longitudinally assess the relationship between patterns and outcomes of care. It is also gives us a chance to examine a range of other important treatment issues, including patient compliance, suicidality, medication side effects, and whether treatments provided in routine practice settings are consistent with evidence-based treatment recommendations," Regier said.

The APA/NetOutcomes Quality Care 2000 Depression Outcomes Project is now enrolling APA members in the study. Participants must have Internet access and provide at least 10 hours per week of direct patient care.