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Research Letter |

Adjusting Antidepressant Quality Measures for Race and Ethnicity

Gregory E. Simon, MD, MPH1; Karen J. Coleman, PhD2; Beth E. Waitzfelder, PhD3; Arne Beck, PhD4; Rebecca C. Rossom, MD, MS5; Christine Stewart, PhD1; Robert B. Penfold, PhD1
[+] Author Affiliations
1Group Health Research Institute, Seattle, Washington
2Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena
3Kaiser Permanente Hawaii Center for Health Research, Honolulu
4Kaiser Permanente Colorado Institute for Health Research, Denver
5HealthPartners Institute for Education and Research, Minneapolis, Minnesota
JAMA Psychiatry. 2015;72(10):1055-1056. doi:10.1001/jamapsychiatry.2015.1437.
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This cohort study across 5 health systems examines how stratifying by race/ethnicity would affect a specific mental health care quality measure: the proportion of outpatients starting antidepressant treatment who receive adequate or potentially effective acute-phase treatment.

Increasing awareness of health care disparities has prompted reexamination of the National Quality Forum recommendation that measures of health care quality not be adjusted for patients’ sociodemographic characteristics. Adjustment might appear to endorse poorer-quality care for those traditionally underserved. However, Fiscella and colleagues1 pointed out that failure to adjust for sociodemographic differences might unfairly penalize health systems serving disadvantaged groups. Jha and Zaslavsky2 argued that quality measures should be adjusted for patient characteristics when differences between health systems are confounded by differences between the patients they serve. In those cases, stratified reporting of quality measures would both reveal health disparities and permit fairer comparisons of quality across health systems or facilities.

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