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Identifying and addressing bias in depression and anxiety quality measures

Award Number: R01MH137060
ORGANIZATION: NATIONAL INSTITUTE OF MENTAL HEALTH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 08/07/2024
PERIOD OF PERFORMANCE END DATE: 04/30/2027

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Identifying and addressing bias in depression and anxiety quality measures - Abstract RFA MH-23-265 identifies a crucial need for validated outcome-focused quality measures to incentivize quality improvement, inform consumers’ choices regarding care providers, and motivate systematic assessment of outcomes in community practice. Quality measures based in patient-reported depression outcomes are now included in National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set (HEDIS) “report cards” for healthcare systems and the Center for Medicare and Medicaid Services Merit-based Incentive Payment System (MIPS) program to adjust fee-for-service Medicare payments. Similar measures are proposed to assess and reward the quality of anxiety treatment. While outcome-based quality measures should reward more effective care, implementation must guard against delivering inaccurate incentives. Incentives intended to reward more effective care can have unintended negative consequences, penalizing those serving patients less likely to continue treatment or to improve during treatment Four specific aspects of existing depression measures may lead to inaccurate incentives: • Broad denominator definitions, including patients with widely varying treatment history and prognosis • Preference for measures of remission rather than proportional improvement or response • Focus on relatively narrow outcome windows as late as 12 months after initiating treatment • Considering all observations without recorded outcome scores to be treatment failures Data regarding current depression measures both demonstrate substantial differences between health systems serving different populations and raise concerns regarding specific design decisions that may exacerbate inaccuracies. While these problems could be addressed by detailed adjustment, benefits of more complex measures must be weighed against simplicity and transparency to measurement users. We propose to use data from 5 large health systems, including over 350,000 episodes of care for depression to evaluate inaccuracies in existing and proposed outcome-based quality measures. Specific aims include: Aim 1 – Identify patient characteristics that lead to different HEDIS/MIPS quality scores for those serving different patient populations by measuring to the populations they serve rather than the care they provide. Aim 2 – Adjust quality measures to account for differences in patient populations identified in Aim 1 and compare ranking from adjusted measures to existing HEDIS/MIPS measures. Aim 3 – Evaluate how altering specific aspects of existing depression measures can reduce inaccuracies in comparisons of care effectiveness without introducing unnecessary complexity. Aim 4 – Extend analyses for Aims 1-3 to proposed outcome-focused quality measures for anxiety. Aim 5 – In collaboration with a range of interested parties, develop proposals for improved outcome-focused quality measures for depression and anxiety.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $1,047,720 )
2025	2025	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Mental Health Research Grants	000	2	6/23/2025	NON-COMPETING CONTINUATION	$1,047,720
														Subtotal = $1,047,720

Issue Date FY: 2024 ( Subtotal = $1,111,596 )
2024	2024	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Mental Health Research Grants	000	1	8/7/2024	NEW	$1,111,596
														Subtotal = $1,111,596

Grand Total All Awards = $2,159,316

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Identifying and addressing bias in depression and anxiety quality measures

Award Number: R01MH137060

ORGANIZATION: NATIONAL INSTITUTE OF MENTAL HEALTH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 08/07/2024

PERIOD OF PERFORMANCE END DATE: 04/30/2027

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