Comparing outcomes of routine care for depression: the dilemma of case-mix adjustment

J Behav Health Serv Res. 2001 Aug;28(3):287-300. doi: 10.1007/BF02287245.

Abstract

The purpose of this study was to formulate and test two case-mix models for depression treatment that permit comparisons of patient outcomes across diverse clinical settings. It assessed demographics; eight, diagnostic-specific, case-mix variables; and clinical status at baseline and follow-up for 187 patients. Regressions were performed to test two models for four dependent variables including depression severity and diagnosis. Individual treatment settings were then ranked based on a comparison of actual versus predicted outcomes using regression coefficients and predictor variables. A model inclusive of baseline physical health status and depression severity predicted depression severity, mental health, and physical health functioning at follow-up. A simpler model performed well in predicting depression remission. This study identifies variables to be included in case-mix adjustment models and demonstrates statistical methods to control for differences across settings when comparing depression outcomes.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Academic Medical Centers
  • Adult
  • Ambulatory Care Facilities
  • Arkansas
  • Data Interpretation, Statistical
  • Depression / diagnosis
  • Depression / therapy*
  • Diagnosis-Related Groups*
  • Female
  • Follow-Up Studies
  • Hospitals, Veterans
  • Humans
  • Male
  • Mental Health Services / standards*
  • Mental Health Services / statistics & numerical data
  • Middle Aged
  • Models, Statistical
  • Outcome Assessment, Health Care / methods*
  • Prognosis
  • Prospective Studies
  • Risk Adjustment*