Referral Bias and Other Perspectives on the HEDIS Measuring Stick for Quality of Care in Depression Treatment

The National Committee for Quality Assurance (NCQA) is an independent not-for-profit organization based in Washington, DC, whose vision is to transform health care quality through measurement, transparency and accountability. 1 Using the Health Plan Employer Data and Information Set (HEDIS), NCQA has determined how more than 90 percent of the nation's managed care organizations will collect, audit, and report their performance on a range of standardized quality measures. Many of the HEDIS measures are undisputedly useful in promoting population health, such as rate of beta-blocker use after myocardial infarctions or rate of cervical cancer screening. Other measures, such as antidepressant medication management (AMM), have less evidence supporting the goals promoted by NCQA. Although the latest report on the State of Health Care Quality 2005 from NCQA appropriately describes and cites support for the need to treat depression, it does not cite supporting trials that validate the definitions chosen for their AMM measures.