Rebecca A. Andrews, MD: Issues and Steps to Improve MDD Performance Measures

Published on: 

Vice Chair of the Performance Measurement Committee Rebecca A. Andrews spoke to HCPLive about the challenges with performance measures for treating major depressive disorder.

The American College of Physicians reviewed major depressive disorder (MDD) performance measures, and after a committee vote, decided the suicide risk assessment was the only valid measure.1,2

The committee voted on 7 other measures, including Preventative Care and Screening for Depression and Follow-Up, Depression Utilization of the PHQ-9 Tool, Antidepressant Medication Management, Depression Response at 6 Months—Progress Towards Remission, Depression Response at 12 Months—Progress Towards Remission, Depression Remission at 6 Months, and Depression Remission at 12 Months. On a 9-point scale, votes were based on 5 quality indicators: importance, appropriate care, clinical evidence base, measure specifications, and feasibility or applicability. For each measure, they voted for 3 levels of attribution, including individual physician, group practice, and health plan level.

In an interview with HCPLive, Rebecca A. Andrews, MD, MS, FACP from the University of Connecticut and vice chair of the Performance Measurement Committee, discussed challenges related to developing MDD performance measures, as well as ways to improve the measures.

“I think performance measures in general are a challenge to create,” Andrews said. “Right now, in electronic health records, there are areas that have discrete data, meaning plug-in numbers or click-the-box, which can be recorded and turned into some kind of a report. But a lot of what happens with the patient in the room is either free text or written out and therefore is a little more challenging to collect. It's very burdensome on the physicians who are trying to see the patients.”

Additionally, treatment for depression can vary between patients—pharmacotherapy is not the only option. This makes measuring a treatment outcome challenging, particularly since a patient can seek therapy with someone else without a referral.

“We don't want to insert performance measures into the patient-physician relationship, in a way that creates negative tension,” Andrews said.

She explained how research found a good primary care physician and patient relationship can increase quality of life and longevity, as well as reduce morbidity.

“And soon we don't want to put something in between that strains it so you really shouldn't have a performance measure that is antagonistic,” Andrews said. “If I'm required to have a patient on something for 84 days, and my patients stops it, I should not feel the pressure to push them to take that. My job should be why did we stop it? Are you feeling better? Was it not working for you? Did you have side effects? Should we try something else? And as soon as you insert those sorts of mandates into a performance measure, it can really alter the therapeutic relationship between patient and the physician.”

Relevant disclosures for Andrews include Medtronic Vascular, Inc.


  1. Qaseem A, Andrews RA, Campos K, et al. Quality Indicators for Major Depressive Disorder in Adults: A Review of Performance Measures by the American College of Physicians. Ann Intern Med. Published online March 5, 2024. doi:10.7326/M23-3077
  2. Derman, C. Rebecca Andrews, MD: MDD Performance Measures Review Highlight Need for Tweaking. HCPLive. March 20, 2024. Accessed March 20, 2024.