ecqm.measure

CMS128v7 - Anti-depressant Medication Management

Rationale:

Anti-depressant Medication Management. In 2013, over 15 million adults in the United States had at least one major depressive episode in the past 12 months (National Institute of Mental Health 2013), and depression is estimated to affect nearly a quarter of adults in their lifetime (Burcusa and Iacono 2007). Symptoms of depression include appetite and sleep disturbances, anxiety, irritability and decreased concentration (Charbonneau et al. 2005). The American Psychiatric Association recommends use of antidepressant medication and behavioral therapies, such as psychotherapy, to treat depression (American Psychiatric Association 2010). For the past 50 years, antidepressant medication has proven to be effective especially for patients with more severe symptoms (Fournier et al. 2010). Among patients who initiate antidepressant treatment, one in three discontinues treatment within one month, before the effect of medication can be assessed, and nearly one in two discontinues treatment within three months (Simon 2002). Due to increased risky behaviors for chronic disease (eg, physical inactivity, smoking, excessive drinking and insufficient sleep), evidence has shown that depressive disorders are strongly related to the occurrence of many chronic diseases including diabetes, cancer, cardiovascular disease and asthma (Centers for Disease Control and Prevention 2011). Aligning depression quality improvement with methods used in managing other chronic illnesses has been an important step in depression care. Depression management systems have demonstrated improved short- and long-term outcomes of depression severity and persistence, employment retention, functional status and patient satisfaction (Katon et al. 2002; Rost et al. 2001).

Data Elements

MajorDepressionDiagnosis

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

ResultValue constrained to codes in the Major Depression valueset (2.16.840.1.113883.3.464.1003.105.12.1007)

Diagnosis: Condition/Diagnosis/Problem represents a practitioner’s identification of a patient’s disease, illness, injury, or condition. This category contains a single datatype to represent all of these concepts: Diagnosis. A practitioner determines the diagnosis by means of examination, diagnostic test results, patient history, and/or family history. Diagnoses are usually considered unfavorable, but may also represent neutral or favorable conditions that affect a patient’s plan of care (e.g., pregnancy). The QDM does not prescribe the source of diagnosis data in the EHR. Diagnoses may be found in a patient’s problem list, encounter diagnosis list, claims data, or other sources within the EHR. The preferred terminology for diagnoses is SNOMED-CT, but diagnoses may also be encoded using ICD-9/10. The Diagnosis datatype should not be used for differential diagnoses or rule-out diagnoses (neither of which are currently supported by the QDM).

DataType

Cardinality

MajorDepressionDiagnosis

0..*

EncounterInpatientPerformed

Clinical Focus: This set of values identify the most common inpatient encounter types.

Data Element Scope: The intent of this data element is to identify patients who have had an inpatient encounter. Using the Quality Data Model, this particular element will map to the 'encounter' category.

Inclusion Criteria: Only SNOMED CT codes representing inpatient encounter should be included.

Exclusion Criteria: None.

Subject constrained to the Encounter Inpatient

EncounterPerformed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

EncounterInpatientPerformed

0..*

OfficeVisit1Performed

Clinical Focus: This value set identifies patients who have had an office or other outpatient visit.

Data Element Scope: This value set was intended to map to the QDM data type of encounter.

Inclusion Criteria: Includes comprehensive history, evaluation, and management of a patient in an office or outpatient facility. Patient can be presenting with problems that are minor to high severity.

Exclusion Criteria: Excludes non-office visits, including telehealth services.

Subject constrained to the Office Visit1

EncounterPerformed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

OfficeVisit1Performed

0..*

HomeHealthcareServicesPerformed

Clinical Focus: This value set identifies patients who have had a home health visit by a provider for the evaluation or management of a new or existing patient.

Data Element Scope: This value set was intended to map to the QDM data type of encounter.

Inclusion Criteria: Include all home visits for the evaluation and management of a new or established patient.

Exclusion Criteria: None

Subject constrained to the Home Healthcare Services

EncounterPerformed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

HomeHealthcareServicesPerformed

0..*

PreventiveCareServicesInitialOfficeVisit18AndUp1Performed

Clinical Focus: This value set identifies patients over the age of 18 who have had an initial preventive care office visit.

Data Element Scope: This value set was intended to map to the QDM data type of encounter.

Inclusion Criteria: Includes comprehensive preventive medicine reevaluation and management of an individual over the age of 18.

Exclusion Criteria: Excludes non-office visits, including telehealth services.

Subject constrained to the Preventive Care Services-Initial Office Visit, 18 and Up1

EncounterPerformed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

PreventiveCareServicesInitialOfficeVisit18AndUp1Performed

0..*

PreventiveCareServicesEstablishedOfficeVisit18AndUp1Performed

Clinical Focus: This value set identifies patients over the age of 18 who have had an established preventive care office visit.

Data Element Scope: This value set was intended to map to the QDM data type of encounter.

Inclusion Criteria: Includes comprehensive preventive medicine reevaluation and management of an individual over the age of 18.

Exclusion Criteria: Excludes non-office visits, including telehealth services.

Subject constrained to the Preventive Care Services - Established Office Visit, 18 and Up1

EncounterPerformed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

PreventiveCareServicesEstablishedOfficeVisit18AndUp1Performed

0..*

TelephoneManagementPerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the Telephone Management

EncounterPerformed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

TelephoneManagementPerformed

0..*

TelephoneEvaluationPerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the Telephone Evaluation

EncounterPerformed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

TelephoneEvaluationPerformed

0..*

AnnualWellnessVisit1Performed

Clinical Focus: This value set contains concepts related to annual wellness visits.

Data Element Scope: The intent of this data element is to identify patients who have had an annual wellness visit. Using the Quality Data Model, this particular data element would be classified under the 'Encounter' category.

Inclusion Criteria: Includes encounters specific to annual wellness visits.

Exclusion Criteria: None

Subject constrained to the Annual Wellness Visit1

EncounterPerformed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

AnnualWellnessVisit1Performed

0..*

PsychVisitDiagnosticEvaluationPerformed

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

Subject constrained to the Psych Visit - Diagnostic Evaluation

EncounterPerformed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

PsychVisitDiagnosticEvaluationPerformed

0..*

PsychVisitPsychotherapyPerformed

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

Subject constrained to the Psych Visit - Psychotherapy

EncounterPerformed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

PsychVisitPsychotherapyPerformed

0..*

HospiceCareAmbulatoryOrder

Clinical Focus: Patients receiving hospice care outside of hospital or long term care facility.

Data Element Scope: The intent of this value set is to identify all patients receiving hospice care outside of hospital or long term care facility . Using the quality data model this maps to 'Intervention, Order' and 'Procedure, Order'.

Inclusion Criteria: All hospice care concepts should be included.

Exclusion Criteria: Do not include concepts for palliative care or comfort measures.

Subject constrained to the Hospice care ambulatory

InterventionOrder: Data elements that meet criteria using this datatype should document a request to perform the intervention indicated by the QDM category and its corresponding value set. Timing: The time the order is signed; Author dateTime

DataType

Cardinality

HospiceCareAmbulatoryOrder

0..*

HospiceCareAmbulatoryPerformed

Clinical Focus: Patients receiving hospice care outside of hospital or long term care facility.

Data Element Scope: The intent of this value set is to identify all patients receiving hospice care outside of hospital or long term care facility . Using the quality data model this maps to 'Intervention, Order' and 'Procedure, Order'.

Inclusion Criteria: All hospice care concepts should be included.

Exclusion Criteria: Do not include concepts for palliative care or comfort measures.

Subject constrained to the Hospice care ambulatory

InterventionPerformed: Data elements that meet criteria using this datatype should document the completion of the intervention indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: startTime – The time the intervention begins stopTime – The time the intervention ends NOTE - timing refers to a single instance of an intervention. If a measure seeks to evaluate multiple interventions over a period of time, the measure developer should use CQL logic to represent the query request.

DataType

Cardinality

HospiceCareAmbulatoryPerformed

0..*

AntidepressantMedicationActive

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the Antidepressant Medication

MedicationActive: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set is being taken by the patient. Keep in mind that when this datatype is used with timing relationships, the criterion is looking for a medication being taken for the time frame indicated by the timing relationships. Timing: The Relevant Period addresses: StartTime = when the medication is first known to be used (generally the time of entry on the medication list); StopTime = when the medication is discontinued (generally, the time discontinuation is recorded on the medication list)

DataType

Cardinality

AntidepressantMedicationActive

0..*

AntidepressantMedicationDispensed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the Antidepressant Medication

MedicationDispensed: Data elements that meet criteria using this datatype should document that a prescription for the medication indicated by the QDM category and its corresponding value set has been dispensed and provided to the patient or patient proxy. In the ambulatory setting, medications are primarily taken directly by patients and not directly observed. Hence, dispensed, or fulfillment, information is the closest health provider documentation of medication compliance. In settings where patients attest to taking medications in electronic format (perhaps a Personal Health Record), patient attestation of medication taken may be available. The QDM datatype, Medication, Administered addresses medication taken; to address the source of the information, a measure addressing such patient attestation would require use of the dataflow attribute, source. Timing: The time the medication dispensing event occurs; the Author dateTime. Timing: The Relevant Period addresses: startTime = when the first administration of the medication is expected. If not specified. the startTime defaults to the Author dateTime (the time the medication dispensing event occurs). stopTime = when the medication supply provided by the dispensing event is expected to be completed. Note that when calculating cumulative medication duration, the medication dispensed stopTime may be present directly in the fulfillment record. If the stopTime is not available, the duration in days is the difference between the Relevant Period start and stop times. The record may indicate which of the available refills the fulfillment represents but each dispensing event is unique. Therefore, the measure developer should use CQL logic to address multiple dispensing events over a period of time. Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

AntidepressantMedicationDispensed

0..*

EthnicityPatientCharacteristicEthnicity

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

ResultValue constrained to codes in the Ethnicity valueset (2.16.840.1.114222.4.11.837)

PatientCharacteristicEthnicity: Data elements that meet criteria using this datatype should document that the patient has one or more of the ethnicities indicated by the QDM category and its corresponding value set. Timing: Ethnicity does not have a specific timing. Measures using Patient Characteristic, Ethnicity should address the most recent entry in the clinical record.

DataType

Cardinality

EthnicityPatientCharacteristicEthnicity

0..*

OncAdministrativeSexPatientCharacteristicGender

Clinical Focus: Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.

Data Element Scope: Gender

Inclusion Criteria: Male and Female only.

Exclusion Criteria: Any gender identity that is not male or female.

ResultValue constrained to codes in the ONC Administrative Sex valueset (2.16.840.1.113762.1.4.1)

PatientCharacteristicGender: Data elements that meet criteria using this datatype should document that the patient's sex matches the QDM category and its corresponding value set. Timing: Birth (administrative) sex does not have a specific timing.

DataType

Cardinality

OncAdministrativeSexPatientCharacteristicGender

0..*

PayerPatientCharacteristicPayer

Clinical Focus: Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system

Data Element Scope: @code in CCDA r2.1 template Planned Coverage [act: identifier urn:oid:2.16.840.1.113883.10.20.22.4.129 (open)] DYNAMIC

Inclusion Criteria: All codes in the code system

Exclusion Criteria: none

ResultValue constrained to codes in the Payer valueset (2.16.840.1.114222.4.11.3591)

PatientCharacteristicPayer: Data elements that meet criteria using this datatype should document that the patient has one or more of the payers indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: startTime – The first day of insurance coverage with the referenced payer stopTime – The last day of insurance coverage with the referenced payer

DataType

Cardinality

PayerPatientCharacteristicPayer

0..*

RacePatientCharacteristicRace

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

ResultValue constrained to codes in the Race valueset (2.16.840.1.114222.4.11.836)

PatientCharacteristicRace: Data elements that meet criteria using this datatype should document the patient’s race. Timing: Race does not have a specific timing. Measures using Patient Characteristic, Race should address the most recent entry in the clinical record.

DataType

Cardinality

RacePatientCharacteristicRace

0..*