ecqm.measure

CMS169v7 - Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical substance use

Rationale:

Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical substance use. Individuals with bipolar disorder or major depression have high rates of co-morbid substance abuse and should be screened for substance use disorders. Between 40-70% of people with bipolar disorder have a history of substance use disorder. A current or past co-morbid substance use disorder may lead to worse outcomes for bipolar disorders, including more symptoms, more suicide attempts, longer episodes and lower quality of life. Substance abuse may obscure or exacerbate mood swings that have no other apparent external cause. Substance abuse may also precipitate mood episodes or be used by patients to self-treat in an attempt to improve the symptoms of episodes. Patients suffering from major depressive disorder with co-morbid addiction are more likely to require hospitalization, more likely to attempt suicide and less likely to comply with treatment than are patients with these disorders of similar severity not complicated by these factors.

Data Elements

BhConditionInvolvingBipolarDisorderDiagnosis

Clinical Focus: Under development

Data Element Scope: Under development

Inclusion Criteria: Under development

Exclusion Criteria: Under development

ResultValue constrained to codes in the BH Condition Involving Bipolar Disorder valueset (2.16.840.1.113883.3.1257.1.1504)

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

BhConditionInvolvingBipolarDisorderDiagnosis

0..*

BhConditionInvolvingUnipolarDepressionDiagnosis

Clinical Focus: Under development

Data Element Scope: Under development

Inclusion Criteria: Under development

Exclusion Criteria: Under development

ResultValue constrained to codes in the BH Condition Involving Unipolar Depression valueset (2.16.840.1.113883.3.1257.1.1505)

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

BhConditionInvolvingUnipolarDepressionDiagnosis

0..*

BhOutpatientPsychotherapyPerformed

Clinical Focus: Under development

Data Element Scope: Under development

Inclusion Criteria: Under development

Exclusion Criteria: Under development

Subject constrained to the BH Outpatient 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

BhOutpatientPsychotherapyPerformed

0..*

BhOutpatientEncounterPerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the BH Outpatient encounter

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

BhOutpatientEncounterPerformed

0..*

BhMoodStabilizerMedicationActive

Clinical Focus: Under development

Data Element Scope: Under development

Inclusion Criteria: Under development

Exclusion Criteria: Under development

Subject constrained to the BH Mood Stabilizer 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

BhMoodStabilizerMedicationActive

0..*

BhMoodStabilizerMedicationOrder

Clinical Focus: Under development

Data Element Scope: Under development

Inclusion Criteria: Under development

Exclusion Criteria: Under development

Subject constrained to the BH Mood Stabilizer Medication

MedicationOrder: Data elements that meet criteria using this datatype should document a request to a pharmacy to provide the medication indicated by the QDM category and its corresponding value set. Timing: The Author dateTime is the time the order is signed. Timing: The Relevant Period addresses: startTime = when the first administration of the medication is expected. The first administration may be expected at the time of the order or at a specified future date (i.e., the active time for the order); such information should be identified in the medication order. If the startTime is not specified in the order, the startTime defaults to the Author dateTime (the time the order is signed). stopTime = when the medication supply provided by the medication order is expected to be completed, including all fulfillments covered by the number of refills. Note that when calculating cumulative medication duration, the stopTime may be present directly in the medication order. If the stopTime is not available, the duration in days is the difference between the Relevant Period start and stop times multiplied by (1 + the number of refills). Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

BhMoodStabilizerMedicationOrder

0..*

BhAntidepressantMedicationActive

Clinical Focus: Under development

Data Element Scope: Under development

Inclusion Criteria: Under development

Exclusion Criteria: Under development

Subject constrained to the BH 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

BhAntidepressantMedicationActive

0..*

BhAntidepressantMedicationOrder

Clinical Focus: Under development

Data Element Scope: Under development

Inclusion Criteria: Under development

Exclusion Criteria: Under development

Subject constrained to the BH Antidepressant Medication

MedicationOrder: Data elements that meet criteria using this datatype should document a request to a pharmacy to provide the medication indicated by the QDM category and its corresponding value set. Timing: The Author dateTime is the time the order is signed. Timing: The Relevant Period addresses: startTime = when the first administration of the medication is expected. The first administration may be expected at the time of the order or at a specified future date (i.e., the active time for the order); such information should be identified in the medication order. If the startTime is not specified in the order, the startTime defaults to the Author dateTime (the time the order is signed). stopTime = when the medication supply provided by the medication order is expected to be completed, including all fulfillments covered by the number of refills. Note that when calculating cumulative medication duration, the stopTime may be present directly in the medication order. If the stopTime is not available, the duration in days is the difference between the Relevant Period start and stop times multiplied by (1 + the number of refills). Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

BhAntidepressantMedicationOrder

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..*

BhElectroconvulsiveTherapyOrder

Clinical Focus: Under development

Data Element Scope: Under development

Inclusion Criteria: Under development

Exclusion Criteria: Under development

Subject constrained to the BH Electroconvulsive Therapy

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

DataType

Cardinality

BhElectroconvulsiveTherapyOrder

0..*

BhElectroconvulsiveTherapyPerformed

Clinical Focus: Under development

Data Element Scope: Under development

Inclusion Criteria: Under development

Exclusion Criteria: Under development

Subject constrained to the BH Electroconvulsive Therapy

ProcedurePerformed: Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

BhElectroconvulsiveTherapyPerformed

0..*

BhCounselingForDepressionOrder

Clinical Focus: Under development

Data Element Scope: Under development

Inclusion Criteria: Under development

Exclusion Criteria: Under development

Subject constrained to the BH Counseling for Depression

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

DataType

Cardinality

BhCounselingForDepressionOrder

0..*

BhCounselingForDepressionPerformed

Clinical Focus: Under development

Data Element Scope: Under development

Inclusion Criteria: Under development

Exclusion Criteria: Under development

Subject constrained to the BH Counseling for Depression

ProcedurePerformed: Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

BhCounselingForDepressionPerformed

0..*

BhAssessmentForAlcoholOrOtherDrugsPerformed

Clinical Focus: Under development

Data Element Scope: Under development

Inclusion Criteria: Under development

Exclusion Criteria: Under development

Subject constrained to the BH Assessment for Alcohol or Other Drugs

ProcedurePerformed: Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

BhAssessmentForAlcoholOrOtherDrugsPerformed

0..*