ecqm.measure

CMS2v8 - Preventive Care and Screening: Screening for Depression and Follow-Up Plan

Rationale:

Preventive Care and Screening: Screening for Depression and Follow-Up Plan. Depression is a serious medical illness associated with higher rates of chronic disease, increased health care utilization, and impaired functioning (Pratt, Brody 2014). 2014 U.S. survey data indicate that 2.8 million (11.4 percent) adolescents aged 12 to 17 had a major depressive episode (MDE) in the past year and that 15.7 million (6.6 percent) adults aged 18 or older had at least one MDE in the past year, with 10.2 million adults (4.3 percent) having one MDE with severe impairment in the past year (Center for Behavioral Health Statistics and Quality, 2015). Data indicate that severity of depressive symptoms factor into having difficulty with work, home, or social activities. For example, as the severity of depressive symptoms increased, rates of having difficulty with work, home, or social activities related to depressive symptoms increased. For those twelve and older with mild depressive symptoms, 45.7% reported difficulty with activities and those with severe depressive symptoms, 88.0% reported difficulty (Pratt & Brody, 2014). Children and teens with major depressive disorder (MDD) has been found to have difficulty carrying out their daily activities, relating to others, and growing up healthy with an increased risk of suicide (Siu and USPSTF, 2016). Additionally, among pregnant women, especially during the perinatal period, depression and other mood disorders, such as bipolar disorder and anxiety disorders, can have devastating effects on women, infants, and families. Maternal suicide rates rise over hemorrhage and hypertensive disorders as a cause of maternal mortality (American College of Obstetricians and Gynecologists, 2015). Negative outcomes associated with depression make it crucial to screen in order to identify and treat depression in its early stages. While Primary Care Providers (PCPs) serve as the first line of defense in the detection of depression, studies show that PCPs fail to recognize up to 50% of depressed patients (Borner, 2010, p. 948). 'Coyle et al. (2003), suggested that the picture is more grim for adolescents, and that more than 70% of children and adolescents suffering from serious mood disorders go unrecognized or inadequately treated' (Borner, 2010, p. 948). 'In nationally representative U.S. surveys, about 8% of adolescents reported having major depression in the past year. Only 36% to 44% of children and adolescents with depression receive treatment, suggesting that the majority of depressed youth are undiagnosed and untreated' (Sui, A. and USPSTF, 2016). Evidence supports that screening for depression in pregnant and postpartum women is of moderate net benefit and treatment options for positive depression screening should be available for patients twelve and older including pregnant and postpartum women. If preventing negative patient outcomes is not enough, the substantial economic burden of depression for individuals and society alike makes a case for screening for depression on a regular basis. Depression imposes economic burden through direct and indirect costs. 'In the United States, an estimated $22.8 billion was spent on depression treatment in 2009, and lost productivity cost an additional estimated $23 billion in 2011' (Sui, A. and USPSTF, 2016). This measure seeks to align with clinical guideline recommendations as well as the Healthy People 2020 recommendation for routine screening for mental health problems as a part of primary care for both children and adults (U.S. Department of Health and Human Services, 2014) and makes an important contribution to the quality domain of community and population health.

Data Elements

AdultDepressionScreeningAssessmentPerformed

AssessmentPerformed: Data elements that meet criteria using this datatype should document completion of the assessment indicated by the QDM category and its corresponding value set. Timing: The time the assessment is completed; Author dateTime.

DataType

Cardinality

AdultDepressionScreeningAssessmentPerformed

0..*

AdolescentDepressionScreeningAssessmentPerformed

AssessmentPerformed: Data elements that meet criteria using this datatype should document completion of the assessment indicated by the QDM category and its corresponding value set. Timing: The time the assessment is completed; Author dateTime.

DataType

Cardinality

AdolescentDepressionScreeningAssessmentPerformed

0..*

DepressionDiagnosisDiagnosis

Clinical Focus: This set of values includes diagnoses of depression, indicating that there is a current diagnosis of a depressed state or actual depressive disorder whether recurrent, chronic, or diagnosed as moderate, major, or severe.

Data Element Scope:

Inclusion Criteria: Included are depression diagnoses as well as depression as indicated as depressed mood or features, a single episode, or type of psychosis, or a reaction as related to depression.

Exclusion Criteria:

ResultValue constrained to codes in the Depression diagnosis valueset (2.16.840.1.113883.3.600.145)

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

DepressionDiagnosisDiagnosis

0..*

BipolarDiagnosisDiagnosis

Clinical Focus: This set of values includes various diagnoses of Bipolar disorder that could be documented in the medical record by a health care provider.

Data Element Scope:

Inclusion Criteria: Includes mild to severe cases, brief episodes, or chronic disorders, which would indicate that there is a current diagnosis of bipolar disorder documented by the healthcare provider.

Exclusion Criteria: Excludes all other depression diagnoses that do not relate to a bipolar diagnosis.

ResultValue constrained to codes in the Bipolar Diagnosis valueset (2.16.840.1.113883.3.600.450)

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

BipolarDiagnosisDiagnosis

0..*

DepressionScreeningEncounterCodesPerformed

Clinical Focus: This set of values contains encounter codes during which a depression screen could be assessed and documented through an exam, assessment, interview, or evaluation.

Data Element Scope:

Inclusion Criteria: Includes wellness visits, annual visits, therapy evaluations, or primary or specialist physician office visits where a depression screen could be conducted.

Exclusion Criteria:

Subject constrained to the Depression Screening Encounter Codes

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

DepressionScreeningEncounterCodesPerformed

0..*

ReferralForDepressionAdolescentOrder

Clinical Focus: This set of values contains referrals that would commonly be used for management of depression in an adolescent, which includes mental health clinics (mental health worker, counselor or team

Data Element Scope:

Inclusion Criteria: Included are appropriate referrals as specific to the child and adolescent age group for depression management.

Exclusion Criteria:

Subject constrained to the Referral for Depression Adolescent

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

ReferralForDepressionAdolescentOrder

0..*

ReferralForDepressionAdultOrder

Clinical Focus: This set of values contains referrals that would commonly be used for management of depression in an adult, which includes mental health clinics (mental health worker, counselor or team

Data Element Scope:

Inclusion Criteria: Appropriate referrals for depression management of the adult population are included in this set of values.

Exclusion Criteria:

Subject constrained to the Referral for Depression Adult

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

ReferralForDepressionAdultOrder

0..*

AdditionalEvaluationForDepressionAdolescentPerformed

Clinical Focus: This set of values captures an intervention or actual procedure where an adolescent depression screen was completed or depression was evaluated by a health care professional within this age group.

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the Additional evaluation for depression - adolescent

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

AdditionalEvaluationForDepressionAdolescentPerformed

0..*

AdditionalEvaluationForDepressionAdultPerformed

Clinical Focus: This set of values captures an intervention or actual procedure where an adult depression screen was completed or depression was evaluated by a health care professional within this age group.

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the Additional evaluation for depression - adult

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

AdditionalEvaluationForDepressionAdultPerformed

0..*

FollowUpForDepressionAdolescentPerformed

Clinical Focus: This value set contains follow-up plans that are commonly used to document a plan is in place for the treatment of depression that specifically pertains to the adolescent population.

Data Element Scope:

Inclusion Criteria: Incorporates emotional and coping support as well as mental health management in an attempt to follow-up on previously evaluated and diagnosed depression or depressive disorder in the adolescent population.

Exclusion Criteria:

Subject constrained to the Follow-up for depression - adolescent

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

FollowUpForDepressionAdolescentPerformed

0..*

FollowUpForDepressionAdultPerformed

Clinical Focus: This value set contains follow-up plans that are commonly used to document a plan is in place for the treatment of depression specifically pertaining to the adult population.

Data Element Scope:

Inclusion Criteria: Incorporates emotional and coping support as well as mental health management in an attempt to follow-up on previously evaluated and diagnosed depression or depressive disorder in the adult population.

Exclusion Criteria:

Subject constrained to the Follow-up for depression - adult

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

FollowUpForDepressionAdultPerformed

0..*

SuicideRiskAssessmentPerformed

Clinical Focus: The purpose of this set of values is to assess that a suicide risk assessment is collected; that the actual procedure of collecting a suicide assessment is completed and documented.

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the Suicide Risk Assessment

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

SuicideRiskAssessmentPerformed

0..*

DepressionMedicationsAdolescentOrder

Clinical Focus: This set of values contains medications that are commonly used to treat adolescent depression.

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the Depression medications - adolescent

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

DepressionMedicationsAdolescentOrder

0..*

DepressionMedicationsAdultOrder

Clinical Focus: This set of values contains medications that are commonly used to treat adult depression.

Data Element Scope:

Inclusion Criteria: These medications include antidepressants as well as other recommended depressive management medications.

Exclusion Criteria:

Subject constrained to the Depression medications - adult

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

DepressionMedicationsAdultOrder

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..*