{ "_id": "5ab9422eb848465f6789206a", "bundle_id": "582c709c6c5d1c1cf10006aa", "calculate_sdes": null, "category": "Miscellaneous", "cms_id": "CMS160v7", "complexity": { "variables": [ { "name": "Patient", "complexity": 1 }, { "name": "SDE Ethnicity", "complexity": 1 }, { "name": "SDE Payer", "complexity": 1 }, { "name": "SDE Race", "complexity": 1 }, { "name": "SDE Sex", "complexity": 1 }, { "name": "Depression Diagnoses", "complexity": 1 }, { "name": "September through December of Measurement Period", "complexity": 1 }, { "name": "Depression Encounter in September through December", "complexity": 4 }, { "name": "Initial Population 1", "complexity": 1 }, { "name": "Denominator 1", "complexity": 1 }, { "name": "May through August of Measurement Period", "complexity": 1 }, { "name": "Depression Encounter in May through August", "complexity": 4 }, { "name": "Initial Population 2", "complexity": 1 }, { "name": "Denominator 2", "complexity": 1 }, { "name": "January through April of Measurement Period", "complexity": 1 }, { "name": "Depression Encounter in January through April", "complexity": 4 }, { "name": "Initial Population 3", "complexity": 1 }, { "name": "Denominator 3", "complexity": 1 }, { "name": "Disorder Diagnoses Overlaps Depression Encounter in May through August", "complexity": 1 }, { "name": "Expired in September through December", "complexity": 1 }, { "name": "Expired in May through August", "complexity": 1 }, { "name": "Expired in January through April", "complexity": 1 }, { "name": "Stratification 1_1", "complexity": 1 }, { "name": "Stratification 1_2", "complexity": 1 }, { "name": "Stratification 2_1", "complexity": 1 }, { "name": "Stratification 2_2", "complexity": 1 }, { "name": "Stratification 3_1", "complexity": 1 }, { "name": "Stratification 3_2", "complexity": 1 }, { "name": "Numerator 1", "complexity": 1 }, { "name": "Numerator 2", "complexity": 1 }, { "name": "Numerator 3", "complexity": 1 }, { "name": "Long Term Care Overlaps January through April", "complexity": 1 }, { "name": "Long Term Care Overlaps May through August", "complexity": 1 }, { "name": "Long Term Care Overlaps September through December", "complexity": 1 }, { "name": "Palliative Care Order Before End of December", "complexity": 1 }, { "name": "Palliative Care Order Before End of April", "complexity": 1 }, { "name": "Palliative Care Order Before End of August", "complexity": 1 }, { "name": "Encounter Palliative Care Overlaps September through December", "complexity": 1 }, { "name": "Encounter Palliative Care Overlaps May through August", "complexity": 1 }, { "name": "Encounter Palliative Care Overlaps January through April", "complexity": 1 }, { "name": "Disorder Diagnoses Overlaps Depression Encounter in September through December", "complexity": 1 }, { "name": "Denominator Exclusion 1", "complexity": 5 }, { "name": "Denominator Exclusion 2", "complexity": 5 }, { "name": "Disorder Diagnoses Overlaps Depression Encounter in January through April", "complexity": 1 }, { "name": "Denominator Exclusion 3", "complexity": 5 }, { "name": "Patient", "complexity": 1 }, { "name": "Encounter", "complexity": 1 }, { "name": "LengthInDays", "complexity": 1 }, { "name": "Inpatient Encounter", "complexity": 2 }, { "name": "ToDate", "complexity": 1 }, { "name": "CalendarAgeInDaysAt", "complexity": 1 }, { "name": "CalendarAgeInDays", "complexity": 1 }, { "name": "CalendarAgeInMonthsAt", "complexity": 1 }, { "name": "CalendarAgeInMonths", "complexity": 1 }, { "name": "CalendarAgeInYearsAt", "complexity": 1 }, { "name": "CalendarAgeInYears", "complexity": 1 }, { "name": "Hospitalization", "complexity": 0 }, { "name": "Hospitalization Locations", "complexity": 0 }, { "name": "Hospitalization Length of Stay", "complexity": 1 }, { "name": "Hospital Admission Time", "complexity": 1 }, { "name": "Hospital Discharge Time", "complexity": 1 }, { "name": "Hospital Arrival Time", "complexity": 1 }, { "name": "Hospital Departure Time", "complexity": 1 }, { "name": "Emergency Department Arrival Time", "complexity": 1 }, { "name": "First Inpatient Intensive Care Unit", "complexity": 1 } ] }, "continuous_variable": false, "cql": [ "library DepressionUtilizationofthePHQ9Tool version '7.3.000'\r\n\r\nusing QDM version '5.3'\r\n\r\ninclude MATGlobalCommonFunctions version '2.0.000' called Global\r\n\r\ncodesystem \"LOINC:2.63\": 'urn:oid:2.16.840.1.113883.6.1' version 'urn:hl7:version:2.63'\r\n\r\nvalueset \"ONC Administrative Sex\": 'urn:oid:2.16.840.1.113762.1.4.1'\r\nvalueset \"Race\": 'urn:oid:2.16.840.1.114222.4.11.836'\r\nvalueset \"Ethnicity\": 'urn:oid:2.16.840.1.114222.4.11.837'\r\nvalueset \"Payer\": 'urn:oid:2.16.840.1.114222.4.11.3591'\r\nvalueset \"Bipolar Disorder\": 'urn:oid:2.16.840.1.113883.3.67.1.101.1.128'\r\nvalueset \"Care Services in Long-Term Residential Facility\": 'urn:oid:2.16.840.1.113883.3.464.1003.101.12.1014'\r\nvalueset \"Dysthymia\": 'urn:oid:2.16.840.1.113883.3.67.1.101.1.254'\r\nvalueset \"Major Depression Including Remission\": 'urn:oid:2.16.840.113883.3.67.1.101.3.2444'\r\nvalueset \"Palliative Care\": 'urn:oid:2.16.840.1.113883.3.600.1.1579'\r\nvalueset \"Personality Disorder\": 'urn:oid:2.16.840.1.113883.3.67.1.101.1.246'\r\nvalueset \"Palliative care encounter\": 'urn:oid:2.16.840.1.113883.3.600.1.1575'\r\nvalueset \"Contact or Office Visit\": 'urn:oid:2.16.840.1.113762.1.4.1080.5'\r\nvalueset \"Pervasive Developmental Disorder\": 'urn:oid:2.16.840.1.113883.3.464.1003.105.12.1152'\r\nvalueset \"Schizophrenia or Psychotic Disorder\": 'urn:oid:2.16.840.1.113883.3.464.1003.105.12.1104'\r\n\r\ncode \"Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]\": '44261-6' from \"LOINC:2.63\" display 'Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]'\r\n\r\nparameter \"Measurement Period\" Interval\r\n\r\ncontext Patient\r\n\r\ndefine \"SDE Ethnicity\":\r\n\t[\"Patient Characteristic Ethnicity\": \"Ethnicity\"]\r\n\r\ndefine \"SDE Payer\":\r\n\t[\"Patient Characteristic Payer\": \"Payer\"]\r\n\r\ndefine \"SDE Race\":\r\n\t[\"Patient Characteristic Race\": \"Race\"]\r\n\r\ndefine \"SDE Sex\":\r\n\t[\"Patient Characteristic Sex\": \"ONC Administrative Sex\"]\r\n\r\ndefine \"Denominator 1\":\r\n\t\"Initial Population 1\"\r\n\r\ndefine \"Denominator 2\":\r\n\t\"Initial Population 2\"\r\n\r\ndefine \"Denominator 3\":\r\n\t\"Initial Population 3\"\r\n\r\ndefine \"Disorder Diagnoses Overlaps Depression Encounter in May through August\":\r\n\t( [\"Diagnosis\": \"Bipolar Disorder\"]\r\n\t\tunion [\"Diagnosis\": \"Personality Disorder\"]\r\n\t\tunion [\"Diagnosis\": \"Schizophrenia or Psychotic Disorder\"]\r\n\t\tunion [\"Diagnosis\": \"Pervasive Developmental Disorder\"] ) DisorderDiagnoses\r\n\t\twith \"Depression Encounter in May through August\" DepressionEncounter\r\n\t\t\tsuch that DisorderDiagnoses.prevalencePeriod overlaps DepressionEncounter.relevantPeriod\r\n\r\ndefine \"Expired in September through December\":\r\n\t[\"Patient Characteristic Expired\"] Deceased\r\n\t\twhere Deceased.expiredDatetime in \"September through December of Measurement Period\"\r\n\r\ndefine \"Expired in May through August\":\r\n\t[\"Patient Characteristic Expired\"] Deceased\r\n\t\twhere Deceased.expiredDatetime in \"May through August of Measurement Period\"\r\n\r\ndefine \"Expired in January through April\":\r\n\t[\"Patient Characteristic Expired\"] Deceased\r\n\t\twhere Deceased.expiredDatetime in \"January through April of Measurement Period\"\r\n\r\ndefine \"Stratification 1_1\":\r\n\t[\"Patient Characteristic Birthdate\"] Birthdate\r\n\t\twith \"Depression Encounter in September through December\" DepressionEncounter\r\n\t\t\tsuch that Global.\"CalendarAgeInYearsAt\"(Birthdate.birthDatetime, start of DepressionEncounter.relevantPeriod)>= 12\r\n\t\t\t\tand Global.\"CalendarAgeInYearsAt\"(Birthdate.birthDatetime, start of DepressionEncounter.relevantPeriod)< 18\r\n\r\ndefine \"Stratification 1_2\":\r\n\t[\"Patient Characteristic Birthdate\"] Birthdate\r\n\t\twith \"Depression Encounter in September through December\" DepressionEncounter\r\n\t\t\tsuch that Global.\"CalendarAgeInYearsAt\"(Birthdate.birthDatetime, start of DepressionEncounter.relevantPeriod)>= 18\r\n\r\ndefine \"Stratification 2_1\":\r\n\t[\"Patient Characteristic Birthdate\"] Birthdate\r\n\t\twith \"Depression Encounter in May through August\" DepressionEncounter\r\n\t\t\tsuch that Global.\"CalendarAgeInYearsAt\"(Birthdate.birthDatetime, start of DepressionEncounter.relevantPeriod)>= 12\r\n\t\t\t\tand Global.\"CalendarAgeInYearsAt\"(Birthdate.birthDatetime, start of DepressionEncounter.relevantPeriod)< 18\r\n\r\ndefine \"Stratification 2_2\":\r\n\t[\"Patient Characteristic Birthdate\"] Birthdate\r\n\t\twith \"Depression Encounter in May through August\" DepressionEncounter\r\n\t\t\tsuch that Global.\"CalendarAgeInYearsAt\"(Birthdate.birthDatetime, start of DepressionEncounter.relevantPeriod)>= 18\r\n\r\ndefine \"Stratification 3_1\":\r\n\t[\"Patient Characteristic Birthdate\"] Birthdate\r\n\t\twith \"Depression Encounter in January through April\" DepressionEncounter\r\n\t\t\tsuch that Global.CalendarAgeInYearsAt(Birthdate.birthDatetime, start of DepressionEncounter.relevantPeriod)>= 12\r\n\t\t\t\tand Global.\"CalendarAgeInYearsAt\"(Birthdate.birthDatetime, start of DepressionEncounter.relevantPeriod)< 18\r\n\r\ndefine \"Stratification 3_2\":\r\n\t[\"Patient Characteristic Birthdate\"] Birthdate\r\n\t\twith \"Depression Encounter in January through April\" DepressionEncounter\r\n\t\t\tsuch that Global.\"CalendarAgeInYearsAt\"(Birthdate.birthDatetime, start of DepressionEncounter.relevantPeriod)>= 18\r\n\r\ndefine \"Initial Population 1\":\r\n\texists ( \"Depression Encounter in September through December\" )\r\n\r\ndefine \"Initial Population 2\":\r\n\texists ( \"Depression Encounter in May through August\" )\r\n\r\ndefine \"Initial Population 3\":\r\n\texists ( \"Depression Encounter in January through April\" )\r\n\r\ndefine \"Numerator 1\":\r\n\texists ( [\"Assessment, Performed\": \"Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]\"] DepressionAssessment\r\n\t\t\twhere DepressionAssessment.result is not null\r\n\t\t\t\tand DepressionAssessment.authorDatetime in \"September through December of Measurement Period\"\r\n\t)\r\n\r\ndefine \"Numerator 2\":\r\n\texists ( [\"Assessment, Performed\": \"Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]\"] DepressionAssessment\r\n\t\t\twhere DepressionAssessment.result is not null\r\n\t\t\t\tand DepressionAssessment.authorDatetime in \"May through August of Measurement Period\"\r\n\t)\r\n\r\ndefine \"Numerator 3\":\r\n\texists ( [\"Assessment, Performed\": \"Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]\"] DepressionAssessment\r\n\t\t\twhere DepressionAssessment.result is not null\r\n\t\t\t\tand DepressionAssessment.authorDatetime in \"January through April of Measurement Period\"\r\n\t)\r\n\r\ndefine \"Long Term Care Overlaps January through April\":\r\n\t[\"Encounter, Performed\": \"Care Services in Long-Term Residential Facility\"] EncounterLongTermCare\r\n\t\twhere EncounterLongTermCare.relevantPeriod overlaps \"January through April of Measurement Period\"\r\n\r\ndefine \"Long Term Care Overlaps May through August\":\r\n\t[\"Encounter, Performed\": \"Care Services in Long-Term Residential Facility\"] EncounterLongTermCare\r\n\t\twhere EncounterLongTermCare.relevantPeriod overlaps \"May through August of Measurement Period\"\r\n\r\ndefine \"Long Term Care Overlaps September through December\":\r\n\t[\"Encounter, Performed\": \"Care Services in Long-Term Residential Facility\"] EncounterLongTermCare\r\n\t\twhere EncounterLongTermCare.relevantPeriod overlaps \"September through December of Measurement Period\"\r\n\r\ndefine \"Palliative Care Order Before End of December\":\r\n\t[\"Intervention, Order\": \"Palliative Care\"] OrderedPalliativeCare\r\n\t\twhere OrderedPalliativeCare.authorDatetime before end of \"September through December of Measurement Period\"\r\n\r\ndefine \"Palliative Care Order Before End of April\":\r\n\t[\"Intervention, Order\": \"Palliative Care\"] OrderedPalliativeCare\r\n\t\twhere OrderedPalliativeCare.authorDatetime before end of \"January through April of Measurement Period\"\r\n\r\ndefine \"Palliative Care Order Before End of August\":\r\n\t[\"Intervention, Order\": \"Palliative Care\"] OrderedPalliativeCare\r\n\t\twhere OrderedPalliativeCare.authorDatetime before end of \"May through August of Measurement Period\"\r\n\r\ndefine \"Encounter Palliative Care Overlaps September through December\":\r\n\t[\"Encounter, Performed\": \"Palliative care encounter\"] PalliativeCareEncounter\r\n\t\twhere PalliativeCareEncounter.relevantPeriod overlaps \"September through December of Measurement Period\"\r\n\r\ndefine \"Encounter Palliative Care Overlaps May through August\":\r\n\t[\"Encounter, Performed\": \"Palliative care encounter\"] PalliativeCareEncounter\r\n\t\twhere PalliativeCareEncounter.relevantPeriod overlaps \"May through August of Measurement Period\"\r\n\r\ndefine \"Encounter Palliative Care Overlaps January through April\":\r\n\t[\"Encounter, Performed\": \"Palliative care encounter\"] PalliativeCareEncounter\r\n\t\twhere PalliativeCareEncounter.relevantPeriod overlaps \"January through April of Measurement Period\"\r\n\r\ndefine \"Denominator Exclusion 1\":\r\n\texists ( \"Palliative Care Order Before End of December\" )\r\n\t\tor exists ( \"Encounter Palliative Care Overlaps September through December\" )\r\n\t\tor exists ( \"Long Term Care Overlaps September through December\" )\r\n\t\tor exists ( \"Expired in September through December\" )\r\n\t\tor exists ( \"Disorder Diagnoses Overlaps Depression Encounter in September through December\" )\r\n\r\ndefine \"Denominator Exclusion 2\":\r\n\texists ( \"Palliative Care Order Before End of August\" )\r\n\t\tor exists ( \"Encounter Palliative Care Overlaps May through August\" )\r\n\t\tor exists ( \"Long Term Care Overlaps May through August\" )\r\n\t\tor exists ( \"Expired in May through August\" )\r\n\t\tor exists ( \"Disorder Diagnoses Overlaps Depression Encounter in May through August\" )\r\n\r\ndefine \"Denominator Exclusion 3\":\r\n\texists ( \"Palliative Care Order Before End of April\" )\r\n\t\tor exists ( \"Encounter Palliative Care Overlaps January through April\" )\r\n\t\tor exists ( \"Long Term Care Overlaps January through April\" )\r\n\t\tor exists ( \"Expired in January through April\" )\r\n\t\tor exists ( \"Disorder Diagnoses Overlaps Depression Encounter in January through April\" )\r\n\r\ndefine \"Depression Diagnoses\":\r\n\t[\"Diagnosis\": \"Major Depression Including Remission\"]\r\n\t\tunion [\"Diagnosis\": \"Dysthymia\"]\r\n\r\ndefine \"Depression Encounter in January through April\":\r\n\t[\"Encounter, Performed\": \"Contact or Office Visit\"] DepressionEncounter\r\n\t\twith \"Depression Diagnoses\" Depression\r\n\t\t\tsuch that DepressionEncounter.relevantPeriod overlaps Depression.prevalencePeriod\r\n\t\twith [\"Patient Characteristic Birthdate\"] BirthDate\r\n\t\t\tsuch that Global.\"CalendarAgeInYearsAt\"(BirthDate.birthDatetime, start of DepressionEncounter.relevantPeriod)>= 12\r\n\t\twhere DepressionEncounter.relevantPeriod ends during \"Measurement Period\"\r\n\t\t\tand end of DepressionEncounter.relevantPeriod in \"January through April of Measurement Period\"\r\n\r\ndefine \"Depression Encounter in May through August\":\r\n\t[\"Encounter, Performed\": \"Contact or Office Visit\"] DepressionEncounter\r\n\t\twith \"Depression Diagnoses\" Depression\r\n\t\t\tsuch that DepressionEncounter.relevantPeriod overlaps Depression.prevalencePeriod\r\n\t\twith [\"Patient Characteristic Birthdate\"] BirthDate\r\n\t\t\tsuch that Global.\"CalendarAgeInYearsAt\"(BirthDate.birthDatetime, start of DepressionEncounter.relevantPeriod)>= 12\r\n\t\twhere DepressionEncounter.relevantPeriod ends during \"Measurement Period\"\r\n\t\t\tand end of DepressionEncounter.relevantPeriod in \"May through August of Measurement Period\"\r\n\r\ndefine \"Depression Encounter in September through December\":\r\n\t[\"Encounter, Performed\": \"Contact or Office Visit\"] DepressionEncounter\r\n\t\twith \"Depression Diagnoses\" Depression\r\n\t\t\tsuch that DepressionEncounter.relevantPeriod overlaps Depression.prevalencePeriod\r\n\t\twith [\"Patient Characteristic Birthdate\"] BirthDate\r\n\t\t\tsuch that Global.\"CalendarAgeInYearsAt\"(BirthDate.birthDatetime, start of DepressionEncounter.relevantPeriod)>= 12\r\n\t\twhere DepressionEncounter.relevantPeriod ends during \"Measurement Period\"\r\n\t\t\tand end of DepressionEncounter.relevantPeriod in \"September through December of Measurement Period\"\r\n\r\ndefine \"Disorder Diagnoses Overlaps Depression Encounter in September through December\":\r\n\t( [\"Diagnosis\": \"Bipolar Disorder\"]\r\n\t\tunion [\"Diagnosis\": \"Personality Disorder\"]\r\n\t\tunion [\"Diagnosis\": \"Schizophrenia or Psychotic Disorder\"]\r\n\t\tunion [\"Diagnosis\": \"Pervasive Developmental Disorder\"] ) DisorderDiagnoses\r\n\t\twith \"Depression Encounter in September through December\" DepressionEncounter\r\n\t\t\tsuch that DisorderDiagnoses.prevalencePeriod overlaps DepressionEncounter.relevantPeriod\r\n\r\ndefine \"Disorder Diagnoses Overlaps Depression Encounter in January through April\":\r\n\t( [\"Diagnosis\": \"Bipolar Disorder\"]\r\n\t\tunion [\"Diagnosis\": \"Personality Disorder\"]\r\n\t\tunion [\"Diagnosis\": \"Schizophrenia or Psychotic Disorder\"]\r\n\t\tunion [\"Diagnosis\": \"Pervasive Developmental Disorder\"] ) DisorderDiagnoses\r\n\t\twith \"Depression Encounter in January through April\" DepressionEncounter\r\n\t\t\tsuch that DisorderDiagnoses.prevalencePeriod overlaps DepressionEncounter.relevantPeriod\r\n\r\ndefine \"January through April of Measurement Period\":\r\n\tInterval[start of \"Measurement Period\", start of \"Measurement Period\" + 4 months )\r\n\r\ndefine \"May through August of Measurement Period\":\r\n\tInterval[start of \"Measurement Period\" + 4 months, start of \"Measurement Period\" + 8 months )\r\n\r\ndefine \"September through December of Measurement Period\":\r\n\tInterval[start of \"Measurement Period\" + 8 months, end of \"Measurement Period\"]\r\n", "library MATGlobalCommonFunctions version '2.0.000'\r\n\r\nusing QDM version '5.3'\r\n\r\ncodesystem \"LOINC:2.46\": 'urn:oid:2.16.840.1.113883.6.1' version 'urn:hl7:version:2.46'\r\ncodesystem \"SNOMEDCT:2016-03\": 'urn:oid:2.16.840.1.113883.6.96' version 'urn:hl7:version:2016-03'\r\n\r\nvalueset \"Emergency Department Visit\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.292'\r\nvalueset \"Encounter Inpatient\": 'urn:oid:2.16.840.1.113883.3.666.5.307'\r\nvalueset \"Intensive Care Unit\": 'urn:oid:2.16.840.1.113762.1.4.1110.23'\r\n\r\ncode \"Birthdate\": '21112-8' from \"LOINC:2.46\" display 'Birth date'\r\ncode \"Dead\": '419099009' from \"SNOMEDCT:2016-03\" display 'Dead'\r\n\r\nparameter \"Measurement Period\" Interval\r\n\r\ncontext Patient\r\n\r\ndefine \"Encounter\":\r\n\t[\"Encounter, Performed\": \"Emergency Department Visit\"]\r\n\r\ndefine \"Inpatient Encounter\":\r\n\t[\"Encounter, Performed\": \"Encounter Inpatient\"] EncounterInpatient\r\n\t\twhere \"LengthInDays\"(EncounterInpatient.relevantPeriod)<= 120\r\n\t\t\tand EncounterInpatient.relevantPeriod ends during \"Measurement Period\"\n\n/*ToDate takes a given DateTime value and returns a DateTime with the time components \"zeroed\", and the timezone of the input value, for example, given the DateTime @2012-01-01T06:30:00.0Z, this function will return @2012-01-01T00:00:00.0Z.*/\r\n\r\ndefine function \"ToDate\"(Value DateTime):\r\n\tDateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezone from Value)\n\n/*CalendarAgeInDaysAt calculates the calendar age (meaning the age without considering time components) in days.*/\r\n\r\ndefine function \"CalendarAgeInDaysAt\"(BirthDateTime DateTime, AsOf DateTime):\r\n\tdays between ToDate(BirthDateTime)and ToDate(AsOf)\n\n/*CalendarAgeInDays calculates the calendar age (meaning the age without considering time components) in days as of today*/\r\n\r\ndefine function \"CalendarAgeInDays\"(BirthDateTime DateTime):\r\n\tCalendarAgeInDaysAt(BirthDateTime, Today())\n\n/*CalendarAgeInMonthsAt calculates the calendar age (meaning the age without considering time components) in months.*/\r\n\r\ndefine function \"CalendarAgeInMonthsAt\"(BirthDateTime DateTime, AsOf DateTime):\r\n\tmonths between ToDate(BirthDateTime)and ToDate(AsOf)\n\n/*CalendarAgeInMonths calculates the calendar age (meaning the age without considering time components) in months as of today.*/\r\n\r\ndefine function \"CalendarAgeInMonths\"(BirthDateTime DateTime):\r\n\tCalendarAgeInMonthsAt(BirthDateTime, Today())\n\n/*CalendarAgeInYearsAt calculates the calendar age (meaning the age without considering time components) in years.*/\r\n\r\ndefine function \"CalendarAgeInYearsAt\"(BirthDateTime DateTime, AsOf DateTime):\r\n\tyears between ToDate(BirthDateTime)and ToDate(AsOf)\n\n/*CalendarAgeInYears calculates the calendar age (meaning the age without considering time components) in years as of today.*/\r\n\r\ndefine function \"CalendarAgeInYears\"(BirthDateTime DateTime):\r\n\tCalendarAgeInYearsAt(BirthDateTime, Today())\n\n/*Hospitalization returns the total interval for admission to discharge for the given encounter, or for the admission of any immediately prior emergency department visit to the discharge of the given encounter.*/\r\n\r\ndefine function \"Hospitalization\"(Encounter \"Encounter, Performed\"):\r\n\t( singleton from ( [\"Encounter, Performed\": \"Emergency Department Visit\"] EDVisit\r\n\t\t\twhere EDVisit.relevantPeriod ends 1 hour or less on or before start of Encounter.relevantPeriod\r\n\t) ) X\r\n\t\treturn if X is null then Encounter.relevantPeriod else Interval[start of X.relevantPeriod, end of Encounter.relevantPeriod]\n\n/*calculates the difference in calendar days between the start and end of the given interval.*/\r\n\r\ndefine function \"LengthInDays\"(Value Interval):\r\n\tdifference in days between start of Value and end of Value\n\n/* returns list of all locations within an encounter, including locations for immediately prior ED visit. If data contains many encounters within 1 hour before the start of encounter error will occur indicating the hospitalization cannot be determined*/\r\n\r\ndefine function \"Hospitalization Locations\"(Encounter \"Encounter, Performed\"):\r\n\t( singleton from ( [\"Encounter, Performed\": \"Emergency Department Visit\"] EDVisit\r\n\t\t\twhere EDVisit.relevantPeriod ends 1 hour or less on or before start of Encounter.relevantPeriod\r\n\t) ) EDEncounter\r\n\t\treturn if EDEncounter is null then Encounter.facilityLocations else flatten { EDEncounter.facilityLocations, Encounter.facilityLocations }\n\n/*Returns the length of stay in days (i.e. the number of days between admission and discharge) for the given encounter, or from the admission of any immediately prior emergency department visit to the discharge of the encounter*/\r\n\r\ndefine function \"Hospitalization Length of Stay\"(Encounter \"Encounter, Performed\"):\r\n\tLengthInDays(\"Hospitalization\"(Encounter))\n\n/*Returns admission time for an encounter or for immediately prior emergency department visit. If the data contain many encounters within 1 hour before the start of the encounter an error indicating hospitalization cannot be determined\n*/\r\n\r\ndefine function \"Hospital Admission Time\"(Encounter \"Encounter, Performed\"):\r\n\tstart of \"Hospitalization\"(Encounter)\n\n/*Hospital Discharge Time returns the discharge time for an encounter*/\r\n\r\ndefine function \"Hospital Discharge Time\"(Encounter \"Encounter, Performed\"):\r\n\tend of Encounter.relevantPeriod\n\n/*Returns earliest arrival time for an encounter including any prior ED visit. If the data contain multiple encounters within 1 hour before the start of the encounter, an error will occur indicating it cannot be unambiguously determined\n*/\r\n\r\ndefine function \"Hospital Arrival Time\"(Encounter \"Encounter, Performed\"):\r\n\tstart of First((\"Hospitalization Locations\"(Encounter))HospitalLocation\r\n\t\t\tsort by start of locationPeriod\r\n\t).locationPeriod\n\n/*Returns the latest departure time for encounter including any prior ED visit. If the data contain multiple encounters within 1 hour before the start of the encounter, an error will occur indicating it cannot be unambiguously determined*/\r\n\r\ndefine function \"Hospital Departure Time\"(Encounter \"Encounter, Performed\"):\r\n\tend of Last((\"Hospitalization Locations\"(Encounter))HospitalLocation\r\n\t\t\tsort by start of locationPeriod\r\n\t).locationPeriod\n\n/*Returns the arrival time in the ED for the encounter. If the data contain multiple encounters within 1 hour before the start of the encounter or multiple ED locations an error will occur indicating it cannot be determined\n*/\r\n\r\ndefine function \"Emergency Department Arrival Time\"(Encounter \"Encounter, Performed\"):\r\n\tstart of ( singleton from ( ( \"Hospitalization Locations\"(Encounter)) HospitalLocation\r\n\t\t\t\twhere HospitalLocation.code in \"Emergency Department Visit\"\r\n\t\t)\r\n\t).locationPeriod\n\n/*First Inpatient Intensive Care Unit returns the first intensive care unit for\nthe given encounter, without considering any immediately prior emergency\ndepartment visit.*/\r\n\r\ndefine function \"First Inpatient Intensive Care Unit\"(Encounter \"Encounter, Performed\"):\r\n\tFirst((Encounter.facilityLocations)HospitalLocation\r\n\t\t\twhere HospitalLocation.code in \"Intensive Care Unit\"\r\n\t\t\t\tand HospitalLocation.locationPeriod during Encounter.relevantPeriod\r\n\t\t\tsort by start of locationPeriod\r\n\t)\r\n" ], "cql_statement_dependencies": { "DepressionUtilizationofthePHQ9Tool": { "Patient": [ ], "SDE Ethnicity": [ ], "SDE Payer": [ ], "SDE Race": [ ], "SDE Sex": [ ], "Depression Diagnoses": [ ], "September through December of Measurement Period": [ ], "Depression Encounter in September through December": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Depression Diagnoses" }, { "library_name": "MATGlobalCommonFunctions", "statement_name": "CalendarAgeInYearsAt" }, { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "September through December of Measurement Period" } ], "Initial Population 1": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Depression Encounter in September through December" } ], "Denominator 1": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Initial Population 1" } ], "May through August of Measurement Period": [ ], "Depression Encounter in May through August": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Depression Diagnoses" }, { "library_name": "MATGlobalCommonFunctions", "statement_name": "CalendarAgeInYearsAt" }, { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "May through August of Measurement Period" } ], "Initial Population 2": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Depression Encounter in May through August" } ], "Denominator 2": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Initial Population 2" } ], "January through April of Measurement Period": [ ], "Depression Encounter in January through April": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Depression Diagnoses" }, { "library_name": "MATGlobalCommonFunctions", "statement_name": "CalendarAgeInYearsAt" }, { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "January through April of Measurement Period" } ], "Initial Population 3": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Depression Encounter in January through April" } ], "Denominator 3": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Initial Population 3" } ], "Disorder Diagnoses Overlaps Depression Encounter in May through August": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Depression Encounter in May through August" } ], "Expired in September through December": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "September through December of Measurement Period" } ], "Expired in May through August": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "May through August of Measurement Period" } ], "Expired in January through April": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "January through April of Measurement Period" } ], "Stratification 1_1": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Depression Encounter in September through December" }, { "library_name": "MATGlobalCommonFunctions", "statement_name": "CalendarAgeInYearsAt" }, { "library_name": "MATGlobalCommonFunctions", "statement_name": "CalendarAgeInYearsAt" } ], "Stratification 1_2": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Depression Encounter in September through December" }, { "library_name": "MATGlobalCommonFunctions", "statement_name": "CalendarAgeInYearsAt" } ], "Stratification 2_1": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Depression Encounter in May through August" }, { "library_name": "MATGlobalCommonFunctions", "statement_name": "CalendarAgeInYearsAt" }, { "library_name": "MATGlobalCommonFunctions", "statement_name": "CalendarAgeInYearsAt" } ], "Stratification 2_2": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Depression Encounter in May through August" }, { "library_name": "MATGlobalCommonFunctions", "statement_name": "CalendarAgeInYearsAt" } ], "Stratification 3_1": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Depression Encounter in January through April" }, { "library_name": "MATGlobalCommonFunctions", "statement_name": "CalendarAgeInYearsAt" }, { "library_name": "MATGlobalCommonFunctions", "statement_name": "CalendarAgeInYearsAt" } ], "Stratification 3_2": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Depression Encounter in January through April" }, { "library_name": "MATGlobalCommonFunctions", "statement_name": "CalendarAgeInYearsAt" } ], "Numerator 1": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "September through December of Measurement Period" } ], "Numerator 2": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "May through August of Measurement Period" } ], "Numerator 3": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "January through April of Measurement Period" } ], "Long Term Care Overlaps January through April": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "January through April of Measurement Period" } ], "Long Term Care Overlaps May through August": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "May through August of Measurement Period" } ], "Long Term Care Overlaps September through December": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "September through December of Measurement Period" } ], "Palliative Care Order Before End of December": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "September through December of Measurement Period" } ], "Palliative Care Order Before End of April": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "January through April of Measurement Period" } ], "Palliative Care Order Before End of August": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "May through August of Measurement Period" } ], "Encounter Palliative Care Overlaps September through December": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "September through December of Measurement Period" } ], "Encounter Palliative Care Overlaps May through August": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "May through August of Measurement Period" } ], "Encounter Palliative Care Overlaps January through April": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "January through April of Measurement Period" } ], "Disorder Diagnoses Overlaps Depression Encounter in September through December": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Depression Encounter in September through December" } ], "Denominator Exclusion 1": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Palliative Care Order Before End of December" }, { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Encounter Palliative Care Overlaps September through December" }, { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Long Term Care Overlaps September through December" }, { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Expired in September through December" }, { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Disorder Diagnoses Overlaps Depression Encounter in September through December" } ], "Denominator Exclusion 2": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Palliative Care Order Before End of August" }, { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Encounter Palliative Care Overlaps May through August" }, { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Long Term Care Overlaps May through August" }, { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Expired in May through August" }, { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Disorder Diagnoses Overlaps Depression Encounter in May through August" } ], "Disorder Diagnoses Overlaps Depression Encounter in January through April": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Depression Encounter in January through April" } ], "Denominator Exclusion 3": [ { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Palliative Care Order Before End of April" }, { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Encounter Palliative Care Overlaps January through April" }, { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Long Term Care Overlaps January through April" }, { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Expired in January through April" }, { "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Disorder Diagnoses Overlaps Depression Encounter in January through April" } ] }, "MATGlobalCommonFunctions": { "CalendarAgeInYearsAt": [ { "library_name": "MATGlobalCommonFunctions", "statement_name": "ToDate" } ], "ToDate": [ ] } }, "created_at": "2018-03-26T18:55:42.536Z", "data_criteria": { "Payer_PatientCharacteristicPayer_51c5eb3e_7f59_43f3_ac6e_a2d2a0562e4e": { "title": "Payer", "description": "Patient Characteristic Payer: Payer", "code_list_id": "2.16.840.1.114222.4.11.3591", "property": "payer", "type": "characteristic", "definition": "patient_characteristic_payer", "hard_status": false, "negation": false, "source_data_criteria": "Payer_PatientCharacteristicPayer_51c5eb3e_7f59_43f3_ac6e_a2d2a0562e4e_source", "variable": false, "inline_code_list": { "Source of Payment Typology": [ "1", "11", "111", "112", 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"type": "CD", "null_flavor": "OTH", "original_text": "NQF Number" }, "value_obj": { "type": "ED", "value": "0712", "media_type": "text/plain" } }, { "code": "COPY", "value": "Copyright MN Community Measurement, 2018. All rights reserved.", "name": "Copyright", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "COPY", "title": "Copyright" }, "value_obj": { "type": "ED", "value": "Copyright MN Community Measurement, 2018. All rights reserved.", "media_type": "text/plain" } }, { "code": "DISC", "value": "This measure is \"re-tooled\" from the existing NQF # 712 measure. eMeasure development was a collaboration between MN Community Measurement and Telligen with technical assistance provided by Telligen.", "name": "Disclaimer", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "DISC", "title": "Disclaimer" }, "value_obj": { "type": "ED", "value": "This measure is \"re-tooled\" from the existing NQF # 712 measure. eMeasure development was a collaboration between MN Community Measurement and Telligen with technical assistance provided by Telligen.", "media_type": "text/plain" } }, { "code": "MSRSCORE", "name": "Measure Scoring", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "MSRSCORE", "title": "Measure Scoring" }, "value_obj": { "type": "CD", "system": "2.16.840.1.113883.1.11.20367", "code": "PROPOR", "title": "Proportion" } }, { "code": "MSRTYPE", "name": "Measure Type", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "MSRTYPE", "title": "Measure Type" }, "value_obj": { "type": "CD", "system": "2.16.840.1.113883.1.11.20368", "code": "PROCESS", "title": "PROCESS" } }, { "code": "STRAT", "value": "Ages 12 to 17\nAges 18 and older", "name": "Stratification", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "STRAT", "title": "Stratification" }, "value_obj": { "type": "ED", "value": "Ages 12 to 17\nAges 18 and older", "media_type": "text/plain" } }, { "code": "MSRADJ", "value": "None", "name": "Risk Adjustment", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "MSRADJ", "title": "Risk Adjustment" }, "value_obj": { "type": "ED", "value": "None", "media_type": "text/plain" } }, { "code": "MSRAGG", "value": "None", "name": "Rate Aggregation", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "MSRAGG", "title": "Rate Aggregation" }, "value_obj": { "type": "ED", "value": "None", "media_type": "text/plain" } }, { "code": "RAT", "value": "Adults:\nDepression is a common and treatable mental disorder. The Centers for Disease Control and Prevention states that an estimated 6.6% of the U.S. adult population (14.8 million people) experiences a major depressive disorder during any given 12-month period. Additionally, dysthymia accounts for an additional 3.3 million Americans. In 2006 and 2008, an estimated 9.1% of U.S. adults reported symptoms for current depression (Centers for Disease Control and Prevention, 2010).\n\nPersons with a current diagnosis of depression and a lifetime diagnosis of depression or anxiety were significantly more likely than persons without these conditions to have cardiovascular disease, diabetes, asthma and obesity and to be a current smoker, to be physically inactive and to drink heavily (Strine, 2008).\n \nPeople who suffer from depression have lower incomes, lower educational attainment and fewer days working each year, leading to seven fewer weeks of work per year, a loss of 20% in potential income and a lifetime loss for each family who has a depressed family member of $300,000 (Smith, 2010). \n\nThe cost of depression (lost productivity and increased medical expense) in the United States is $83 billion each year (Greenberg, 2003). \n\n \nAdolescents and Adults:\nThe Centers for Disease Control and Prevention states that during 2009-2012 an estimated 7.6% of the U.S. population aged 12 and over had depression, including 3% of Americans with severe depressive symptoms. Almost 43% of persons with severe depressive symptoms reported serious difficulties in work, home and social activities, yet only 35% reported having contact with a mental health professional in the past year.\nDepression is associated with higher mortality rates in all age groups. People who are depressed are 30 times more likely to take their own lives than people who are not depressed and five times more likely to abuse drugs. Depression is the leading cause of medical disability for people aged 14 - 44. Depressed people lose 5.6 hours of productive work every week when they are depressed, fifty percent of which is due to absenteeism and short-term disability.\n\nAdolescents:\nIn 2014, an estimated 2.8 million adolescents age 12 to 17 in the United States had at least one major depressive episode in the past year. This represented 11.4% of the U.S. population. The same survey found that only 41.2 percent of those who had a Major Depressive Episode received treatment in the past year. The 2013 Youth Risk Behavior Survey of students grades 9 to 12 indicated that during the past 12 months 39.1% (F) and 20.8% (M) indicated feeling sad or hopeless almost every day for at least 2 weeks, planned suicide attempt 16.9% (F) and 10.3% (M), with attempted suicide 10.6% (F) and 5.4% (M). Adolescent-onset depression is associated with chronic depression in adulthood. Many mental health conditions (anxiety, bipolar, depression, eating disorders, and substance abuse) are evident by age 14. The 12-month prevalence of MDEs increased from 8.7% in 2005 to 11.3% in 2014 in adolescents and from 8.8% to 9.6% in young adults (both P < .001). The increase was larger and statistically significant only in the age range of 12 to 20 years. The trends remained significant after adjustment for substance use disorders and sociodemographic factors. Mental health care contacts overall did not change over time; however, the use of specialty mental health providers increased in adolescents and young adults, and the use of prescription medications and inpatient hospitalizations increased in adolescents. In 2015, 9.7% of adolescents in MN who were screened for depression or other mental health conditions, screened positively.\n\nPlease note that this process measure for administration of the PHQ-9 or PHQ-9M depression tool, a PROM that is validated for both the assessment and diagnosis of depression as well as for monitoring ongoing outcomes of treatment, is a PAIRED process measure with RELATED measures of depression remission (PHQ-9/PHQ-9M < 5) and depression response (PHQ-9/PHQ-9M is improved by > 50%) at six and twelve months. To quote a NQF Behavioral Steering Committee member as these measures were initially endorsed \"the best way to avoid being measured is to never give the PHQ-9\". This process measure allows an understanding of the use of the tool in the target population, promotes frequent and follow-up contact with patients whose score indicates a need for treatment and serves as a catalyst in a collaborative care model for patients with major depression or dysthymia. It is estimated that up to 90% of patients diagnosed with depression and anxiety are treated solely in primary care (National Institute for Health and Care Excellence, 2011).", "name": "Rationale", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "RAT", "title": "Rationale" }, "value_obj": { "type": "ED", "value": "Adults:\nDepression is a common and treatable mental disorder. The Centers for Disease Control and Prevention states that an estimated 6.6% of the U.S. adult population (14.8 million people) experiences a major depressive disorder during any given 12-month period. Additionally, dysthymia accounts for an additional 3.3 million Americans. In 2006 and 2008, an estimated 9.1% of U.S. adults reported symptoms for current depression (Centers for Disease Control and Prevention, 2010).\n\nPersons with a current diagnosis of depression and a lifetime diagnosis of depression or anxiety were significantly more likely than persons without these conditions to have cardiovascular disease, diabetes, asthma and obesity and to be a current smoker, to be physically inactive and to drink heavily (Strine, 2008).\n \nPeople who suffer from depression have lower incomes, lower educational attainment and fewer days working each year, leading to seven fewer weeks of work per year, a loss of 20% in potential income and a lifetime loss for each family who has a depressed family member of $300,000 (Smith, 2010). \n\nThe cost of depression (lost productivity and increased medical expense) in the United States is $83 billion each year (Greenberg, 2003). \n\n \nAdolescents and Adults:\nThe Centers for Disease Control and Prevention states that during 2009-2012 an estimated 7.6% of the U.S. population aged 12 and over had depression, including 3% of Americans with severe depressive symptoms. Almost 43% of persons with severe depressive symptoms reported serious difficulties in work, home and social activities, yet only 35% reported having contact with a mental health professional in the past year.\nDepression is associated with higher mortality rates in all age groups. People who are depressed are 30 times more likely to take their own lives than people who are not depressed and five times more likely to abuse drugs. Depression is the leading cause of medical disability for people aged 14 - 44. Depressed people lose 5.6 hours of productive work every week when they are depressed, fifty percent of which is due to absenteeism and short-term disability.\n\nAdolescents:\nIn 2014, an estimated 2.8 million adolescents age 12 to 17 in the United States had at least one major depressive episode in the past year. This represented 11.4% of the U.S. population. The same survey found that only 41.2 percent of those who had a Major Depressive Episode received treatment in the past year. The 2013 Youth Risk Behavior Survey of students grades 9 to 12 indicated that during the past 12 months 39.1% (F) and 20.8% (M) indicated feeling sad or hopeless almost every day for at least 2 weeks, planned suicide attempt 16.9% (F) and 10.3% (M), with attempted suicide 10.6% (F) and 5.4% (M). Adolescent-onset depression is associated with chronic depression in adulthood. Many mental health conditions (anxiety, bipolar, depression, eating disorders, and substance abuse) are evident by age 14. The 12-month prevalence of MDEs increased from 8.7% in 2005 to 11.3% in 2014 in adolescents and from 8.8% to 9.6% in young adults (both P < .001). The increase was larger and statistically significant only in the age range of 12 to 20 years. The trends remained significant after adjustment for substance use disorders and sociodemographic factors. Mental health care contacts overall did not change over time; however, the use of specialty mental health providers increased in adolescents and young adults, and the use of prescription medications and inpatient hospitalizations increased in adolescents. In 2015, 9.7% of adolescents in MN who were screened for depression or other mental health conditions, screened positively.\n\nPlease note that this process measure for administration of the PHQ-9 or PHQ-9M depression tool, a PROM that is validated for both the assessment and diagnosis of depression as well as for monitoring ongoing outcomes of treatment, is a PAIRED process measure with RELATED measures of depression remission (PHQ-9/PHQ-9M < 5) and depression response (PHQ-9/PHQ-9M is improved by > 50%) at six and twelve months. To quote a NQF Behavioral Steering Committee member as these measures were initially endorsed \"the best way to avoid being measured is to never give the PHQ-9\". This process measure allows an understanding of the use of the tool in the target population, promotes frequent and follow-up contact with patients whose score indicates a need for treatment and serves as a catalyst in a collaborative care model for patients with major depression or dysthymia. It is estimated that up to 90% of patients diagnosed with depression and anxiety are treated solely in primary care (National Institute for Health and Care Excellence, 2011).", "media_type": "text/plain" } }, { "code": "CRS", "value": "Adults: \nSource: Institute for Clinical Systems Improvement (ICSI) Health Care Guideline for Adult Depression in Primary Care (Trangle, 2016)\n\nMajor depression is a treatable cause of pain, suffering, disability and death, yet primary care clinicians detect major depression in only one-third to one-half of their patients with major depression (Williams Jr, 2002; Schonfeld, 1997).\n\nUsual care for depression in the primary care setting has resulted in only about half of depressed adults getting treated (Kessler, 2005) and only 20-40% showing substantial improvement over 12 months (Unutzer, 2002; Katon, 1999).\n\nRecommendations and algorithm notations supporting depression assessment and monitoring of depression outcomes according to ICSI's Health Care Guideline:\n\nRecommendation: Clinicians should establish and maintain follow-up with patients. Appropriate, reliable follow-up is highly correlated with improved response and remission scores. It is also correlated with the improved safety and efficacy of medications and helps prevent relapse. \n\nProactive follow-up contacts (in person, telephone) based on the collaborative care model have been shown to significantly lower depression severity (Unutzer, 2002). In the available clinical effectiveness trials conducted in real clinical practice settings, even the addition of a care manager leads to modest remission rates (Trivedi, 2006-; Unutzer, 2002). Interventions are critical to educating the patient regarding the importance of preventing relapse, safety and efficacy of medications, and management of potential side effects. Establish and maintain initial follow-up contact intervals (office, phone, other) (Hunkeler, 2000; Simon, 2000).\n \nPHQ-9 as monitor and management tool. The PHQ-9 is an effective management tool, as well, and should be used routinely for subsequent visits to monitor treatment outcomes and severity. It can also help the clinician decide if/how to modify the treatment plan (Duffy, 2008; Lowe, 2004). Using a measurement-based approach to depression care, PHQ-9 results and side effect evaluation should be combined with treatment algorithms to drive patients toward remission. A five-point drop in PHQ-9 score is considered the minimal clinically significant difference (Trivedi, 2009). \n\nEvery time that the PHQ-9 is assessed, suicidality is assessed, as well. If the suicidality was indeed of high risk, urgent referral to crisis specialty health care is advised. In case of low suicide risk, the patient can proceed with treatment in the primary care practice (Huijbregts, 2013).\n\nAdult Depression in Primary Care - Guideline Aims \n- Increase the percentage of patients with major depression or persistent depressive disorder who have improvement in outcomes from treatment for major depression or persistent depressive disorder. \n- Increase the percentage of patients with major depression or persistent depressive disorder who have follow-up to assess for outcomes from treatment.\n- Improve communication between the primary care physician and the mental health care clinician (if patient is co-managed).\n\nAdolescents:\nSource: American Academy of Child and Adolescent Psychiatry Practice Parameter for the Assessment and Treatment of Children and Adolescents with Depressive Disorders (2007)\nhttp://www.jaacap.com/article/S0890-8567(09)62053-0/pdf\n\nRecommendations:\nRecommendations supporting depression outcomes and duration of treatment according to AACAP guideline:\n- Treatment of depressive disorders should always include an acute and continuation phase; some children may also require maintenance treatment. The main goal of the acute phase is to achieve response and ultimately full symptomatic remission (definitions below).\n- Each phase of treatment should include psychoeducation, supportive management, and family and school involvement\n- Education, support, and case management appear to be sufficient treatment for the management of depressed children and adolescents with an uncomplicated or brief depression or with mild psychosocial impairment\n- For children and adolescents who do not respond to supportive psychotherapy or who have more complicated depressions, a trial with specific types of psychotherapy and/or antidepressants is indicated\n\nDefinitions:\nResponse: No symptoms or a significant reduction in depressive symptoms for at least 2 weeks\nRemission: A period of at least 2 weeks and <2months with no or few depressive symptoms \nRecovery: Absence of significant symptoms of depression (eg, no more than 1 to 2 symptoms) for greater than 2 months \nRelapse: A DSM episode of depression during the period of remission\nRecurrence: The emergence of symptoms of depression during the period of recovery (a new episode)\n\nSources: \nGuidelines for Adolescent Depression in Primary Care (GLAD-PC) (2018) http://pediatrics.aappublications.org/content/141/3/e20174081\nGuidelines for adolescent depression in primary care (GLAD-PC): II. Treatment and ongoing management\nhttp://pediatrics.aappublications.org/content/141/3/e20174082\n\nRecommendations supporting depression outcomes and duration of treatment according to GLAD-PC:\nRecommendations for Ongoing Management of Depression:\n- Mild depression: consider a period of active support and monitoring before starting other evidence based treatment\n- Moderate or severe major clinical depression or complicating factors: \n -- consultation with mental health specialist with agreed upon roles \n -- evidence based treatment (CBT or IPT and/or antidepressant SSRI)\n- Monitor for adverse effects during antidepressant therapy\n -- clinical worsening, suicidality, unusual changes in behavior\n- Systematic and regular tracking of goals and outcomes\n -- improvement in functioning status and resolution of depressive symptoms \nRegardless of the length of treatment, all patients should be monitored on a monthly basis for 6 to 12 months after the full resolution of symptoms", "name": "Clinical Recommendation Statement", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "CRS", "title": "Clinical Recommendation Statement" }, "value_obj": { "type": "ED", "value": "Adults: \nSource: Institute for Clinical Systems Improvement (ICSI) Health Care Guideline for Adult Depression in Primary Care (Trangle, 2016)\n\nMajor depression is a treatable cause of pain, suffering, disability and death, yet primary care clinicians detect major depression in only one-third to one-half of their patients with major depression (Williams Jr, 2002; Schonfeld, 1997).\n\nUsual care for depression in the primary care setting has resulted in only about half of depressed adults getting treated (Kessler, 2005) and only 20-40% showing substantial improvement over 12 months (Unutzer, 2002; Katon, 1999).\n\nRecommendations and algorithm notations supporting depression assessment and monitoring of depression outcomes according to ICSI's Health Care Guideline:\n\nRecommendation: Clinicians should establish and maintain follow-up with patients. Appropriate, reliable follow-up is highly correlated with improved response and remission scores. It is also correlated with the improved safety and efficacy of medications and helps prevent relapse. \n\nProactive follow-up contacts (in person, telephone) based on the collaborative care model have been shown to significantly lower depression severity (Unutzer, 2002). In the available clinical effectiveness trials conducted in real clinical practice settings, even the addition of a care manager leads to modest remission rates (Trivedi, 2006-; Unutzer, 2002). Interventions are critical to educating the patient regarding the importance of preventing relapse, safety and efficacy of medications, and management of potential side effects. Establish and maintain initial follow-up contact intervals (office, phone, other) (Hunkeler, 2000; Simon, 2000).\n \nPHQ-9 as monitor and management tool. The PHQ-9 is an effective management tool, as well, and should be used routinely for subsequent visits to monitor treatment outcomes and severity. It can also help the clinician decide if/how to modify the treatment plan (Duffy, 2008; Lowe, 2004). Using a measurement-based approach to depression care, PHQ-9 results and side effect evaluation should be combined with treatment algorithms to drive patients toward remission. A five-point drop in PHQ-9 score is considered the minimal clinically significant difference (Trivedi, 2009). \n\nEvery time that the PHQ-9 is assessed, suicidality is assessed, as well. If the suicidality was indeed of high risk, urgent referral to crisis specialty health care is advised. In case of low suicide risk, the patient can proceed with treatment in the primary care practice (Huijbregts, 2013).\n\nAdult Depression in Primary Care - Guideline Aims \n- Increase the percentage of patients with major depression or persistent depressive disorder who have improvement in outcomes from treatment for major depression or persistent depressive disorder. \n- Increase the percentage of patients with major depression or persistent depressive disorder who have follow-up to assess for outcomes from treatment.\n- Improve communication between the primary care physician and the mental health care clinician (if patient is co-managed).\n\nAdolescents:\nSource: American Academy of Child and Adolescent Psychiatry Practice Parameter for the Assessment and Treatment of Children and Adolescents with Depressive Disorders (2007)\nhttp://www.jaacap.com/article/S0890-8567(09)62053-0/pdf\n\nRecommendations:\nRecommendations supporting depression outcomes and duration of treatment according to AACAP guideline:\n- Treatment of depressive disorders should always include an acute and continuation phase; some children may also require maintenance treatment. The main goal of the acute phase is to achieve response and ultimately full symptomatic remission (definitions below).\n- Each phase of treatment should include psychoeducation, supportive management, and family and school involvement\n- Education, support, and case management appear to be sufficient treatment for the management of depressed children and adolescents with an uncomplicated or brief depression or with mild psychosocial impairment\n- For children and adolescents who do not respond to supportive psychotherapy or who have more complicated depressions, a trial with specific types of psychotherapy and/or antidepressants is indicated\n\nDefinitions:\nResponse: No symptoms or a significant reduction in depressive symptoms for at least 2 weeks\nRemission: A period of at least 2 weeks and <2months with no or few depressive symptoms \nRecovery: Absence of significant symptoms of depression (eg, no more than 1 to 2 symptoms) for greater than 2 months \nRelapse: A DSM episode of depression during the period of remission\nRecurrence: The emergence of symptoms of depression during the period of recovery (a new episode)\n\nSources: \nGuidelines for Adolescent Depression in Primary Care (GLAD-PC) (2018) http://pediatrics.aappublications.org/content/141/3/e20174081\nGuidelines for adolescent depression in primary care (GLAD-PC): II. Treatment and ongoing management\nhttp://pediatrics.aappublications.org/content/141/3/e20174082\n\nRecommendations supporting depression outcomes and duration of treatment according to GLAD-PC:\nRecommendations for Ongoing Management of Depression:\n- Mild depression: consider a period of active support and monitoring before starting other evidence based treatment\n- Moderate or severe major clinical depression or complicating factors: \n -- consultation with mental health specialist with agreed upon roles \n -- evidence based treatment (CBT or IPT and/or antidepressant SSRI)\n- Monitor for adverse effects during antidepressant therapy\n -- clinical worsening, suicidality, unusual changes in behavior\n- Systematic and regular tracking of goals and outcomes\n -- improvement in functioning status and resolution of depressive symptoms \nRegardless of the length of treatment, all patients should be monitored on a monthly basis for 6 to 12 months after the full resolution of symptoms", "media_type": "text/plain" } }, { "code": "IDUR", "value": "Higher scores indicate better quality", "name": "Improvement Notation", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "IDUR", "title": "Improvement Notation" }, "value_obj": { "type": "ED", "value": "Higher scores indicate better quality", "media_type": "text/plain" } }, { "code": "REF", "value": "Trangle M, Gursky J, Haight R, Hardwig J, Hinnenkamp T, Kessler D, Mack N, Myszkowski M. Institute for Clinical Systems Improvement. Adult Depression in Primary Care. Updated March 2016. https://www.icsi.org/guidelines__more/catalog_guidelines_and_more/catalog_guidelines/catalog_behavioral_health_guidelines/depression/", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Trangle M, Gursky J, Haight R, Hardwig J, Hinnenkamp T, Kessler D, Mack N, Myszkowski M. Institute for Clinical Systems Improvement. Adult Depression in Primary Care. Updated March 2016. https://www.icsi.org/guidelines__more/catalog_guidelines_and_more/catalog_guidelines/catalog_behavioral_health_guidelines/depression/", "media_type": "text/plain" } }, { "code": "REF", "value": "Gonzolez O, Berry JT, McKnight-Eily LR, et al. Centers for Disease Control and Prevention. Current Depression Among Adults United States, 2006 and 2008. MMWR 2010;59(38);1229-1235. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5938a2.htm", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Gonzolez O, Berry JT, McKnight-Eily LR, et al. Centers for Disease Control and Prevention. Current Depression Among Adults United States, 2006 and 2008. MMWR 2010;59(38);1229-1235. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5938a2.htm", "media_type": "text/plain" } }, { "code": "REF", "value": "Strine TW, Mokdad AH, Balluz LS, et al. Depression and anxiety in the United States: findings from the 2006 Behavioral Risk Factor Surveillance System. Psychiatr Serv 2008;59:1383-90. http://ps.psychiatryonline.org/doi/abs/10.1176/ps.2008.59.12.1383", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Strine TW, Mokdad AH, Balluz LS, et al. Depression and anxiety in the United States: findings from the 2006 Behavioral Risk Factor Surveillance System. Psychiatr Serv 2008;59:1383-90. http://ps.psychiatryonline.org/doi/abs/10.1176/ps.2008.59.12.1383", "media_type": "text/plain" } }, { "code": "REF", "value": "Smith JP, Smith GC. Long-term economic costs of psychological problems during childhood. Soc Sci Med 2010;71:110-115. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2887689/", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Smith JP, Smith GC. Long-term economic costs of psychological problems during childhood. Soc Sci Med 2010;71:110-115. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2887689/", "media_type": "text/plain" } }, { "code": "REF", "value": "Greenberg PE, Kessler RC, Birnbaum HG, et al. The economic burden of depression in the United States: how did it change between 1990 and 2000? J Clin Psychiatry 2003;64(10):1465-1475.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Greenberg PE, Kessler RC, Birnbaum HG, et al. The economic burden of depression in the United States: how did it change between 1990 and 2000? J Clin Psychiatry 2003;64(10):1465-1475.", "media_type": "text/plain" } }, { "code": "REF", "value": "Kendrick T, Pilling S, et al. National Institute for Health and Care Excellence. Clinical guideline CG123. Common mental health problems; identification and pathways to care. May 2011. https://www.nice.org.uk/guidance/cg123/chapter/introduction", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Kendrick T, Pilling S, et al. National Institute for Health and Care Excellence. Clinical guideline CG123. Common mental health problems; identification and pathways to care. May 2011. https://www.nice.org.uk/guidance/cg123/chapter/introduction", "media_type": "text/plain" } }, { "code": "REF", "value": "Williams Jr JW, Noel PH, Cordes JA, et al. Is this patient clinically depressed? JAMA 2002;287:1160-70.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Williams Jr JW, Noel PH, Cordes JA, et al. Is this patient clinically depressed? JAMA 2002;287:1160-70.", "media_type": "text/plain" } }, { "code": "REF", "value": "Schonfeld WH, Verboncoeur CJ, Fifer SK, et al. The functioning and well-being of patients with unrecognized anxiety disorders and major depressive disorder. J Affect Disord 1997;43:105-19.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Schonfeld WH, Verboncoeur CJ, Fifer SK, et al. The functioning and well-being of patients with unrecognized anxiety disorders and major depressive disorder. J Affect Disord 1997;43:105-19.", "media_type": "text/plain" } }, { "code": "REF", "value": "Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry 2005;62:617-27.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry 2005;62:617-27.", "media_type": "text/plain" } }, { "code": "REF", "value": "Unutzer J, Katon W, Callahan CM, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA 2002;288:2836-45.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Unutzer J, Katon W, Callahan CM, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA 2002;288:2836-45.", "media_type": "text/plain" } }, { "code": "REF", "value": "Katon W, Von Korff M, Lin E, et al. Stepped collaborative care for primary care patients with persistent symptoms of depression: a randomized trial. Arch Gen Psychiatry 1999;56:1109-15.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Katon W, Von Korff M, Lin E, et al. Stepped collaborative care for primary care patients with persistent symptoms of depression: a randomized trial. Arch Gen Psychiatry 1999;56:1109-15.", "media_type": "text/plain" } }, { "code": "REF", "value": "Trivedi MH, Rush AJ, Wisniewski SR, et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry 2006;163:28-40.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Trivedi MH, Rush AJ, Wisniewski SR, et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry 2006;163:28-40.", "media_type": "text/plain" } }, { "code": "REF", "value": "Hunkeler EM, Meresman JF, Hargreaves WA, et al. Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care. Arch Fam Med 2000;9:700-08.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Hunkeler EM, Meresman JF, Hargreaves WA, et al. Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care. Arch Fam Med 2000;9:700-08.", "media_type": "text/plain" } }, { "code": "REF", "value": "Simon GE, Van Korff M, Rutter C, Wagner E. Randomised trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care. BMJ 2000;320:550-54.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Simon GE, Van Korff M, Rutter C, Wagner E. Randomised trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care. BMJ 2000;320:550-54.", "media_type": "text/plain" } }, { "code": "REF", "value": "Duffy FF, Chung H, Trivedi M, et al. Systematic use of patient-rated depression severity monitoring: is it helpful and feasible in clinical psychiatry? Psychiatric Serv 2008;59:1148-54.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Duffy FF, Chung H, Trivedi M, et al. Systematic use of patient-rated depression severity monitoring: is it helpful and feasible in clinical psychiatry? Psychiatric Serv 2008;59:1148-54.", "media_type": "text/plain" } }, { "code": "REF", "value": "Lowe B, Unutzer J, Callahan CM, et al. Monitoring depression treatment outcomes with the patient health questionnaire-9. Med Care 2004;42:1194-1201.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Lowe B, Unutzer J, Callahan CM, et al. Monitoring depression treatment outcomes with the patient health questionnaire-9. Med Care 2004;42:1194-1201.", "media_type": "text/plain" } }, { "code": "REF", "value": "Trivedi MH. Tools and strategies for ongoing assessment of depression: a measurement-based approach to remission. J Clin Psychiatry 2009;70:26-31.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Trivedi MH. Tools and strategies for ongoing assessment of depression: a measurement-based approach to remission. J Clin Psychiatry 2009;70:26-31.", "media_type": "text/plain" } }, { "code": "REF", "value": "Huijbregts KML, de Jong FJ, van Marwijk HWJ, et al. A target-driven collaborative care model for major depressive disorder is effective in primary care in the Netherlands: a randomized clinical trial from the depression initiative. J Affect Dis 2013;146:328-37.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Huijbregts KML, de Jong FJ, van Marwijk HWJ, et al. A target-driven collaborative care model for major depressive disorder is effective in primary care in the Netherlands: a randomized clinical trial from the depression initiative. J Affect Dis 2013;146:328-37.", "media_type": "text/plain" } }, { "code": "REF", "value": "Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16:606-13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495268/", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16:606-13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495268/", "media_type": "text/plain" } }, { "code": "REF", "value": "Birmaher B, Brent D. Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adoles Psychiatry 2007;46(11)1503-1526. http://www.jaacap.com/article/S0890-8567(09)62053-0/pdf", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Birmaher B, Brent D. Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adoles Psychiatry 2007;46(11)1503-1526. http://www.jaacap.com/article/S0890-8567(09)62053-0/pdf", "media_type": "text/plain" } }, { "code": "REF", "value": "Zuckerbrot RA, Cheung A, Jensen PS, et al. Guidelines for adolescent depression in primary care (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management. Pediatrics March 2018, Volume 141 / Issue 3. http://pediatrics.aappublications.org/content/141/3/e20174081", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Zuckerbrot RA, Cheung A, Jensen PS, et al. Guidelines for adolescent depression in primary care (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management. 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Prevalence of major depressive episode among adolescents. 2014. https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adolescents.shtml", "media_type": "text/plain" } }, { "code": "REF", "value": "Shain B. Suicide and suicide attempts in adolescents. Pediatrics 2016;138(1):e1-11. http://pediatrics.aappublications.org/content/138/1/e20161420", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Shain B. Suicide and suicide attempts in adolescents. Pediatrics 2016;138(1):e1-11. http://pediatrics.aappublications.org/content/138/1/e20161420", "media_type": "text/plain" } }, { "code": "REF", "value": "Lewinsohn PM, Rohde P, Klein DN, Seeley JR. Natural course of adolescent major depressive disorder: I. Continuity into young adulthood. J Am Acad Child Adoles Psychiatry 1999;38(1):56-63.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Lewinsohn PM, Rohde P, Klein DN, Seeley JR. Natural course of adolescent major depressive disorder: I. Continuity into young adulthood. J Am Acad Child Adoles Psychiatry 1999;38(1):56-63.", "media_type": "text/plain" } }, { "code": "REF", "value": "Giedd JN, Keshavan M, Paus T. Why do many psychiatric disorders emerge during adolescence? Nat Rev Neurosci 2008;9(12):947-57. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762785/", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Giedd JN, Keshavan M, Paus T. Why do many psychiatric disorders emerge during adolescence? Nat Rev Neurosci 2008;9(12):947-57. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762785/", "media_type": "text/plain" } }, { "code": "REF", "value": "Ramin M, Olfson M, Han B. National trends in the prevalence and treatment of depression in adolescents and young adults. Pediatrics 2016;138(6):e20161878. http://pediatrics.aappublications.org/content/early/2016/11/10/peds.2016-1878", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Ramin M, Olfson M, Han B. National trends in the prevalence and treatment of depression in adolescents and young adults. Pediatrics 2016;138(6):e20161878. http://pediatrics.aappublications.org/content/early/2016/11/10/peds.2016-1878", "media_type": "text/plain" } }, { "code": "REF", "value": "Minnesota Community Measurement. New measures evaluate rates of obesity counseling for kids, depression screening for teens. Oct 2015. http://www.mncm.org/new-measures-evaluate-rates-of-obesity-counseling-for-kids-depression-screening-for-teens/", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Minnesota Community Measurement. New measures evaluate rates of obesity counseling for kids, depression screening for teens. Oct 2015. http://www.mncm.org/new-measures-evaluate-rates-of-obesity-counseling-for-kids-depression-screening-for-teens/", "media_type": "text/plain" } }, { "code": "DEF", "value": "Completed PHQ-9 or PHQ-9M - The patient must answer ALL nine questions for the score to be valid", "name": "Definition", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "DEF", "title": "Definition" }, "value_obj": { "type": "ED", "value": "Completed PHQ-9 or PHQ-9M - The patient must answer ALL nine questions for the score to be valid", "media_type": "text/plain" } }, { "code": "GUIDE", "value": "If a patient has a qualifying diagnosis and encounter in more than one of the 4 month periods within the measurement year, the patient must be counted (denominator and numerator) in each qualifying 4 month period. For example, a patient could be counted in the first and third 4 month periods.", "name": "Guidance", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "GUIDE", "title": "Guidance" }, "value_obj": { "type": "ED", "value": "If a patient has a qualifying diagnosis and encounter in more than one of the 4 month periods within the measurement year, the patient must be counted (denominator and numerator) in each qualifying 4 month period. For example, a patient could be counted in the first and third 4 month periods.", "media_type": "text/plain" } }, { "code": "TRANF", "value": "TBD", "name": "Transmission Format", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "TRANF", "title": "Transmission Format" }, "value_obj": { "type": "ED", "value": "TBD", "media_type": "text/plain" } }, { "code": "IPOP", "value": "Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older with an office visit and the diagnosis of major depression or dysthymia during the four month period", "name": "Initial Population", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "IPOP", "title": "Initial Population" }, "value_obj": { "type": "ED", "value": "Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older with an office visit and the diagnosis of major depression or dysthymia during the four month period", "media_type": "text/plain" } }, { "code": "DENOM", "value": "Equals Initial Population", "name": "Denominator", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "DENOM", "title": "Denominator" }, "value_obj": { "type": "ED", "value": "Equals Initial Population", "media_type": "text/plain" } }, { "code": "DENEX", "value": "1: Patients who died\n2: Patients who received hospice or palliative care services\n3: Patients who were permanent nursing home residents \n4: Patients with a diagnosis of bipolar disorder\n5: Patients with a diagnosis of personality disorder\n6: Patients with a diagnosis of schizophrenia or psychotic disorder\n7: Patients with a diagnosis of pervasive developmental disorder", "name": "Denominator Exclusions", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "DENEX", "title": "Denominator Exclusions" }, "value_obj": { "type": "ED", "value": "1: Patients who died\n2: Patients who received hospice or palliative care services\n3: Patients who were permanent nursing home residents \n4: Patients with a diagnosis of bipolar disorder\n5: Patients with a diagnosis of personality disorder\n6: Patients with a diagnosis of schizophrenia or psychotic disorder\n7: Patients with a diagnosis of pervasive developmental disorder", "media_type": "text/plain" } }, { "code": "NUMER", "value": "Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older who have a PHQ-9 or PHQ-9M tool administered at least once during the four-month period", "name": "Numerator", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "NUMER", "title": "Numerator" }, "value_obj": { "type": "ED", "value": "Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older who have a PHQ-9 or PHQ-9M tool administered at least once during the four-month period", "media_type": "text/plain" } }, { "code": "NUMEX", "value": "Not applicable", "name": "Numerator Exclusions", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "NUMEX", "title": "Numerator Exclusions" }, "value_obj": { "type": "ED", "value": "Not applicable", "media_type": "text/plain" } }, { "code": "DENEXCEP", "value": "None", "name": "Denominator Exceptions", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "DENEXCEP", "title": "Denominator Exceptions" }, "value_obj": { "type": "ED", "value": "None", "media_type": "text/plain" } }, { "code": "SDE", "value": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex", "name": "Supplemental Data Elements", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "SDE", "title": "Supplemental Data Elements" }, "value_obj": { "type": "ED", "value": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex", "media_type": "text/plain" } } ], "measure_id": "40280382-6258-7581-0162-63106F9201B2", "measure_period": { "type": "IVL_TS", "low": { "type": "TS", "value": 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