{ "calculate_sdes": null, "calculation_method": "PATIENT", "cms_id": "CMS160v6", "component": false, "component_hqmf_set_ids": [ ], "composite": false, "composite_hqmf_set_id": null, "cql_libraries": [ { "cql": "library DepressionUtilizationofthePHQ9Tool version '6.1.001'\r\n\r\nusing QDM version '5.3'\r\n\r\ncodesystem \"SNOMEDCT:2016-03\": 'urn:oid:2.16.840.1.113883.6.96' version 'urn:hl7:version:2016-03'\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 \"Face to Face Interaction - No ED\": 'urn:oid:2.16.840.1.113762.1.4.1080.1'\r\nvalueset \"Major Depression Including Remission\": 'urn:oid:2.16.840.113883.3.67.1.101.3.2444'\r\nvalueset \"Office Visit\": 'urn:oid:2.16.840.1.113883.3.464.1003.101.12.1001'\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 \"PHQ-9 Tool\": 'urn:oid:2.16.840.1.113883.3.67.1.101.11.723'\r\nvalueset \"Psych Visit\": 'urn:oid:2.16.840.113883.3.67.1.101.3.2445'\r\nvalueset \"Palliative care encounter\": 'urn:oid:2.16.840.1.113883.3.600.1.1575'\r\n\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 \"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 \"Initial Population 1\":\r\n\tAgeInYearsAt(start of \"Measurement Period\")>= 18\r\n\t\tand ( exists ( \"Depression Office Visit Encounter 1\" )\r\n\t\t\t\tor exists ( \"Depression Behavioral Health Encounter 1\" )\r\n\t\t\t\tor exists ( \"Depression Face to Face Encounter 1\" )\r\n\t\t)\r\n\r\ndefine \"Initial Population 2\":\r\n\tAgeInYearsAt(start of \"Measurement Period\")>= 18\r\n\t\tand ( exists ( \"Depression Office Visit Encounter 2\" )\r\n\t\t\t\tor exists ( \"Depression Behavioral Health Encounter 2\" )\r\n\t\t\t\tor exists ( \"Depression Face to Face Encounter 2\" )\r\n\t\t)\r\n\r\ndefine \"Initial Population 3\":\r\n\tAgeInYearsAt(start of \"Measurement Period\")>= 18\r\n\t\tand ( exists ( \"Depression Office Visit Encounter 3\" )\r\n\t\t\t\tor exists ( \"Depression Behavioral Health Encounter 3\" )\r\n\t\t\t\tor exists ( \"Depression Face to Face Encounter 3\" )\r\n\t\t)\r\n\r\ndefine \"Palliative Care Order\":\r\n\t[\"Intervention, Order\": \"Palliative Care\"] OrderedPalliativeCare\r\n\t\twhere OrderedPalliativeCare.authorDatetime 1 year or less before end of \"Measurement Period\"\r\n\r\ndefine \"Long Term Care\":\r\n\t[\"Encounter, Performed\": \"Care Services in Long-Term Residential Facility\"] EncounterLongTermCare\r\n\t\twhere EncounterLongTermCare.relevantPeriod starts 1 year or less before end of \"Measurement Period\"\r\n\r\ndefine \"Expired\":\r\n\t[\"Patient Characteristic Expired\": \"Dead\"] Deceased\r\n\t\twhere Deceased.expiredDatetime before end of \"Measurement Period\"\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 \"Denominator Exclusion 1\":\r\n\t\"Denominator Exclusions\"\r\n\r\ndefine \"Denominator Exclusion 2\":\r\n\t\"Denominator Exclusions\"\r\n\r\ndefine \"Denominator Exclusion 3\":\r\n\t\"Denominator Exclusions\"\r\n\r\ndefine \"Encounter Palliative Care\":\r\n\t[\"Encounter, Performed\": \"Palliative care encounter\"] PalliativeCareEncounter\r\n\t\twhere PalliativeCareEncounter.relevantPeriod starts 1 year or less before end of \"Measurement Period\"\r\n\r\ndefine \"Depression Behavioral Health Encounter 2\":\r\n\t[\"Encounter, Performed\": \"Psych Visit\"] BehaviorHealthEncounter2\r\n\t\twhere ( BehaviorHealthEncounter2.principalDiagnosis in \"Major Depression Including Remission\"\r\n\t\t\t\tor BehaviorHealthEncounter2.principalDiagnosis in \"Dysthymia\"\r\n\t\t)\r\n\t\t\tand BehaviorHealthEncounter2.relevantPeriod ends 8 months or less after start of \"Measurement Period\"\r\n\t\t\tand difference in months between end of BehaviorHealthEncounter2.relevantPeriod and ( start of \"Measurement Period\" + 8 months ) <= 4\r\n\r\ndefine \"Numerator 2\":\r\n\texists ( [\"Assessment, Performed\": \"PHQ-9 Tool\"] DepressionAssessment2\r\n\t\t\twhere DepressionAssessment2.result is not null\r\n\t\t\t\tand DepressionAssessment2.authorDatetime 8 months or less after start of \"Measurement Period\"\r\n\t\t\t\tand difference in months between DepressionAssessment2.authorDatetime and ( start of \"Measurement Period\" + 8 months ) <= 4\r\n\t)\r\n\r\ndefine \"Depression Behavioral Health Encounter 3\":\r\n\t[\"Encounter, Performed\": \"Psych Visit\"] BehaviorHealthEncounter3\r\n\t\twhere ( BehaviorHealthEncounter3.principalDiagnosis in \"Major Depression Including Remission\"\r\n\t\t\t\tor BehaviorHealthEncounter3.principalDiagnosis in \"Dysthymia\"\r\n\t\t)\r\n\t\t\tand BehaviorHealthEncounter3.relevantPeriod ends during \"Measurement Period\"\r\n\t\t\tand difference in months between start of \"Measurement Period\" and end of BehaviorHealthEncounter3.relevantPeriod <= 3\r\n\r\ndefine \"Depression Behavioral Health Encounter 1\":\r\n\t[\"Encounter, Performed\": \"Psych Visit\"] BehaviorHealthEncounter1\r\n\t\twhere ( BehaviorHealthEncounter1.principalDiagnosis in \"Major Depression Including Remission\"\r\n\t\t\t\tor BehaviorHealthEncounter1.principalDiagnosis in \"Dysthymia\"\r\n\t\t)\r\n\t\t\tand BehaviorHealthEncounter1.relevantPeriod ends during \"Measurement Period\"\r\n\t\t\tand difference in months between end of BehaviorHealthEncounter1.relevantPeriod and end of \"Measurement Period\" <= 3\r\n\r\ndefine \"Depression Diagnoses\":\r\n\t( [\"Diagnosis\": \"Major Depression Including Remission\"]\r\n\t\tunion [\"Diagnosis\": \"Dysthymia\"] ) Diagnoses\r\n\t\twhere Diagnoses.prevalencePeriod is not null\r\n\r\ndefine \"Disorder Diagnoses\":\r\n\t( [\"Diagnosis\": \"Bipolar Disorder\"]\r\n\t\tunion [\"Diagnosis\": \"Personality Disorder\"] ) DisorderDiagnoses\r\n\t\twhere DisorderDiagnoses.prevalencePeriod starts before end of \"Measurement Period\"\r\n\r\ndefine \"Depression Face to Face Encounter 1\":\r\n\t[\"Encounter, Performed\": \"Face to Face Interaction - No ED\"] FacetoFaceEncounter1\r\n\t\twith \"Depression Diagnoses\" Diagnoses\r\n\t\t\tsuch that FacetoFaceEncounter1.relevantPeriod overlaps Diagnoses.prevalencePeriod\r\n\t\t\t\tand FacetoFaceEncounter1.relevantPeriod ends during \"Measurement Period\"\r\n\t\t\t\tand difference in months between end of FacetoFaceEncounter1.relevantPeriod and end of \"Measurement Period\" <= 3\r\n\r\ndefine \"Depression Face to Face Encounter 2\":\r\n\t[\"Encounter, Performed\": \"Face to Face Interaction - No ED\"] FacetoFaceEncounter2\r\n\t\twith \"Depression Diagnoses\" Diagnoses\r\n\t\t\tsuch that FacetoFaceEncounter2.relevantPeriod overlaps Diagnoses.prevalencePeriod\r\n\t\t\t\tand FacetoFaceEncounter2.relevantPeriod ends 8 months or less after start of \"Measurement Period\"\r\n\t\t\t\tand difference in months between end of FacetoFaceEncounter2.relevantPeriod and ( start of \"Measurement Period\" + 8 months ) <= 4\r\n\r\ndefine \"Depression Face to Face Encounter 3\":\r\n\t[\"Encounter, Performed\": \"Face to Face Interaction - No ED\"] FacetoFaceEncounter3\r\n\t\twith \"Depression Diagnoses\" Diagnoses\r\n\t\t\tsuch that FacetoFaceEncounter3.relevantPeriod overlaps Diagnoses.prevalencePeriod\r\n\t\t\t\tand FacetoFaceEncounter3.relevantPeriod ends during \"Measurement Period\"\r\n\t\t\t\tand difference in months between start of \"Measurement Period\" and end of FacetoFaceEncounter3.relevantPeriod <= 3\r\n\r\ndefine \"Depression Office Visit Encounter 1\":\r\n\t[\"Encounter, Performed\": \"Office Visit\"] OfficeVisitEncounter1\r\n\t\twith \"Depression Diagnoses\" Diagnoses\r\n\t\t\tsuch that OfficeVisitEncounter1.relevantPeriod overlaps Diagnoses.prevalencePeriod\r\n\t\t\t\tand OfficeVisitEncounter1.relevantPeriod ends during \"Measurement Period\"\r\n\t\t\t\tand difference in months between end of OfficeVisitEncounter1.relevantPeriod and end of \"Measurement Period\" <= 3\r\n\r\ndefine \"Depression Office Visit Encounter 2\":\r\n\t[\"Encounter, Performed\": \"Office Visit\"] OfficeVisitEncounter2\r\n\t\twith \"Depression Diagnoses\" Diagnoses\r\n\t\t\tsuch that OfficeVisitEncounter2.relevantPeriod overlaps Diagnoses.prevalencePeriod\r\n\t\t\t\tand OfficeVisitEncounter2.relevantPeriod ends 8 months or less after start of \"Measurement Period\"\r\n\t\t\t\tand difference in months between end of OfficeVisitEncounter2.relevantPeriod and ( start of \"Measurement Period\" + 8 months ) <= 4\r\n\r\ndefine \"Depression Office Visit Encounter 3\":\r\n\t[\"Encounter, Performed\": \"Office Visit\"] OfficeVisitEncounter3\r\n\t\twith \"Depression Diagnoses\" Diagnoses\r\n\t\t\tsuch that OfficeVisitEncounter3.relevantPeriod overlaps Diagnoses.prevalencePeriod\r\n\t\t\t\tand OfficeVisitEncounter3.relevantPeriod ends during \"Measurement Period\"\r\n\t\t\t\tand difference in months between start of \"Measurement Period\" and end of OfficeVisitEncounter3.relevantPeriod <= 3\r\n\r\ndefine \"Numerator 1\":\r\n\texists ( [\"Assessment, Performed\": \"PHQ-9 Tool\"] DepressionAssessment1\r\n\t\t\twhere DepressionAssessment1.result is not null\r\n\t\t\t\tand DepressionAssessment1.authorDatetime during \"Measurement Period\"\r\n\t\t\t\tand difference in months between DepressionAssessment1.authorDatetime and end of \"Measurement Period\" <= 3\r\n\t)\r\n\r\ndefine \"Denominator Exclusions\":\r\n\texists ( \"Palliative Care Order\" )\r\n\t\tor exists ( \"Encounter Palliative Care\" )\r\n\t\tor exists ( \"Long Term Care\" )\r\n\t\tor exists ( \"Expired\" )\r\n\t\tor exists ( \"Disorder Diagnoses\" )\r\n\r\ndefine \"Numerator 3\":\r\n\texists ( [\"Assessment, Performed\": \"PHQ-9 Tool\"] DepressionAssessment3\r\n\t\t\twhere DepressionAssessment3.result is not null\r\n\t\t\t\tand DepressionAssessment3.authorDatetime during \"Measurement Period\"\r\n\t\t\t\tand difference in months between start of \"Measurement Period\" and DepressionAssessment3.authorDatetime <= 3\r\n\t)\r\n", "elm": { "library": { "identifier": { "id": "DepressionUtilizationofthePHQ9Tool", "version": "6.1.001" }, "schemaIdentifier": { "id": "urn:hl7-org:elm", "version": "r1" }, "usings": { "def": [ { "localIdentifier": "System", "uri": "urn:hl7-org:elm-types:r1" }, { "localId": "1", "locator": "3:1-3:23", "localIdentifier": "QDM", "uri": "urn:healthit-gov:qdm:v5_3", "version": "5.3" } ] }, "parameters": { "def": [ { "localId": "22", "locator": "25:1-25:49", "name": "Measurement Period", "accessLevel": "Public", "parameterTypeSpecifier": { "localId": "21", "locator": "25:32-25:49", "type": "IntervalTypeSpecifier", "pointType": { "localId": "20", "locator": "25:41-25:48", "name": "{urn:hl7-org:elm-types:r1}DateTime", "type": "NamedTypeSpecifier" } } } ] }, "codeSystems": { "def": [ { "localId": "2", "locator": "5:1-5:97", "name": "SNOMEDCT:2016-03", "id": "2.16.840.1.113883.6.96", "version": "urn:hl7:version:2016-03", "accessLevel": "Public" } ] }, "valueSets": { "def": [ { "localId": "3", "locator": "7:1-7:68", "name": "ONC Administrative Sex", "id": "2.16.840.1.113762.1.4.1", "accessLevel": "Public" }, { "localId": "4", "locator": "8:1-8:53", "name": "Race", "id": "2.16.840.1.114222.4.11.836", "accessLevel": "Public" }, { "localId": "5", "locator": "9:1-9:58", "name": "Ethnicity", "id": "2.16.840.1.114222.4.11.837", "accessLevel": "Public" }, { "localId": "6", "locator": "10:1-10:55", "name": "Payer", "id": "2.16.840.1.114222.4.11.3591", "accessLevel": "Public" }, { "localId": "7", "locator": "11:1-11:73", "name": "Bipolar Disorder", "id": "2.16.840.1.113883.3.67.1.101.1.128", "accessLevel": "Public" }, { "localId": "8", "locator": "12:1-12:110", "name": "Care Services in Long-Term Residential Facility", "id": "2.16.840.1.113883.3.464.1003.101.12.1014", "accessLevel": "Public" }, { "localId": "9", "locator": "13:1-13:66", "name": "Dysthymia", "id": "2.16.840.1.113883.3.67.1.101.1.254", "accessLevel": "Public" }, { "localId": "10", "locator": "14:1-14:83", "name": "Face to Face Interaction - No ED", "id": "2.16.840.1.113762.1.4.1080.1", "accessLevel": "Public" }, { "localId": "11", "locator": "15:1-15:92", "name": "Major Depression Including Remission", "id": "2.16.840.113883.3.67.1.101.3.2444", "accessLevel": "Public" }, { "localId": "12", "locator": "16:1-16:75", "name": "Office Visit", "id": "2.16.840.1.113883.3.464.1003.101.12.1001", "accessLevel": "Public" }, { "localId": "13", "locator": "17:1-17:68", "name": "Palliative Care", "id": "2.16.840.1.113883.3.600.1.1579", "accessLevel": "Public" }, { "localId": "14", "locator": "18:1-18:77", "name": "Personality Disorder", "id": "2.16.840.1.113883.3.67.1.101.1.246", "accessLevel": "Public" }, { "localId": "15", "locator": "19:1-19:68", "name": "PHQ-9 Tool", "id": "2.16.840.1.113883.3.67.1.101.11.723", "accessLevel": "Public" }, { "localId": "16", "locator": "20:1-20:67", "name": "Psych Visit", "id": "2.16.840.113883.3.67.1.101.3.2445", "accessLevel": "Public" }, { "localId": "17", "locator": "21:1-21:78", "name": "Palliative care encounter", "id": "2.16.840.1.113883.3.600.1.1575", "accessLevel": "Public" } ] }, "codes": { "def": [ { "localId": "19", "locator": "23:1-23:63", "name": "Dead", "id": "419099009", "display": "Dead", "accessLevel": "Public", "codeSystem": { "localId": "18", "locator": "23:31-23:48", "name": "SNOMEDCT:2016-03" } } ] }, "statements": { "def": [ { "locator": "27:1-27:15", "name": "Patient", "context": "Patient", "expression": { "type": "SingletonFrom", "operand": { "locator": "27:1-27:15", "dataType": "{urn:healthit-gov:qdm:v5_3}Patient", "templateId": "Patient", "type": "Retrieve" } } }, { "localId": "24", "locator": "29:1-30:50", "name": "SDE Ethnicity", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "24", "s": [ { "value": [ "define ", "\"SDE Ethnicity\"", ":\n\t" ] }, { "r": "23", "s": [ { "value": [ "[", "\"Patient Characteristic Ethnicity\"", ": " ] }, { "s": [ { "value": [ "\"Ethnicity\"" ] } ] }, { "value": [ "]" ] } ] } ] } } ], "expression": { "localId": "23", "locator": "30:2-30:50", "dataType": "{urn:healthit-gov:qdm:v5_3}PatientCharacteristicEthnicity", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Ethnicity", "type": "ValueSetRef" } } }, { "localId": "26", "locator": "32:1-33:42", "name": "SDE Payer", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "26", "s": [ { "value": [ "define ", "\"SDE Payer\"", ":\n\t" ] }, { "r": "25", "s": [ { "value": [ "[", "\"Patient Characteristic Payer\"", ": " ] }, { "s": [ { "value": [ "\"Payer\"" ] } ] }, { "value": [ "]" ] } ] } ] } } ], "expression": { "localId": "25", "locator": "33:2-33:42", "dataType": "{urn:healthit-gov:qdm:v5_3}PatientCharacteristicPayer", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Payer", "type": "ValueSetRef" } } }, { "localId": "28", "locator": "35:1-36:40", "name": "SDE Race", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "28", "s": [ { "value": [ "define ", "\"SDE Race\"", ":\n\t" ] }, { "r": "27", "s": [ { "value": [ "[", "\"Patient Characteristic Race\"", ": " ] }, { "s": [ { "value": [ "\"Race\"" ] } ] }, { "value": [ "]" ] } ] } ] } } ], "expression": { "localId": "27", "locator": "36:2-36:40", "dataType": "{urn:healthit-gov:qdm:v5_3}PatientCharacteristicRace", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Race", "type": "ValueSetRef" } } }, { "localId": "30", "locator": "38:1-39:57", "name": "SDE Sex", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "30", "s": [ { "value": [ "define ", "\"SDE Sex\"", ":\n\t" ] }, { "r": "29", "s": [ { "value": [ "[", "\"Patient Characteristic Sex\"", ": " ] }, { "s": [ { "value": [ "\"ONC Administrative Sex\"" ] } ] }, { "value": [ "]" ] } ] } ] } } ], "expression": { "localId": "29", "locator": "39:2-39:57", "dataType": "{urn:healthit-gov:qdm:v5_3}PatientCharacteristicSex", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "ONC Administrative Sex", "type": "ValueSetRef" } } }, { "localId": "46", "locator": "124:1-127:46", "name": "Depression Diagnoses", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "46", "s": [ { "value": [ "define ", "\"Depression Diagnoses\"", ":\n\t" ] }, { "r": "45", "s": [ { "s": [ { "r": "41", "s": [ { "r": "40", "s": [ { "value": [ "( " ] }, { "r": "40", "s": [ { "r": "38", "s": [ { "value": [ "[", "\"Diagnosis\"", ": " ] }, { "s": [ { "value": [ "\"Major Depression Including Remission\"" ] } ] }, { "value": [ "]" ] } ] }, { "value": [ "\n\t\tunion " ] }, { "r": "39", "s": [ { "value": [ "[", "\"Diagnosis\"", ": " ] }, { "s": [ { "value": [ "\"Dysthymia\"" ] } ] }, { "value": [ "]" ] } ] } ] }, { "value": [ " )" ] } ] }, { "value": [ " ", "Diagnoses" ] } ] } ] }, { "value": [ "\n\t\t" ] }, { "r": "44", "s": [ { "value": [ "where " ] }, { "r": "44", "s": [ { "r": "43", "s": [ { "r": "42", "s": [ { "value": [ "Diagnoses" ] } ] }, { "value": [ "." ] }, { "r": "43", "s": [ { "value": [ "prevalencePeriod" ] } ] } ] }, { "value": [ " is not null" ] } ] } ] } ] } ] } } ], "expression": { "localId": "45", "locator": "125:2-127:46", "type": "Query", "source": [ { "localId": "41", "locator": "125:2-126:46", "alias": "Diagnoses", "expression": { "localId": "40", "locator": "125:2-126:36", "type": "Union", "operand": [ { "localId": "38", "locator": "125:4-125:56", "dataType": "{urn:healthit-gov:qdm:v5_3}Diagnosis", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Major Depression Including Remission", "type": "ValueSetRef" } }, { "localId": "39", "locator": "126:9-126:34", "dataType": "{urn:healthit-gov:qdm:v5_3}Diagnosis", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Dysthymia", "type": "ValueSetRef" } } ] } } ], "relationship": [ ], "where": { "localId": "44", 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"statement_references": [ { "hqmf_id": null, "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Initial Population 3" } ] }, { "statement_name": "Encounter Palliative Care" }, { "statement_name": "Disorder Diagnoses" }, { "statement_name": "Denominator Exclusions", "statement_references": [ { "hqmf_id": null, "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Palliative Care Order" }, { "hqmf_id": null, "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Encounter Palliative Care" }, { "hqmf_id": null, "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Long Term Care" }, { "hqmf_id": null, "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Expired" }, { "hqmf_id": null, "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Disorder Diagnoses" } ] }, { "statement_name": "Denominator Exclusion 1", "statement_references": [ { "hqmf_id": null, "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Denominator Exclusions" } ] }, { "statement_name": "Denominator Exclusion 2", "statement_references": [ { "hqmf_id": null, "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Denominator Exclusions" } ] }, { "statement_name": "Denominator Exclusion 3", "statement_references": [ { "hqmf_id": null, "library_name": "DepressionUtilizationofthePHQ9Tool", "statement_name": "Denominator Exclusions" } ] }, { "statement_name": "Numerator 2" }, { "statement_name": "Numerator 1" }, { "statement_name": "Numerator 3" } ] } ], "created_at": null, "description": "The percentage of patients age 18 and older with the diagnosis of major depression or dysthymia who have a completed PHQ-9 during each applicable 4 month period in which there was a qualifying visit", "hqmf_id": "40280382-5FA6-FE85-015F-B5B5982402D6", "hqmf_set_id": "A4B9763C-847E-4E02-BB7E-ACC596E90E2C", "hqmf_version_number": "0", "main_cql_library": "DepressionUtilizationofthePHQ9Tool", "measure_attributes": [ { "code": "OTH", "value": "160", "name": "eCQM Identifier (Measure Authoring Tool)", "code_obj": { "type": "CD", "null_flavor": "OTH", "original_text": "eCQM Identifier (Measure Authoring Tool)" }, "value_obj": { "type": "ED", "value": "160", "media_type": "text/plain" } }, { "code": "OTH", "value": "0712", "name": "NQF Number", "code_obj": { "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, 2017. 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, 2017. 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": "None", "name": "Stratification", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "STRAT", "title": "Stratification" }, "value_obj": { "type": "ED", "value": "None", "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": "Depression 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\nPlease note that this process measure for administration of the PHQ-9 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 < 5) and depression response (PHQ-9 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": "Depression 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\nPlease note that this process measure for administration of the PHQ-9 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 < 5) and depression response (PHQ-9 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": "Source: 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).", "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": "Source: 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).", "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/_asset/fnhdm3/Depr.pdf", "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/_asset/fnhdm3/Depr.pdf", "media_type": "text/plain" } }, { "code": "REF", "value": "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": "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": "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": "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": "DEF", "value": "Completed PHQ-9 - 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 - 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. 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