Anti-depressant Medication Management

Last updated: May 4, 2017

CMS Measure ID: CMS128v4
Version: 4
NQF Number: 0105
Measure Description:

Percentage of patients 18 years of age and older who were diagnosed with major depression and treated with antidepressant medication, and who remained on antidepressant medication treatment. Two rates are reported.

a. Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks).

b. Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months).

Initial Patient Population:

Patients 18 years of age and older with a diagnosis of major depression in the time within 270 days (9 months) prior to the measurement period through the first 90 days (3 months) of the measurement period, who were treated with antidepressant medication, and with a visit during the measurement period

Denominator Statement:

Equals Initial Population

Denominator Exclusions:

Patients who were actively on an antidepressant medication in the 90 days prior to the Index Prescription Start Date

Numerator Statement:

Numerator 1: Patients who have received antidepressant medication for at least 84 days (12 weeks) of continuous treatment during the 114-day period following the Index Prescription Start Date

Numerator 2: Patients who have received antidepressant medications for at least 180 days (6 months) of continuous treatment during the 231-day period following the Index Prescription Start Date

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: National Committee for Quality Assurance
Domain: Effective Clinical Care
Next Version: Anti-depressant Medication Management
Previous Version: Anti-depressant Medication Management
Measure Score: Proportion
Improvement Notation:

Higher score indicates better quality.

Guidance:

To identify new treatment episodes for major depression, there must be a 90-day negative medication history (a period during which the patient was not taking antidepressant medication) prior to the first dispensing event associated with the Index Episode Start Date (Index Prescription Start Date).

CUMULATIVE MEDICATION DURATION is an individual's total number of medication days over a specific period; the period counts multiple prescriptions with gaps in between, but does not count the gaps during which a medication was not dispensed.

To determine the cumulative medication duration, determine first the number of the Medication Days for each prescription in the period: the number of doses divided by the dose frequency per day. Then add the Medication Days for each prescription without counting any days between the prescriptions.

For example, there is an original prescription for 30 days with 2 refills for thirty days each. After a gap of 3 months, the medication was prescribed again for 60 days with 1 refill for 60 days. The cumulative medication duration is (30 x 3) + (60 x 2) = 210 days over the 10 month period.

Specifications

Release Notes

Header

  • eMeasure version number incremented.
  • Copyright updated.
  • Disclaimer updated.
  • Added the concurrent operator to the initial population to capture patients whose diagnosis starts at the same time as the measurement period.
  • eMeasure version number incremented from 4.0.000 to 4.1.000.

Logic

  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.
  • Introduced variables $InitialMajDepressionDiagnosis and $InitialDepMedication to allow re-use of logical expressions and reduce redundancy/complexity.
  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Replaced 'ORs' with 'Union of' operator.
  • Introduced logic to capture Sum >= 84 day(s) of: 'Medication, Active: Antidepressant Medication' to with attribute cumulative medication duration to calculate cumulative medication duration.
  • The top level logical operator for the Numerator Exclusions, Denominator Exclusions, Denominator Exceptions, and Measure Population Exclusions defaults to 'OR'.

Value Sets

  • Value set Major Depression (OID 2.16.840.1.113883.3.464.1003.105.12.1007): Added 2 ICD9CM codes (298.0, 311).

XML

  • This measure contains multiple Population Criteria sections. The earlier version of this measure contained mismatches between the applicable Population Criteria human readable narrative sections and their associated computer-readable sections in the XML file. This issue has been corrected.

External Resources