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

Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented from the date of the screening to two days after the date of the qualifying encounter or an active depression medication or active depression management intervention was active or prescribed at any time on the date of qualifying encounter

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Depression affects more than two hundred sixty million people across the world and is a leading cause of disability, with a variety of depressive disorders that are independent risk factors for chronic diseases, such as cardiovascular disease and diabetes, lending screening for depression as paramount to identify depressive disorders that can affect the most vulnerable populations (Costantini et al., 2021). Results from a 2018 U.S. survey indicated that 14.4 percent of adolescents (3.5 million adolescents) had a major depressive episode (MDE) in the past year, with nine percent of adolescents (2.4 million adolescents) having one MDE with severe impairment (Substance Abuse and Mental Health Services Administration [SAMHSA], 2019). The odds of a diagnosis of depression are believed to be 2.6 times greater for children and adolescents exposed to trauma as compared to those unexposed or less exposed (Vibhakar et al., 2019). Children and teens with major depressive disorder (MDD) have been found to have difficulty carrying out their daily activities, relating to others, growing up healthy, and are at an increased risk of suicide (Siu, on behalf of the U.S. Preventive Services Task Force [USPSTF], 2016).
The same 2018 study indicated that 7.2 percent of adults aged 18 or older (17.7 million adults) had at least one MDE with 4.7 percent of adults (11.5 million adults) having one MDE with severe impairment in the past year (SAMHSA, 2019). Moreover, it is estimated 22.9 percent of adult patients with chronic pain (2.2 million adults) were diagnosed with comorbid depression from 2011 to 2015, with an upward trend of prevalence among Black Americans, patients aged 65 to 84 years old, Medicare and Medicaid insured patients, and patients from zip code areas with low annual household incomes (Orhurhu et al., 2019).
Depression and other mood disorders, such as bipolar disorder and anxiety disorders, especially during the perinatal period, can have devastating effects on women, infants, and families (American College of Obstetricians and Gynecologists [ACOG], 2018). It's estimated that the global prevalence of antenatal (or perinatal) depression ranges from 15 to 65 percent, with current or previous exposure to abuse and violence, lack of social support, and family history of mental disorders being risk factors. Depressive symptoms measured during pregnancy have been shown to influence the quality of the postpartum mother-infant relationship (Hazell Raine et al., 2020). Additionally, the risk of low birth weight and preterm birth is higher among infants born from depressed mothers (Dadi et al., 2020).
Negative outcomes associated with depression make it crucial to screen in order to identify and treat depression in its early stages. Multiple social costs of depression have been identified, such as reduced educational achievements, poor financial success and role performance, higher amount of days out of role, and increased risk of job loss (Costantini et al., 2021). Depression also imposes significant economic burden through direct and indirect costs, supporting the need for regular depression screening. "In the United States, an estimated $22.8 billion was spent on depression treatment in 2009, and lost productivity cost an additional estimated $23 billion in 2011" (Siu & USPSTF, 2016, p. 383-384).
Numerous studies have found significant disparities in depression prevalence and treatment among racial/ethnic minorities. One study revealed that Indigenous adults are at a high risk for posttraumatic stress disorder, depression, suicide, substance use disorder, and concurrent behavioral health disorders secondary to these initial health problems (Ka’apu & Burnette, 2019). Additionally, though rates of depression are lower among Blacks and Hispanics than among whites, depression among Blacks and Hispanics is likely to be more recurrent. Furthermore, 48 percent of whites receive mental health services, compared to just 31 percent of Blacks and Hispanics, and 22 percent of Asians (American Psychiatric Association, 2017). Asian Americans and Black Americans are also significantly more likely to utilize emergency rooms for depression treatment, which contributes to inconsistent follow-up care (Lee et al., 2014).
While primary care providers (PCPs) serve as the first line of defense in the detection of depression, studies show that PCPs fail to recognize up to 46 percent of depressed patients (Borner et al., 2010). "In nationally representative U.S. surveys, about eight percent of adolescents reported having major depression in the past year. Only 36 percent to 44 percent of children and adolescents with depression receive treatment, suggesting that a majority of depressed youth are undiagnosed and untreated" (Siu, on behalf of USPSTF, 2016). Furthermore, evidence supports that screening for depression in pregnant and postpartum women is of moderate net benefit, and treatment options for positive depression screening should be available for patients twelve and older including pregnant and postpartum women.
This measure seeks to align with USPSTF clinical guideline recommendations as well as the Healthy People 2030 recommendation to increase the proportion of adolescents and adults who are screened for depression and if positive, receive appropriate treatment (U.S. Preventive Services Task Force, 2023; U.S. Department of Health and Human Services, 2020).
For patients experiencing depression, rescreening has been shown to be an effective tool for measuring response to therapy, therefore influencing appropriate care adjustments in the treatment of depression (Anderson et al., 2002). Chen et al. (2006) noted that when patients were re-administered a screening tool after at least eight weeks after starting treatment, their "score gave primary care physicians a clear idea about the nature of patients' depressive symptoms and gave both the patient and the physician an indication of treatment progress."

Adolescent Recommendation (12-18 years):
In 2022, the USPSTF issued a recommendation that adolescents aged 12 to 18 years of age be screened for major depressive disorder (MDD) (B recommendation), and that there is “insufficient evidence to assess the balance of benefits and harms of screening for MDD in children 11 years or younger" (U.S. Preventive Services Task Force [USPSTF], 2022). The USPSTF recommendation notes that treatment options for adolescents with MDD may include pharmacotherapy, psychotherapy, collaborative care, psychosocial support interventions, and complementary and alternative medicine approaches (USPSTF, 2022).
In 2018, the American Academy of Pediatrics (AAP) issued an updated clinical practice guideline stating that “adolescent patients aged 12 years and older should be screened annually for depression (MDD or depressive disorders) with a formal self-report screening tool either on paper or electronically (universal screening).” In particular, patients with greater risk factors (e.g., a history of previous depressive episodes, a family history, other psychiatric disorders, substance use, trauma, psychosocial adversity, frequent somatic complaints, previous high-scoring screens without a depression diagnosis, etc.) should be identified for targeted screening, and monitored over time by using a formal depression instrument or tool (Zuckerbrot et al., 2018).
Patients who screen positive on a formal screening tool, who present with any emotional problem as the chief complaint, and/or in whom depression is highly suspected despite a negative screen result should be evaluated by a primary care clinician for depression based on: diagnostic criteria established in the DSM-5 or the International Classification of Diseases, 10th Revision (ICD-10-CM). The assessment should include an interview with the adolescent when they are alone, as well as direct interviews with the adolescent’s family and/or caregivers and “should include the assessment of functional impairment in different domains and other existing psychiatric conditions.” Upon diagnosis, the AAP recommends that “clinicians should educate and counsel families and patients about depression and options for the management of the disorder. Clinicians should also discuss the limits of confidentiality with the adolescent and family.” Primary care clinicians should work with the patient and family to develop a treatment plan and “set specific treatment goals in key areas of functioning, including home, peer, and school settings.” The AAP also recommends that “all management should include the establishment of a safety plan, which includes restricting lethal means, engaging a concerned third party, and developing an emergency communication mechanism should the patient deteriorate, become actively suicidal or dangerous to others, or experience an acute crisis associated with psychosocial stressors, especially during the period of initial treatment, when safety concerns are the highest. The establishment and development of a safety plan within the home environment is another important management step" (Zuckerbrot et al., 2018).
Adult Recommendation (18 years and older):
In 2023, the USPSTF issued a recommendation statement that adults should be screened for depression (B recommendation). The statement does not specify a recommended frequency (USPSTF, 2023). “This recommendation applies to adults 19 years or older who do not have a diagnosed mental health disorder or recognizable signs or symptoms of depression or suicide risk.” The USPSTF recommends screening for depression in all adults regardless of risk factors. Commonly used depression screening instruments, according to USPSTF, “include the Patient Health Questionnaire (PHQ) in various forms in adults, the Center for Epidemiologic Studies Depression Scale (CES-D), the Geriatric Depression Scale (GDS) in older adults, and the Edinburgh Postnatal Depression Scale (EPDS) in postpartum and pregnant persons.” The USPSTF found little evidence regarding the optimal timing for screening for depression; a pragmatic approach might include screening adults who have not been screened previously and using clinical judgment while considering risk factors, comorbid conditions, and life events to determine if additional screening of patients at increased risk is warranted. The USPSTF recommendation states that effective treatment generally includes antidepressant medications and/or psychotherapy (USPSTF, 2023).
In 2022, the Department of Veterans Affairs, Department of Defense (VA/DoD) released an updated guideline for the screening and management of MDD. The VA recommends that “all patients not currently receiving treatment for depression be screened for depression” (Department of Veterans Affairs & Department of Defense, 2022). According to the VA/DoD guidelines, a diagnosis of MDD should include a quantitative measurement for depression severity at the initial treatment planning stage and should continue to be measured throughout treatment progress measured at regular intervals and used to guide shared decision making. They also recommend that collaborative/integrated care models be used for patients who are being treated for MDD in a primary care setting (Department of Veterans Affairs & Department of Defense, 2022).
VA/DoD guidelines state that patients diagnosed with MDD should be treated with either psychotherapy (individual or group format) or pharmacotherapy, based on patient preference. Patients aged 65 or greater with mild to moderate MDD should be offered first-line psychotherapy. Patients with severe or persistent MDD (greater than 2 years, or depression that has a partial or limited response to treatment) should be offered a combination of pharmacotherapy and evidence-based psychotherapy. For patients with mild to moderate MDD who decline pharmacotherapy and who decline or cannot access evidence-based psychotherapy, VA/DoD guidelines recommend considering non-directive supportive therapy. Computer-guided or internet-based cognitive behavioral therapy (CBT) can be offered to patients with mild to moderate MDD as a first-line treatment or adjunct to pharmacotherapy. Psychotherapy options that should be offered include acceptance and commitment therapy, behavioral therapy/behavioral activation, CBT, interpersonal therapy, mindfulness-based cognitive therapy, problem-solving therapy, or short-term psychodynamic psychotherapy. Patients with mild to moderate MDD and significant relationship distress should be offered couples-focused therapy. When choosing an initial pharmacotherapy, or for patients who have previously responded well to pharmacotherapy, the following medications should be considered: selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), bupropion, mirtazapine, trazodone, vilazodone, or vortioxetine (Department of Veterans Affairs & Department of Defense, 2022).
Pregnant and Postpartum Patients:
A 2023 clinical practice guideline from the American College of Obstetricians and Gynecologists (ACOG) recommends that “everyone receiving well-woman, prepregnancy, prenatal, and postpartum care be screened for depression and anxiety using standardized, validated instruments” (ACOG, 2023a). The guideline recommends use of psychotherapy as first-line treatment (regardless of symptom severity) but that pharmacotherapy concomitant with psychotherapy is indicated for patients with moderate and severe symptoms (ACOG 2023a; ACOG 2023b). ACOG also states that “mental health screening be implemented with systems in place to ensure timely access to assessment and diagnosis, effective treatment, and appropriate monitoring and follow-up based on severity" (ACOG 2023a; ACOG 2023b).
In 2023, the USPSTF issued a recommendation statement that adults, including pregnant and postpartum persons, should be screened for depression (USPSTF, 2023). A 2019 USPSTF guideline recommends that "clinicians provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions (B recommendation)”.

Higher score indicates better quality

Reference Type: Citation

Reference Text: 
American College of Obstetricians and Gynecologists, Committee on Obstetric Practice. (2018). Screening for perinatal depression (Committee Opinion No. 757). Obstetrics & Gynecology, 132(5), e208–e212. https://doi.org/10.1097/AOG.0000000000002927

Reference Type: Citation

Reference Text: 
American College of Obstetricians and Gynecologists. (2023a). Screening and diagnosis of mental health conditions during pregnancy and postpartum (Clinical Practice Guideline No. 4). Obstetrics & Gynecology, 141(6), 1232–1261. https://doi.org/10.1097/AOG.0000000000005200

Reference Type: Citation

Reference Text: 
American College of Obstetricians and Gynecologists. (2023b). Treatment and management of mental health conditions during pregnancy and postpartum (Clinical Practice Guideline No. 5). Obstetrics & Gynecology, 141(6), 1262–1288. https://doi.org/10.1097/AOG.0000000000005202

Reference Type: Citation

Reference Text: 
American Psychiatric Association. (2017). Mental health disparities: Diverse populations. https://www.psychiatry.org/psychiatrists/diversity/education/mental-health-facts

Reference Type: Citation

Reference Text: 
Anderson, J. E., Michalak, E. E., & Lam, R. W. (2002). Depression in primary care: Tools for screening, diagnosis, and measuring response to treatment. British Columbia Medical Journal, 44(8), 415–419. https://bcmj.org/articles/depression-primary-care-tools-screening-diagnosis-and-measuring-response-treatment

Reference Type: Citation

Reference Text: 
Borner, I., Braunstein, J. W., St. Victor, R., & Pollack, J. (2010). Evaluation of a 2-question screening tool for detecting depression in adolescents in primary care. Clinical Pediatrics, 49(10), 947–955. https://doi.org/10.1177/0009922810370203

Reference Type: Citation

Reference Text: 
Chen, T. M., Huang, F. Y., Chang, C., & Chung, H. (2006). Using the PHQ-9 for depression screening and treatment monitoring for Chinese Americans in primary care. Psychiatric Services, 57(7), 976–981. https://doi.org/10.1176/ps.2006.57.7.976

Reference Type: Citation

Reference Text: 
Costantini, L., Costanza, A., Odone, A., Aguglia, A., Escelsior, A., Serafini, G., Amore, M., & Amerio, A. (2021). A breakthrough in research on depression screening: From validation to efficacy studies. Acta Bio-Medica: Atenei Parmensis, 92(3), e2021215. https://doi.org/10.23750/abm.v92i3.11574

Reference Type: Citation

Reference Text: 
Dadi, A. F., Miller, E. R., Bisetegn, T. A., & Mwanri, L. (2020). Global burden of antenatal depression and its association with adverse birth outcomes: An umbrella review. BMC Public Health, 20(1), 173. https://doi.org/10.1186/s12889-020-8293-9

Reference Type: Citation

Reference Text: 
Department of Veterans Affairs & Department of Defense. (2022). VA/DoD clinical practice guideline for the management of major depressive disorder. https://www.healthquality.va.gov/guidelines/MH/mdd/VADODMDDCPGFinal508.pdf

Reference Type: Citation

Reference Text: 
Hazell Raine, K., Nath, S., Howard, L. M., Cockshaw, W., Boyce, P., Sawyer, E., & Thorpe, K. (2020). Associations between prenatal maternal mental health indices and mother-infant relationship quality 6 to 18 months postpartum: A systematic review. Infant Mental Health Journal, 41(1), 24–39. https://doi.org/10.1002/imhj.21825

Reference Type: Citation

Reference Text: 
Ka'apu, K., & Burnette, C. E. (2019). A culturally informed systematic review of mental health disparities among adult Indigenous men and women of the USA: What is known? British Journal of Social Work, 49(4), 880–898. https://doi.org/10.1093/bjsw/bcz009

Reference Type: Citation

Reference Text: 
Lee, S. Y., Xue, Q. L., Spira, A. P., & Lee, H. B. (2014). Racial and ethnic differences in depressive subtypes and access to mental health care in the United States. Journal of Affective Disorders, 155, 130–137. https://doi.org/10.1016/j.jad.2013.10.037

Reference Type: Citation

Reference Text: 
Orhurhu, V., Olusunmade, M., Akinola, Y., Urits, I., Orhurhu, M. S., Viswanath, O., Kaye, A. D., Simopoulos, T., & Gill, J. S. (2019). Depression trends in patients with chronic pain: An analysis of the Nationwide Inpatient Sample. Pain Physician, 22(5), E487–E494.

Reference Type: Citation

Reference Text: 
Siu, A. L. & U.S. Preventive Services Task Force. (2016). Screening for depression in adults: U.S. Preventive Services Task Force recommendation statement. JAMA, 315(4), 380–387. https://doi.org/10.1001/jama.2015.18392

Reference Type: Citation

Reference Text: 
Siu, A. L., on behalf of the U.S. Preventive Services Task Force. (2016). Screening for depression in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 164(5), 360–366. https://doi.org/10.7326/M15-2957

Reference Type: Citation

Reference Text: 
Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068). https://www.samhsa.gov/data/report/2018-nsduh-annual-national-report

Reference Type: Citation

Reference Text: 
U.S. Department of Health and Human Services. (2020). Healthy People 2030: Depression in adults: Screening. https://odphp.health.gov/healthypeople/tools-action/browse-evidence-based-resources/depression-adults-screening

Reference Type: Citation

Reference Text: 
U.S. Preventive Services Task Force. (2019). Interventions to prevent perinatal depression: U.S. Preventive Services Task Force recommendation statement. JAMA, 321(6), 580–587. https://doi.org/10.1001/jama.2019.0007

Reference Type: Citation

Reference Text: 
U.S. Preventive Services Task Force. (2022). Screening for depression and suicide risk in children and adolescents: U.S. Preventive Services Task Force recommendation statement. JAMA, 328(15), 1534–1542. https://doi.org/10.1001/jama.2022.16946

Reference Type: Citation

Reference Text: 
U.S. Preventive Services Task Force. (2023). Screening for depression and suicide risk in adults: U.S. Preventive Services Task Force recommendation statement. JAMA, 329(23), 2057–2067. https://doi.org/10.1001/jama.2023.9297

Reference Type: Citation

Reference Text: 
Vibhakar, V., Allen, L. R., Gee, B., & Meiser-Stedman, R. (2019). A systematic review and meta-analysis on the prevalence of depression in children and adolescents after exposure to trauma. Journal of Affective Disorders, 255, 77–89. https://doi.org/10.1016/j.jad.2019.05.005

Reference Type: Citation

Reference Text: 
Zuckerbrot, R. A., Cheung, A., Jensen, P. S., Stein, R. E. K., Laraque, D., & GLAD-PC Steering Group. (2018). Guidelines for adolescent depression in primary care (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management. Pediatrics, 141(3), e20174081. https://doi.org/10.1542/peds.2017-4081

Screening: Completion of a clinical or diagnostic tool used to identify people at risk of developing or having a certain disease or condition, even in the absence of symptoms.
Standardized Depression Screening Tool: A normalized and validated depression screening tool developed for the patient population in which it is being utilized. Examples of standardized depression screening tools include but are not limited to:

 

  
Adolescent Screening Tools (12-17 years)
  

   

    
Patient Health Questionnaire for Adolescents (PHQ-A)
   
   

    
Beck Depression Inventory-Primary Care Version (BDI-PC)
   
   

    
Mood Feeling Questionnaire (MFQ)
   
   

    
Center for Epidemiologic Studies Depression Scale (CES-D)
   
   

    
Patient Health Questionnaire (PHQ-9)
   
   

    
Pediatric Symptom Checklist (PSC-17)
   
   

    
Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD PHQ-2)
   
  
 
 

  
Adult Screening Tools (18 years and older)
  

   

    
Patient Health Questionnaire (PHQ-9)
   
   

    
Beck Depression Inventory (BDI or BDI-II)
   
   

    
Center for Epidemiologic Studies Depression Scale (CES-D)
   
   

    
Depression Scale (DEPS)
   
   

    
Duke Anxiety-Depression Scale (DADS)
   
   

    
Geriatric Depression Scale (GDS)
   
   

    
Cornell Scale for Depression in Dementia (CSDD)
   
   

    
PRIME MD-PHQ-2
   
   

    
Hamilton Rating Scale for Depression (HAM-D)
   
   

    
Quick Inventory of Depressive Symptomatology Self-Report (QID-SR)
   
   

    
Computerized Adaptive Testing Depression Inventory (CAT-DI)
   
   

    
Computerized Adaptive Diagnostic Screener (CAD-MDD)
   
  
 
 

  
Perinatal Screening Tools
  

   

    
Edinburgh Postnatal Depression Scale
   
   

    
Postpartum Depression Screening Scale
   
   

    
Patient Health Questionnaire 9 (PHQ-9)
   
   

    
Beck Depression Inventory
   
   

    
Beck Depression Inventory-II
   
   

    
Center for Epidemiologic Studies Depression Scale
   
   

    
Zung Self-rating Depression Scale
   
  
 

Follow-Up Plan: Documented follow-up for a positive depression screening must include one or more of the following:

 

  
Referral to a provider for additional evaluation and assessment to formulate a follow-up plan for a positive depression screen
 
 

  
Pharmacological interventions (prescribed or active depression medication)
 
 

  
Other interventions or follow-up for the diagnosis or treatment of depression
 

Active Depression Medication or Active Depression Management Intervention

 

  
Documentation that patient is actively receiving interventions designed to treat depression such as behavioral health evaluation, psychotherapy, pharmacological interventions, or additional treatment options
 

The intent of the measure is to screen all patients for depression except those with previous diagnosis of bipolar disorder. Patients who have ever been diagnosed with bipolar disorder prior to the qualifying encounter will be excluded from the measure regardless of whether the diagnosis is active or not.
A depression screen is completed on the date of the encounter or up to 14 calendar days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan must be documented from the end of the screening or up to two calendar days after the date of the encounter, such as referral to a provider for additional evaluation, pharmacological interventions, or other interventions for the treatment of depression. An example to illustrate the follow-up plan documentation timing: if the encounter is on a Monday from 3-4 pm (day 0) and the patient screens positive, the clinician has through anytime on Wednesday (day 2) to complete follow-up plan documentation.
This measure does not require documentation of a specific score, just whether results of the normalized and validated depression screening tool used are considered positive or negative. Each standardized screening tool provides guidance on whether a particular score is considered positive for depression.
The measure is not prescriptive in the specific screening tool being used and provides no hierarchy for acceptance of one tool over another. In the case where two screenings are documented on the same date/time with different results (one positive and one negative), the measure only assesses the most recent screening. Since both screenings are both considered the most recent, the patient will be captured in the numerator if the positive screening result also includes documentation of an intervention following the positive screen. For patients who are 17 years old at the start of the measurement period, either adolescent or adult screening tools may be used to satisfy the numerator. If both types of screenings occur during the year, the most recent of the two (and its follow-up, if positive) should be used to satisfy the numerator.
This eCQM is a patient-based measure. Depression screening is required once per measurement period, not at all encounters.
Screening Tools:

 

  
An age-appropriate, standardized, and validated depression screening tool must be used for numerator compliance.
 
 

  
The name of the age-appropriate standardized depression screening tool utilized must be documented in the medical record.
 
 

  
The depression screening must be reviewed and addressed by the provider, filing the code, on the date of the encounter. Positive pre-screening results indicating a patient is at high risk for self-harm should receive more urgent intervention as determined by the provider practice.
 
 

  
The screening should occur during a qualifying encounter or up to 14 calendar days prior to the date of the qualifying encounter.
 
 

  
The measure assesses the most recent depression screening completed either during the qualifying encounter or within the 14 calendar days prior to that encounter. Therefore, a clinician would not be able to complete another screening at the time of the encounter to count towards a follow-up, because that would serve as the most recent screening. The most recent screening must also have documented results; otherwise, the prior screening with non-null results will be considered for the measure. In order to satisfy the follow-up requirement for a patient screening positively, the eligible clinician would need to provide one of the aforementioned follow-up actions, which does not include use of a standardized depression screening tool.
 

Follow-Up Plan:
While there are many validated depression screening tools, they are not necessarily diagnostic tools. Patients with elevated depression screening scores should be followed by a clinician to evaluate whether a depression diagnosis is appropriate, but a medication and/or referral are not always indicated for a positive score. In these cases, a follow up plan is appropriate.
The follow-up plan MUST still be provided for and discussed with the patient during the qualifying encounter used to evaluate the numerator. However, documentation of the follow-up plan can occur up to two calendar days after the qualifying encounter, in accordance with the policies of an eligible clinician or provider’s practice or health system. All services should be documented during, or as soon as practicable, after the qualifying encounter in order to maintain an accurate medical record.
Examples of a follow-up plan include but are not limited to:

 

  
Referral to a provider or program for further evaluation for depression, for example, referral to a psychiatrist, psychiatric nurse practitioner, psychologist, clinical social worker, mental health counselor, or other mental health service such as family or group therapy, support group, depression management program, or other service for treatment of depression.
 
 

  
Other interventions designed to treat depression such as behavioral health evaluation, psychotherapy, pharmacological interventions, or additional treatment options.
 
 

  
Exercise regimens, education counseling, coping support, and completion of a mental health crisis plan.
 

Should a patient screen positive for depression, a clinician should:

 

  
Only order pharmacological intervention when appropriate and after sufficient diagnostic evaluation. However, for the purposes of this measure, additional screening and assessment during the qualifying encounter will not qualify as a follow-up plan.
 
 

  
Opt to complete a suicide risk assessment when appropriate and based on individual patient characteristics. However, for the purposes of this measure, a suicide risk assessment or an additional screening using a standardized tool will not qualify as a follow-up plan.
 

This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

TBD

All patients aged 12 years and older at the beginning of the measurement period with at least one qualifying encounter during the measurement period

Equals Initial Population

Patients who have ever been diagnosed with bipolar disorder at any time prior to the qualifying encounter

Patients screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented from the date of the screening to two days after the date of the qualifying encounter or an active depression medication or active depression management intervention was active or prescribed at any time during the qualifying encounter

None

Patient Reason(s)

 

  
Patient refuses to participate in or complete the depression screening.
 

OR
Medical Reason(s) 

 

  
Documentation of medical reason for not screening patient for depression (e.g., cognitive, functional, or motivational limitations that may impact accuracy of results; patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient's health status).
 

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Preventive Care and Screening