Depression Remission at Twelve Months
Compare Versions of: "Depression Remission at Twelve Months"
The Compare function compares two years of the measure specifications found in the header of the measure's HTML. It does not include a comparison of any information in the body of the HTML, e.g., population criteria, Clinical Quality Language, or value sets.
Strikethrough text highlighted in red indicates information changed from the previous version. Text highlighted in green indicates information updated in the new eCQM version.
Compare 2023 version to
| Measure Information | 2023 Performance Period | 2024 Performance Period | 2025 Performance Period | 2026 Performance Period |
|---|---|---|---|---|
| Title | Depression Remission at Twelve Months | Depression Remission at Twelve Months | Depression Remission at Twelve Months | Depression Remission at Twelve Months |
| CMS eCQM ID | CMS159v11 | CMS159v12 | CMS159v13 | CMS159v14 |
| CBE ID* | 0710e | 0710e | 0710e | 0710e |
| MIPS Quality ID | 370 | 370 | 370 | 370 |
| Measure Steward | MN Community Measurement | MN Community Measurement | MN Community Measurement | MN Community Measurement |
| Description |
The percentage of adolescent patients 12 to 17 years of age and adult patients 18 years of age or older with major depression or dysthymia who reached remission 12 months (+/- 60 days) after an index event |
The percentage of adolescent patients 12 to 17 years of age and adult patients 18 years of age or older with major depression or dysthymia who reached remission 12 months (+/- 60 days) after an index event |
The percentage of adolescent patients 12 to 17 years of age and adult patients 18 years of age or older with major depression or dysthymia who reached remission 12 months (+/- 60 days) after an index event |
The percentage of adolescent patients 12 to 17 years of age and adult patients 18 years of age or older with major depression or dysthymia who reached remission 12 months (+/- 60 days) after an index event |
| Measure Scoring | Proportion | Proportion | Proportion | Proportion |
| Measure Type | Outcome | Outcome | Outcome | Outcome |
| Stratification | *See CMS159v11.html |
Ages 12 to 17 at the time of the index assessment Ages 18 and older at the time of the index assessment |
Ages 12 to 17 at the time of the index assessment Ages 18 and older at the time of the index assessment |
Ages 12 to 17 at the time of the index assessment Ages 18 and older at the time of the index assessment |
| Risk Adjustment | *See CMS159v11.html |
None |
None |
None |
| Rationale | *See CMS159v11.html | Adults: Depression is a common and treatable mental disorder. During 2013-2016, 8.1% of American adults age 20 and over had depression in a given 2 week period. Women (10.4%) were almost twice as likely as men (5.5%) to have had depression. The prevalence of depression among adults...decreased as family income levels increased. About 80% of adults with depression reported at least some difficulty with work, home, or social activities because of their depression symptoms (Brody, Pratt, and Hughes, 2018). Depression is a risk factor for development of chronic illnesses such as diabetes and coronary heart disease and adversely affects the course, complications and management of chronic medical illness. Both maladaptive health risk behaviors and psychobiological factors associated with depression may explain depression's negative effect on outcomes of chronic illness (Katon, 2011). Adolescents and Adults: The 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 (Pratt and Brody, 2014). Depression is associated with higher mortality rates in all age groups. Depression is also a leading cause of medical disability, and depressed people lose 5.6 hours of productive work every week when they are depressed, 50% of which is due to absenteeism and short-term disability (Stewart et al., 2003). Adolescents: In 2014, an estimated 2.8 million adolescents age 12 to 17 in the United States had at least one major depressive episode (MDE) in the past year (Center for Behavioral Health Statistics and Quality, 2015). 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) (Kann et al., 2014). 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 (Mojtabai, Olfson, and Han 2016). 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 (Mojtabai, Olfson, and Han 2016). Show more >Adults: Depression is a common and treatable mental disorder. During 2013-2016, 8.1% of American adults age 20 and over had depression in a given 2 week period. Women (10.4%) were almost twice as likely as men (5.5%) to have had depression. The prevalence of depression among adults decreased as family income levels increased. About 80% of adults with depression reported at least some difficulty with work, home, or social activities because of their depression symptoms (Brody, Pratt, and Hughes, 2018). Depression is a risk factor for development of chronic illnesses such as diabetes and coronary heart disease and adversely affects the course, complications and management of chronic medical illness. Both maladaptive health risk behaviors and psychobiological factors associated with depression may explain depression's negative effect on outcomes of chronic illness (Katon, 2011). Adolescents and Adults: The 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 (Pratt and Brody, 2014). Depression is associated with higher mortality rates in all age groups. Depression is also a leading cause of medical disability, and depressed people lose 5.6 hours of productive work every week when they are depressed, 50% of which is due to absenteeism and short-term disability (Stewart et al., 2003). Adolescents: In 2014, an estimated 2.8 million adolescents age 12 to 17 in the United States had at least one major depressive episode (MDE) in the past year (Center for Behavioral Health Statistics and Quality, 2015). 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) (Kann et al., 2014). 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 (Mojtabai, Olfson, and Han 2016). 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 (Mojtabai, Olfson, and Han 2016). Show less |
Adults: Depression is a common and treatable mental disorder. During 2013-2016, 8.1% of American adults age 20 and over had depression in a given 2 week period. Women (10.4%) were almost twice as likely as men (5.5%) to have had depression. The prevalence of depression among adults...decreased as family income levels increased. About 80% of adults with depression reported at least some difficulty with work, home, or social activities because of their depression symptoms (Brody, Pratt, and Hughes, 2018). Depression is a risk factor for development of chronic illnesses such as diabetes and coronary heart disease and adversely affects the course, complications and management of chronic medical illness. Both maladaptive health risk behaviors and psychobiological factors associated with depression may explain depression's negative effect on outcomes of chronic illness (Katon, 2011). Adolescents and Adults: The 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 (Pratt and Brody, 2014). Depression is associated with higher mortality rates in all age groups. Depression is also a leading cause of medical disability, and depressed people lose 5.6 hours of productive work every week when they are depressed, 50% of which is due to absenteeism and short-term disability (Stewart et al., 2003). Adolescents: In 2014, an estimated 2.8 million adolescents age 12 to 17 in the United States had at least one major depressive episode (MDE) in the past year (Center for Behavioral Health Statistics and Quality, 2015). 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) (Kann et al., 2014). 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 (Mojtabai, Olfson, and Han 2016). 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 (Mojtabai, Olfson, and Han 2016). Show more >Adults: Depression is a common and treatable mental disorder. During 2013-2016, 8.1% of American adults age 20 and over had depression in a given 2 week period. Women (10.4%) were almost twice as likely as men (5.5%) to have had depression. The prevalence of depression among adults decreased as family income levels increased. About 80% of adults with depression reported at least some difficulty with work, home, or social activities because of their depression symptoms (Brody, Pratt, and Hughes, 2018). Depression is a risk factor for development of chronic illnesses such as diabetes and coronary heart disease and adversely affects the course, complications and management of chronic medical illness. Both maladaptive health risk behaviors and psychobiological factors associated with depression may explain depression's negative effect on outcomes of chronic illness (Katon, 2011). Adolescents and Adults: The 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 (Pratt and Brody, 2014). Depression is associated with higher mortality rates in all age groups. Depression is also a leading cause of medical disability, and depressed people lose 5.6 hours of productive work every week when they are depressed, 50% of which is due to absenteeism and short-term disability (Stewart et al., 2003). Adolescents: In 2014, an estimated 2.8 million adolescents age 12 to 17 in the United States had at least one major depressive episode (MDE) in the past year (Center for Behavioral Health Statistics and Quality, 2015). 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) (Kann et al., 2014). 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 (Mojtabai, Olfson, and Han 2016). 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 (Mojtabai, Olfson, and Han 2016). Show less |
Adults: Depression is a common and treatable mental disorder. During 2013-2016, 8.1% of American adults aged 20 and over had depression in a given 2-week period. Women (10.4%) were almost twice as likely as men (5.5%) to have had depression. The prevalence of depression among adults...decreased as family income levels increased. About 80% of adults with depression reported at least some difficulty with work, home, or social activities because of their depression symptoms (Brody et al., 2018). Depression is a risk factor for development of chronic illnesses such as diabetes and coronary heart disease and adversely affects the course, complications and management of chronic medical illness. Both maladaptive health risk behaviors and psychobiological factors associated with depression may explain depression's negative effect on outcomes of chronic illness (Katon, 2011). Adolescents and Adults: The 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 (Pratt & Brody, 2014). Depression is associated with higher mortality rates in all age groups. Depression is also a leading cause of medical disability, and depressed people lose 5.6 hours of productive work every week when they are depressed, 50% of which is due to absenteeism and short-term disability (Stewart et al., 2003). Adolescents: In 2014, an estimated 2.8 million adolescents aged 12 to 17 in the United States had at least one major depressive episode (MDE) in the past year (Center for Behavioral Health Statistics and Quality, 2015). The 2013 Youth Risk Behavior Survey of students in 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) (Kann et al., 2014). 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 (Mojtabai et al., 2016). 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 (Mojtabai et al., 2016). Show more >Adults: Depression is a common and treatable mental disorder. During 2013-2016, 8.1% of American adults aged 20 and over had depression in a given 2-week period. Women (10.4%) were almost twice as likely as men (5.5%) to have had depression. The prevalence of depression among adults decreased as family income levels increased. About 80% of adults with depression reported at least some difficulty with work, home, or social activities because of their depression symptoms (Brody et al., 2018). Depression is a risk factor for development of chronic illnesses such as diabetes and coronary heart disease and adversely affects the course, complications and management of chronic medical illness. Both maladaptive health risk behaviors and psychobiological factors associated with depression may explain depression's negative effect on outcomes of chronic illness (Katon, 2011). Adolescents and Adults: The 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 (Pratt & Brody, 2014). Depression is associated with higher mortality rates in all age groups. Depression is also a leading cause of medical disability, and depressed people lose 5.6 hours of productive work every week when they are depressed, 50% of which is due to absenteeism and short-term disability (Stewart et al., 2003). Adolescents: In 2014, an estimated 2.8 million adolescents aged 12 to 17 in the United States had at least one major depressive episode (MDE) in the past year (Center for Behavioral Health Statistics and Quality, 2015). The 2013 Youth Risk Behavior Survey of students in 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) (Kann et al., 2014). 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 (Mojtabai et al., 2016). 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 (Mojtabai et al., 2016). Show less |
| Clinical Recommendation Statement | *See CMS159v11.html | Adults: Recommendations and algorithm notations supporting depression outcomes and duration of treatment according to Institute for Clinical Systems Improvement Health Care Guideline (Trangle et al., 2016):Recommendation: 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 (Trangle et al., 2016). Proactive follow-up contacts (in person, telephone) based on the collaborative care model have been shown to significantly lower depression severity (Unutzer et al., 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 et al., 2006; Unutzer et al., 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 et al., 2000; Simon et al., 2000). The Patient Health Questionnaire-9 (PHQ-9) is an effective monitoring and management tool, 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 et al., 2008; Lowe et al., 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). The goals of treatment should be to achieve remission, reduce relapse and recurrence, and return to previous level of occupational and psychosocial function. If using a PHQ-9 tool, remission translates to PHQ-9 score of less than 5 (Kroenke, 2001). Results from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study showed that remission rates lowered with more treatment steps, but the overall cumulative rate was 67% (Rush et al., 2006). Response and remission take time. In the STAR*D study, longer times than expected were needed to reach response or remission. In fact, one-third of those who ultimately responded did so after six weeks. Of those who achieved remission by Quick Inventory of Depressive Symptomatology, 50% did so only at or after six weeks of treatment (Trivedi et al., 2006). If the primary care clinician is seeing some improvement, continue working with that patient to augment or increase dosage to reach remission. This can take up to three months. This measure assesses achievement of remission, which is a desired outcome of effective depression treatment and monitoring. Adult Depression in Primary Care - Guideline Aims (Trangle et al., 2016): - 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. - Increase the percentage of patients with major depression or persistent depressive disorder who have follow-up to assess for outcomes from treatment. - Improve communication between the primary care physician and the mental health care clinician (if patient is co-managed). Adolescents: Recommendations supporting depression outcomes and duration of treatment according to American Academy of Child and Adolescent Psychiatry guideline (Birmaher et al., 2007): - 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). - Each phase of treatment should include psychoeducation, supportive management, and family and school involvement. - 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. - 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. Recommendations supporting depression outcomes and duration of treatment according to Guidelines for Adolescent Depression in Primary Care (Zuckerbrot et al., 2018 (Part I), Zuckerbrot et al., 2018 (Part II)): - Mild depression: consider a period of active support and monitoring before starting other evidence-based treatment - Moderate or severe major clinical depression or complicating factors: -- consultation with mental health specialist with agreed upon roles -- evidence based treatment (cognitive behavioral therapy or interpersonal psychotherapy and/or antidepressant selective serotonin reuptake inhibitors) - Monitor for adverse effects during antidepressant therapy -- clinical worsening, suicidality, unusual changes in behavior - Systematic and regular tracking of goals and outcomes -- improvement in functioning status and resolution of depressive symptoms Regardless 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. Show more >Adults: Recommendations and algorithm notations supporting depression outcomes and duration of treatment according to Institute for Clinical Systems Improvement Health Care Guideline (Trangle et al., 2016): Recommendation: 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 (Trangle et al., 2016). Proactive follow-up contacts (in person, telephone) based on the collaborative care model have been shown to significantly lower depression severity (Unutzer et al., 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 et al., 2006; Unutzer et al., 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 et al., 2000; Simon et al., 2000). The Patient Health Questionnaire-9 (PHQ-9) is an effective monitoring and management tool, 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 et al., 2008; Lowe et al., 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). The goals of treatment should be to achieve remission, reduce relapse and recurrence, and return to previous level of occupational and psychosocial function. If using a PHQ-9 tool, remission translates to PHQ-9 score of less than 5 (Kroenke, 2001). Results from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study showed that remission rates lowered with more treatment steps, but the overall cumulative rate was 67% (Rush et al., 2006). Response and remission take time. In the STAR*D study, longer times than expected were needed to reach response or remission. In fact, one-third of those who ultimately responded did so after six weeks. Of those who achieved remission by Quick Inventory of Depressive Symptomatology, 50% did so only at or after six weeks of treatment (Trivedi et al., 2006). If the primary care clinician is seeing some improvement, continue working with that patient to augment or increase dosage to reach remission. This can take up to three months. This measure assesses achievement of remission, which is a desired outcome of effective depression treatment and monitoring. Adult Depression in Primary Care - Guideline Aims (Trangle et al., 2016): - 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. - Increase the percentage of patients with major depression or persistent depressive disorder who have follow-up to assess for outcomes from treatment. - Improve communication between the primary care physician and the mental health care clinician (if patient is co-managed). Adolescents: Recommendations supporting depression outcomes and duration of treatment according to American Academy of Child and Adolescent Psychiatry guideline (Birmaher et al., 2007): - 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). - Each phase of treatment should include psychoeducation, supportive management, and family and school involvement. - 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. - 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. Recommendations supporting depression outcomes and duration of treatment according to Guidelines for Adolescent Depression in Primary Care (Zuckerbrot et al., 2018 (Part I), Zuckerbrot et al., 2018 (Part II)): - Mild depression: consider a period of active support and monitoring before starting other evidence-based treatment - Moderate or severe major clinical depression or complicating factors: -- consultation with mental health specialist with agreed upon roles -- evidence based treatment (cognitive behavioral therapy or interpersonal psychotherapy and/or antidepressant selective serotonin reuptake inhibitors) - Monitor for adverse effects during antidepressant therapy -- clinical worsening, suicidality, unusual changes in behavior - Systematic and regular tracking of goals and outcomes -- improvement in functioning status and resolution of depressive symptoms Regardless 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. Show less |
Adults: Recommendations and algorithm notations supporting depression outcomes and duration of treatment according to Institute for Clinical Systems Improvement Health Care Guideline (Trangle et al., 2016):Recommendation: 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 (Trangle et al., 2016). Proactive follow-up contacts (in person, telephone) based on the collaborative care model have been shown to significantly lower depression severity (Unutzer et al., 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 et al., 2006; Unutzer et al., 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 et al., 2000; Simon et al., 2000). The Patient Health Questionnaire-9 (PHQ-9) is an effective monitoring and management tool, 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 et al., 2008; Lowe et al., 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). The goals of treatment should be to achieve remission, reduce relapse and recurrence, and return to previous level of occupational and psychosocial function. If using a PHQ-9 tool, remission translates to PHQ-9 score of less than 5 (Kroenke, 2001). Results from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study showed that remission rates lowered with more treatment steps, but the overall cumulative rate was 67% (Rush et al., 2006). Response and remission take time. In the STAR*D study, longer times than expected were needed to reach response or remission. In fact, one-third of those who ultimately responded did so after six weeks. Of those who achieved remission by Quick Inventory of Depressive Symptomatology, 50% did so only at or after six weeks of treatment (Trivedi et al., 2006). If the primary care clinician is seeing some improvement, continue working with that patient to augment or increase dosage to reach remission. This can take up to three months. This measure assesses achievement of remission, which is a desired outcome of effective depression treatment and monitoring. Adult Depression in Primary Care - Guideline Aims (Trangle et al., 2016): - 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. - Increase the percentage of patients with major depression or persistent depressive disorder who have follow-up to assess for outcomes from treatment. - Improve communication between the primary care physician and the mental health care clinician (if patient is co-managed). Adolescents: Recommendations supporting depression outcomes and duration of treatment according to American Academy of Child and Adolescent Psychiatry guideline (Birmaher et al., 2007): - 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). - Each phase of treatment should include psychoeducation, supportive management, and family and school involvement. - 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. - 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. Recommendations supporting depression outcomes and duration of treatment according to Guidelines for Adolescent Depression in Primary Care (Zuckerbrot et al., 2018 (Part I), Zuckerbrot et al., 2018 (Part II)): - Mild depression: consider a period of active support and monitoring before starting other evidence-based treatment - Moderate or severe major clinical depression or complicating factors: -- consultation with mental health specialist with agreed upon roles -- evidence based treatment (cognitive behavioral therapy or interpersonal psychotherapy and/or antidepressant selective serotonin reuptake inhibitors) - Monitor for adverse effects during antidepressant therapy -- clinical worsening, suicidality, unusual changes in behavior - Systematic and regular tracking of goals and outcomes -- improvement in functioning status and resolution of depressive symptoms Regardless 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. Show more >Adults: Recommendations and algorithm notations supporting depression outcomes and duration of treatment according to Institute for Clinical Systems Improvement Health Care Guideline (Trangle et al., 2016): Recommendation: 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 (Trangle et al., 2016). Proactive follow-up contacts (in person, telephone) based on the collaborative care model have been shown to significantly lower depression severity (Unutzer et al., 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 et al., 2006; Unutzer et al., 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 et al., 2000; Simon et al., 2000). The Patient Health Questionnaire-9 (PHQ-9) is an effective monitoring and management tool, 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 et al., 2008; Lowe et al., 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). The goals of treatment should be to achieve remission, reduce relapse and recurrence, and return to previous level of occupational and psychosocial function. If using a PHQ-9 tool, remission translates to PHQ-9 score of less than 5 (Kroenke, 2001). Results from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study showed that remission rates lowered with more treatment steps, but the overall cumulative rate was 67% (Rush et al., 2006). Response and remission take time. In the STAR*D study, longer times than expected were needed to reach response or remission. In fact, one-third of those who ultimately responded did so after six weeks. Of those who achieved remission by Quick Inventory of Depressive Symptomatology, 50% did so only at or after six weeks of treatment (Trivedi et al., 2006). If the primary care clinician is seeing some improvement, continue working with that patient to augment or increase dosage to reach remission. This can take up to three months. This measure assesses achievement of remission, which is a desired outcome of effective depression treatment and monitoring. Adult Depression in Primary Care - Guideline Aims (Trangle et al., 2016): - 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. - Increase the percentage of patients with major depression or persistent depressive disorder who have follow-up to assess for outcomes from treatment. - Improve communication between the primary care physician and the mental health care clinician (if patient is co-managed). Adolescents: Recommendations supporting depression outcomes and duration of treatment according to American Academy of Child and Adolescent Psychiatry guideline (Birmaher et al., 2007): - 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). - Each phase of treatment should include psychoeducation, supportive management, and family and school involvement. - 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. - 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. Recommendations supporting depression outcomes and duration of treatment according to Guidelines for Adolescent Depression in Primary Care (Zuckerbrot et al., 2018 (Part I), Zuckerbrot et al., 2018 (Part II)): - Mild depression: consider a period of active support and monitoring before starting other evidence-based treatment - Moderate or severe major clinical depression or complicating factors: -- consultation with mental health specialist with agreed upon roles -- evidence based treatment (cognitive behavioral therapy or interpersonal psychotherapy and/or antidepressant selective serotonin reuptake inhibitors) - Monitor for adverse effects during antidepressant therapy -- clinical worsening, suicidality, unusual changes in behavior - Systematic and regular tracking of goals and outcomes -- improvement in functioning status and resolution of depressive symptoms Regardless 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. Show less |
Adults: Recommendations and algorithm notations supporting depression outcomes and duration of treatment according to Institute for Clinical Systems Improvement Health Care Guideline (Trangle et al., 2016):Recommendation: 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 (Trangle et al., 2016). Proactive follow-up contacts (in person, telephone) based on the collaborative care model have been shown to significantly lower depression severity (Unutzer et al., 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 et al., 2006; Unutzer et al., 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 et al., 2000; Simon et al., 2000). The Patient Health Questionnaire-9 (PHQ-9) is an effective monitoring and management tool, 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 et al., 2008; Lowe et al., 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). The goals of treatment should be to achieve remission, reduce relapse and recurrence, and return to previous level of occupational and psychosocial function. If using a PHQ-9 tool, remission translates to PHQ-9 score of less than 5 (Kroenke et al., 2001). Results from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study showed that remission rates lowered with more treatment steps, but the overall cumulative rate was 67% (Rush et al., 2006). Response and remission take time. In the STAR*D study, longer times than expected were needed to reach response or remission. In fact, one-third of those who ultimately responded did so after six weeks. Of those who achieved remission by Quick Inventory of Depressive Symptomatology, 50% did so only at or after six weeks of treatment (Trivedi et al., 2006). If the primary care clinician is seeing some improvement, continue working with that patient to augment or increase dosage to reach remission. This can take up to three months. This measure assesses achievement of remission, which is a desired outcome of effective depression treatment and monitoring. Adult Depression in Primary Care - Guideline Aims (Trangle et al., 2016): - 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. - Increase the percentage of patients with major depression or persistent depressive disorder who have follow-up to assess for outcomes from treatment. - Improve communication between the primary care physician and the mental health care clinician (if patient is co-managed). Adolescents: Recommendations supporting depression outcomes and duration of treatment according to American Academy of Child and Adolescent Psychiatry guideline (Birmaher et al., 2007): - 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). - Each phase of treatment should include psychoeducation, supportive management, and family and school involvement. - 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. - 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. Recommendations supporting depression outcomes and duration of treatment according to Guidelines for Adolescent Depression in Primary Care (Zuckerbrot et al., 2018 (Part I), Zuckerbrot et al., 2018 (Part II)): - Mild depression: consider a period of active support and monitoring before starting other evidence-based treatment - Moderate or severe major clinical depression or complicating factors: -- consultation with mental health specialist with agreed upon roles -- evidence based treatment (cognitive behavioral therapy or interpersonal psychotherapy and/or antidepressant selective serotonin reuptake inhibitors) - Monitor for adverse effects during antidepressant therapy -- clinical worsening, suicidality, unusual changes in behavior - Systematic and regular tracking of goals and outcomes -- improvement in functioning status and resolution of depressive symptoms Regardless 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. Show more >Adults: Recommendations and algorithm notations supporting depression outcomes and duration of treatment according to Institute for Clinical Systems Improvement Health Care Guideline (Trangle et al., 2016): Recommendation: 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 (Trangle et al., 2016). Proactive follow-up contacts (in person, telephone) based on the collaborative care model have been shown to significantly lower depression severity (Unutzer et al., 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 et al., 2006; Unutzer et al., 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 et al., 2000; Simon et al., 2000). The Patient Health Questionnaire-9 (PHQ-9) is an effective monitoring and management tool, 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 et al., 2008; Lowe et al., 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). The goals of treatment should be to achieve remission, reduce relapse and recurrence, and return to previous level of occupational and psychosocial function. If using a PHQ-9 tool, remission translates to PHQ-9 score of less than 5 (Kroenke et al., 2001). Results from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study showed that remission rates lowered with more treatment steps, but the overall cumulative rate was 67% (Rush et al., 2006). Response and remission take time. In the STAR*D study, longer times than expected were needed to reach response or remission. In fact, one-third of those who ultimately responded did so after six weeks. Of those who achieved remission by Quick Inventory of Depressive Symptomatology, 50% did so only at or after six weeks of treatment (Trivedi et al., 2006). If the primary care clinician is seeing some improvement, continue working with that patient to augment or increase dosage to reach remission. This can take up to three months. This measure assesses achievement of remission, which is a desired outcome of effective depression treatment and monitoring. Adult Depression in Primary Care - Guideline Aims (Trangle et al., 2016): - 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. - Increase the percentage of patients with major depression or persistent depressive disorder who have follow-up to assess for outcomes from treatment. - Improve communication between the primary care physician and the mental health care clinician (if patient is co-managed). Adolescents: Recommendations supporting depression outcomes and duration of treatment according to American Academy of Child and Adolescent Psychiatry guideline (Birmaher et al., 2007): - 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). - Each phase of treatment should include psychoeducation, supportive management, and family and school involvement. - 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. - 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. Recommendations supporting depression outcomes and duration of treatment according to Guidelines for Adolescent Depression in Primary Care (Zuckerbrot et al., 2018 (Part I), Zuckerbrot et al., 2018 (Part II)): - Mild depression: consider a period of active support and monitoring before starting other evidence-based treatment - Moderate or severe major clinical depression or complicating factors: -- consultation with mental health specialist with agreed upon roles -- evidence based treatment (cognitive behavioral therapy or interpersonal psychotherapy and/or antidepressant selective serotonin reuptake inhibitors) - Monitor for adverse effects during antidepressant therapy -- clinical worsening, suicidality, unusual changes in behavior - Systematic and regular tracking of goals and outcomes -- improvement in functioning status and resolution of depressive symptoms Regardless 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. Show less |
| Improvement Notation |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
| Definition | *See CMS159v11.html | Denominator Identification Period: The period in which eligible patients can have an index event. The denominator identification period occurs prior to the measurement period and is defined as 14 months to two months prior to the start of the measurement period. For patients with an index...event, there needs to be enough time following index for the patients to have the opportunity to reach remission twelve months +/- 60 days after the index event date. Index Event Date: The date in which the first instance of elevated PHQ-9 or PHQ-9M greater than nine and diagnosis of depression or dysthymia occurs during the denominator identification measurement period. Patients may be assessed using PHQ-9 or PHQ-9M on the same date or up to 7 days prior to the encounter (index event). Measure Assessment Period: The index event date marks the start of the measurement assessment period for each patient which is 14 months (12 months +/- 60 days) in length to allow for a follow-up PHQ-9 or PHQ-9M between 10 and 14 months following the index event. This assessment period is fixed and does not start over with a higher PHQ-9 or PHQ-9M that may occur after the index event date. Remission is defined as a PHQ-9 or PHQ-9M score of less than five. Twelve months is defined as the point in time from the index event date extending out twelve months and then allowing a grace period of sixty days prior to and sixty days after this date. The most recent PHQ-9 or PHQ-9M score less than five obtained during this four month period is deemed as remission at twelve months, values obtained prior to or after this period are not counted as numerator compliant (remission). Show more >Denominator Identification Period: The period in which eligible patients can have an index event. The denominator identification period occurs prior to the measurement period and is defined as 14 months to two months prior to the start of the measurement period. For patients with an index event, there needs to be enough time following index for the patients to have the opportunity to reach remission twelve months +/- 60 days after the index event date. Index Event Date: The date in which the first instance of elevated PHQ-9 or PHQ-9M greater than nine and diagnosis of depression or dysthymia occurs during the denominator identification measurement period. Patients may be assessed using PHQ-9 or PHQ-9M on the same date or up to 7 days prior to the encounter (index event). Measure Assessment Period: The index event date marks the start of the measurement assessment period for each patient which is 14 months (12 months +/- 60 days) in length to allow for a follow-up PHQ-9 or PHQ-9M between 10 and 14 months following the index event. This assessment period is fixed and does not start over with a higher PHQ-9 or PHQ-9M that may occur after the index event date. Remission is defined as a PHQ-9 or PHQ-9M score of less than five. Twelve months is defined as the point in time from the index event date extending out twelve months and then allowing a grace period of sixty days prior to and sixty days after this date. The most recent PHQ-9 or PHQ-9M score less than five obtained during this four month period is deemed as remission at twelve months, values obtained prior to or after this period are not counted as numerator compliant (remission). Show less |
Denominator Identification Period: The period in which eligible patients can have an index event. The denominator identification period occurs prior to the measurement period and is defined as 14 months to two months prior to the start of the measurement period. For patients with an index...event, there needs to be enough time following index for the patients to have the opportunity to reach remission twelve months +/- 60 days after the index event date. Index Event Date: The date in which the first instance of elevated PHQ-9 or PHQ-9M greater than nine and diagnosis of depression or dysthymia occurs during the denominator identification measurement period. Patients may be assessed using PHQ-9 or PHQ-9M on the same date or up to 7 days prior to the encounter (index event). Measure Assessment Period: The index event date marks the start of the measurement assessment period for each patient which is 14 months (12 months +/- 60 days) in length to allow for a follow-up PHQ-9 or PHQ-9M between 10 and 14 months following the index event. This assessment period is fixed and does not start over with a higher PHQ-9 or PHQ-9M that may occur after the index event date. Remission is defined as a PHQ-9 or PHQ-9M score of less than five. Twelve months is defined as the point in time from the index event date extending out twelve months and then allowing a grace period of sixty days prior to and sixty days after this date. The most recent PHQ-9 or PHQ-9M score less than five obtained during this four month period is deemed as remission at twelve months, values obtained prior to or after this period are not counted as numerator compliant (remission). Show more >Denominator Identification Period: The period in which eligible patients can have an index event. The denominator identification period occurs prior to the measurement period and is defined as 14 months to two months prior to the start of the measurement period. For patients with an index event, there needs to be enough time following index for the patients to have the opportunity to reach remission twelve months +/- 60 days after the index event date. Index Event Date: The date in which the first instance of elevated PHQ-9 or PHQ-9M greater than nine and diagnosis of depression or dysthymia occurs during the denominator identification measurement period. Patients may be assessed using PHQ-9 or PHQ-9M on the same date or up to 7 days prior to the encounter (index event). Measure Assessment Period: The index event date marks the start of the measurement assessment period for each patient which is 14 months (12 months +/- 60 days) in length to allow for a follow-up PHQ-9 or PHQ-9M between 10 and 14 months following the index event. This assessment period is fixed and does not start over with a higher PHQ-9 or PHQ-9M that may occur after the index event date. Remission is defined as a PHQ-9 or PHQ-9M score of less than five. Twelve months is defined as the point in time from the index event date extending out twelve months and then allowing a grace period of sixty days prior to and sixty days after this date. The most recent PHQ-9 or PHQ-9M score less than five obtained during this four month period is deemed as remission at twelve months, values obtained prior to or after this period are not counted as numerator compliant (remission). Show less |
Denominator Identification Period: The period in which eligible patients can have an index event. The denominator identification period occurs prior to the measurement period and is defined as 14 months to two months prior to the start of the measurement period. For patients with an index...event, there needs to be enough time following index for the patients to have the opportunity to reach remission twelve months +/- 60 days after the index event date. Index Event Date: The date in which the first instance of elevated PHQ-9 or PHQ-9M greater than nine and diagnosis of depression or dysthymia occurs during the denominator identification measurement period. Patients may be assessed using PHQ-9 or PHQ-9M on the same date or up to 7 days prior to the encounter (index event). Measure Assessment Period: The index event date marks the start of the measurement assessment period for each patient which is 14 months (12 months +/- 60 days) in length to allow for a follow-up PHQ-9 or PHQ-9M between 10 and 14 months following the index event. This assessment period is fixed and does not start over with a higher PHQ-9 or PHQ-9M that may occur after the index event date. Remission is defined as a PHQ-9 or PHQ-9M score of less than five. Twelve months is defined as the point in time from the index event date extending out twelve months and then allowing a grace period of sixty days prior to and sixty days after this date. The most recent PHQ-9 or PHQ-9M score less than five obtained during this four-month period is deemed as remission at twelve months, values obtained prior to or after this period are not counted as numerator compliant (remission). Show more >Denominator Identification Period: The period in which eligible patients can have an index event. The denominator identification period occurs prior to the measurement period and is defined as 14 months to two months prior to the start of the measurement period. For patients with an index event, there needs to be enough time following index for the patients to have the opportunity to reach remission twelve months +/- 60 days after the index event date. Index Event Date: The date in which the first instance of elevated PHQ-9 or PHQ-9M greater than nine and diagnosis of depression or dysthymia occurs during the denominator identification measurement period. Patients may be assessed using PHQ-9 or PHQ-9M on the same date or up to 7 days prior to the encounter (index event). Measure Assessment Period: The index event date marks the start of the measurement assessment period for each patient which is 14 months (12 months +/- 60 days) in length to allow for a follow-up PHQ-9 or PHQ-9M between 10 and 14 months following the index event. This assessment period is fixed and does not start over with a higher PHQ-9 or PHQ-9M that may occur after the index event date. Remission is defined as a PHQ-9 or PHQ-9M score of less than five. Twelve months is defined as the point in time from the index event date extending out twelve months and then allowing a grace period of sixty days prior to and sixty days after this date. The most recent PHQ-9 or PHQ-9M score less than five obtained during this four-month period is deemed as remission at twelve months, values obtained prior to or after this period are not counted as numerator compliant (remission). Show less |
| Guidance |
When an index assessment is conducted with PHQ-9M, the follow-up assessment can use either a PHQ-9M or PHQ-9. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
When an index assessment is conducted with PHQ-9M, the follow-up assessment can use either a PHQ-9M or PHQ-9. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
When an index assessment is conducted with PHQ-9M, the follow-up assessment can use either a PHQ-9M or PHQ-9. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
When an index assessment is conducted with PHQ-9M, the follow-up assessment can use either a PHQ-9M or PHQ-9. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
| Initial Population | Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older with a diagnosis of major depression or dysthymia and an initial PHQ-9 or PHQ-9M score greater than nine during the index event. Patients may be assessed using PHQ-9 or PHQ-9M on the same date or up to... 7 days prior to the encounter (index event). Show more >Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older with a diagnosis of major depression or dysthymia and an initial PHQ-9 or PHQ-9M score greater than nine during the index event. Patients may be assessed using PHQ-9 or PHQ-9M on the same date or up to 7 days prior to the encounter (index event). Show less |
Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older with a diagnosis of major depression or dysthymia and an initial PHQ-9 or PHQ-9M score greater than nine during the index event. Patients may be assessed using PHQ-9 or PHQ-9M on the same date or up to... 7 days prior to the encounter (index event). Show more >Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older with a diagnosis of major depression or dysthymia and an initial PHQ-9 or PHQ-9M score greater than nine during the index event. Patients may be assessed using PHQ-9 or PHQ-9M on the same date or up to 7 days prior to the encounter (index event). Show less |
Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older with a diagnosis of major depression or dysthymia and an initial PHQ-9 or PHQ-9M score greater than nine during the index event. Patients may be assessed using PHQ-9 or PHQ-9M on the same date or up to... 7 days prior to the encounter (index event). Show more >Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older with a diagnosis of major depression or dysthymia and an initial PHQ-9 or PHQ-9M score greater than nine during the index event. Patients may be assessed using PHQ-9 or PHQ-9M on the same date or up to 7 days prior to the encounter (index event). Show less |
Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older with a diagnosis of major depression or dysthymia and an initial PHQ-9 or PHQ-9M score greater than nine during the index event. Patients may be assessed using PHQ-9 or PHQ-9M on the same date or up to... 7 days prior to the encounter (index event). Show more >Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older with a diagnosis of major depression or dysthymia and an initial PHQ-9 or PHQ-9M score greater than nine during the index event. Patients may be assessed using PHQ-9 or PHQ-9M on the same date or up to 7 days prior to the encounter (index event). Show less |
| Denominator |
Equals Initial Population |
Equals Initial Population |
Equals Initial Population |
Equals Initial Population |
| Denominator Exclusions | 1: Patients who died any time prior to the end of the measure assessment period 2: Patients who received hospice or palliative care services between the start of the denominator period and the end of the measurement assessment period3: Patients who were permanent nursing home residents...between the start of the denominator period and the end of the measurement assessment period 4: Patients with a diagnosis of bipolar disorder any time prior to the end of the measure assessment period 5: Patients with a diagnosis of personality disorder emotionally labile any time prior to the end of the measure assessment period 6: Patients with a diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period 7: Patients with a diagnosis of pervasive developmental disorder any time prior to the end of the measure assessment period Show more >1: Patients who died any time prior to the end of the measure assessment period 2: Patients who received hospice or palliative care services between the start of the denominator period and the end of the measurement assessment period 3: Patients who were permanent nursing home residents between the start of the denominator period and the end of the measurement assessment period 4: Patients with a diagnosis of bipolar disorder any time prior to the end of the measure assessment period 5: Patients with a diagnosis of personality disorder emotionally labile any time prior to the end of the measure assessment period 6: Patients with a diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period 7: Patients with a diagnosis of pervasive developmental disorder any time prior to the end of the measure assessment period Show less |
1: Patients who died any time prior to the end of the measure assessment period 2: Patients who received hospice or palliative care services between the start of the denominator period and the end of the measurement assessment period3: Patients with a diagnosis of bipolar disorder any...time prior to the end of the measure assessment period 4: Patients with a diagnosis of personality disorder emotionally labile any time prior to the end of the measure assessment period 5: Patients with a diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period 6: Patients with a diagnosis of pervasive developmental disorder any time prior to the end of the measure assessment period Show more >1: Patients who died any time prior to the end of the measure assessment period 2: Patients who received hospice or palliative care services between the start of the denominator period and the end of the measurement assessment period 3: Patients with a diagnosis of bipolar disorder any time prior to the end of the measure assessment period 4: Patients with a diagnosis of personality disorder emotionally labile any time prior to the end of the measure assessment period 5: Patients with a diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period 6: Patients with a diagnosis of pervasive developmental disorder any time prior to the end of the measure assessment period Show less |
- Patients who died any time prior to the end of the measure assessment period - Patients who received hospice or palliative care services between the start of the denominator period and the end of the measurement assessment period- Patients with a diagnosis of bipolar disorder any time...prior to the end of the measure assessment period - Patients with a diagnosis of personality disorder emotionally labile any time prior to the end of the measure assessment period - Patients with a diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period - Patients with a diagnosis of pervasive developmental disorder any time prior to the end of the measure assessment period Show more >- Patients who died any time prior to the end of the measure assessment period - Patients who received hospice or palliative care services between the start of the denominator period and the end of the measurement assessment period - Patients with a diagnosis of bipolar disorder any time prior to the end of the measure assessment period - Patients with a diagnosis of personality disorder emotionally labile any time prior to the end of the measure assessment period - Patients with a diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period - Patients with a diagnosis of pervasive developmental disorder any time prior to the end of the measure assessment period Show less |
- Patients who died any time prior to the end of the measure assessment period - Patients who received hospice or palliative care services between the start of the denominator period and the end of the measurement assessment period- Patients with a diagnosis of bipolar disorder any time...prior to the end of the measure assessment period - Patients with a diagnosis of personality disorder emotionally labile any time prior to the end of the measure assessment period - Patients with a diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period - Patients with a diagnosis of pervasive developmental disorder (e.g., autism spectrum disorder) any time prior to the end of the measure assessment period Show more >- Patients who died any time prior to the end of the measure assessment period - Patients who received hospice or palliative care services between the start of the denominator period and the end of the measurement assessment period - Patients with a diagnosis of bipolar disorder any time prior to the end of the measure assessment period - Patients with a diagnosis of personality disorder emotionally labile any time prior to the end of the measure assessment period - Patients with a diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period - Patients with a diagnosis of pervasive developmental disorder (e.g., autism spectrum disorder) any time prior to the end of the measure assessment period Show less |
| Numerator |
Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older who achieved remission at twelve months as demonstrated by the most recent twelve month (+/- 60 days) PHQ-9 or PHQ-9M score of less than five |
Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older who achieved remission at twelve months as demonstrated by the most recent twelve month (+/- 60 days) PHQ-9 or PHQ-9M score of less than five |
Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older who achieved remission at twelve months as demonstrated by the most recent twelve month (+/- 60 days) PHQ-9 or PHQ-9M score of less than five |
Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older who achieved remission at twelve months as demonstrated by the most recent twelve month (+/- 60 days) PHQ-9 or PHQ-9M score of less than five |
| Numerator Exclusions |
Not Applicable |
Not Applicable |
Not Applicable |
None |
| Denominator Exceptions |
None |
None |
None |
None |
| Telehealth Eligible | Yes | Yes | Yes | Yes |
| Next Version | No Version Available | |||
| Previous Version | No Version Available |
Additional Resources for CMS159v11
*Note there may be more tickets for CMS159v11 in the eCQM Tracker - ASTP/ONC Project Tracking System (Jira). Only tickets tagged with their associated CMS measure ID appear.
Use the eCQM Tracker to open new issues regarding eCQM implementation. Log in required.
Header
Revised formatting and grammar to improve readability.
Measure Section: Description
Source of Change: Measure Lead
Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update
Updated references.
Measure Section: Reference
Source of Change: Measure Lead
Updated version number of the Quality Data Model (QDM) used in the measure specification to v5.6.
Measure Section: Guidance
Source of Change: Standards/Technical Update
Replaced reference to 'baseline assessment' with 'index assessment' to align with the phrase used elsewhere in the header and logic.
Measure Section: Guidance
Source of Change: Measure Lead
Added denominator exclusion timeframes to reflect the measure logic.
Measure Section: Denominator Exclusions
Source of Change: Measure Lead
Added clarifying text of 'most recent' depression assessment to align with the logic.
Measure Section: Numerator
Source of Change: Measure Lead
Revised formatting and grammar for improved clarity and readability.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Logic
Updated the version of the Quality Data Model (QDM) to 5.6 and Clinical Quality Language (CQL) to 1.5.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v7.0.000.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
Replaced the Global.CalendarAgeInYearsAt function with the native CQL function AgeInYearsAt to take advantage of existing CQL features and increase human readability.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Updated logic to use 'let' statement and updated the timing precision in the definitions from datetime to date by adding 'day of', 'date from', and/or function 'ToDate' to align with the measure intent.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Updated denominator exclusion logic related to patients who receive hospice or palliative care to better harmonize with other measures, and restricted the lookback period to begin during the denominator identification period.
Measure Section: Multiple Sections
Source of Change: ONC Project Tracking System (JIRA): CQM-4194
Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
Value set
The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.
Added direct reference code SNOMED CT code (428361000124107) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Removed two value sets (Palliative Care Encounter 2.16.840.1.113883.3.600.1.1575 and Palliative or Hospice Care 2.16.840.1.113883.3.600.1.1579) and added five value sets (Hospice Care Ambulatory 2.16.840.1.113883.3.526.3.1584, Hospice Encounter 2.16.840.1.113883.3.464.1003.1003, Palliative Care Encounter 2.16.840.1.113883.3.464.1003.101.12.1090, Palliative Care Intervention 2.16.840.1.113883.3.464.1003.198.12.1135, and Encounter Inpatient 2.16.840.1.113883.3.666.5.307) to harmonize with other measures and better identify patients receiving hospice or palliative care for denominator exclusion.
Measure Section: Terminology
Source of Change: ONC Project Tracking System (JIRA): CQM-4194
Value set Contact or Office Visit (2.16.840.1.113762.1.4.1080.5): Added 8 CPT codes (99384, 99394, 99385, 99386, 99387, 99395, 99396, 99397) based on review by technical experts, SMEs, and/or public feedback. Deleted 1 CPT code (99201) based on terminology update.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (428371000124100) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code ICD-10-CM code (Z51.5) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code LOINC code (71007-9) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code LOINC code (45755-6) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (373066001) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead