eMeasure Title Depression Remission at Twelve Months
eMeasure Identifier
(Measure Authoring Tool)
159 eMeasure Version number 3
NQF Number 0710 GUID 8455cd3e-dbb9-4e0c-8084-3ece4068fe94
Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward MN Community Measurement
Measure Developer MN Community Measurement
Endorsed By National Quality Forum
Description
Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at twelve months defined as PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment
Copyright
Copyright MN Community Measurement, 2014. All rights reserved.
Disclaimer
This measure is “re-tooled” from the existing NQF # 710 measure. eMeasure development was a collaboration between MN Community Measurement and Telligen with technical assistance provided by Telligen.
Measure Scoring Proportion
Measure Type Outcome
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
The Centers for Disease Control and Prevention states that nationally 15.7% of people report being told by a health care professional that they had depression at some point in their lifetime. Persons with a current diagnosis of depression and a lifetime diagnosis of depression or anxiety were significantly more likely than persons without these conditions to have cardiovascular disease, diabetes, asthma and obesity and to be a current smoker, to be physically inactive and to drink heavily. According to National Institute of Mental Health (NIMH), 6.7 percent of the U.S. population ages 18 and older (14.8 million people) in any given year have a diagnosis of a major depressive disorder. Major depression is the leading cause of disability in the U.S. for ages 15 - 44. Additionally, dysthymia accounts for an additional 3.3 million Americans.
Clinical Recommendation Statement
Improvement in the symptoms of depression and an ongoing assessment of the current treatment plan is crucial to the reduction of symptoms and psychosocial well being of patients with major depression. Most people treated for initial depression need to be on medication at least six to twelve months after adequate response to symptoms, patients with recurrent depression need to be treated for three years or more and response with psychotherapy can take eight to twelve weeks of regular and frequent therapy to show improvement. Remission is defined as a PHQ-9 score of less than five at twelve months. The Patient Health Questionnaire (PHQ-9) tool is a widely accepted, standardized tool [Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute.] that is completed by the patient, ideally at each visit, and utilized by the provider to monitor treatment progress. This tool was selected for measuring outcomes for this population because it is 1) validated with a sensitivity of .080 and a specificity of 0.92 with substantial heterogeneity I2 = 82%, 2) widely accepted and utilized in Minnesota, 3) available for clinical use, 4) translated into many languages and 5) easy for the patient to complete and the provider to score. Available at www.phqscreeners.com. This nine question tool contains the following questions which are scored on a scale of 0 to 27 based on the scale of Not at All (0), Several Days (1), More Than Half the Days (2), or Nearly Every Day (3) for responses to the questions over the last 2 weeks. 

• Little interest or pleasure in doing things 
• Feeling down, depressed, or hopeless
• Feeling tired or having little energy 
• Poor appetite or overeating 
• Feeling bad about yourself - or that you are a failure or have let yourself or your family down 
• Trouble concentrating on things, such as reading the newspaper or watching television 
• Moving or speaking so slowly that other people could have noticed? Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual 
• Thoughts that you would be better off dead or of hurting yourself in some way
Improvement Notation
Higher score indicates better quality
Reference
Institute for Clinical Systems Improvement (ICSI) Major Depression in Adults in Primary Care 15th edition May 2012 www.icsi.org
Reference
www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america
Reference
National Institute of Mental Health: The Numbers Count: Mental Disorders in America August 2009
Reference
Screening for Depression in Medical Settings with the Patient Health Questionnaire (PHQ) A Diagnostic Meta Analysis. Gilbody, Simon et al Journal of General Internal Medicine Sept 2007
Reference
The PHQ-9: Validity of a Brief Depression Severity Measure Kurt Kroenke, MD, Robert Spitzer, MD J Gen Intern Med 2001 16:606-613
Definition
Remission is defined as a PHQ-9 score of less than five

Twelve Months is defined as the point in time from the date in the measurement period that a patient meets the inclusion criteria (diagnosis and elevated PHQ-9 > 9) extending out twelve months and then allowing a grace period of thirty days prior to and thirty days after this date. Any PHQ-9 less than five obtained during this period is deemed as remission at twelve months, values obtained prior to or after this period are not counted as numerator compliant (remission)
Guidance
None
Transmission Format
TBD
Initial Patient Population
Adults age 18 and older with a diagnosis of major depression or dysthymia and an initial PHQ-9 score greater than nine during an outpatient encounter.
Denominator
Equals the Initial Patient Population
Denominator Exclusions
1: Patients who died
2: Patients who received hospice services
3: Patients who were permanent nursing home residents
4: Patients with a diagnosis of bipolar disorder
5: Patients with a diagnosis of personality disorder
Numerator
Adults who achieved remission at twelve months as demonstrated by a twelve month (+/- 30 days) PHQ-9 score of less than five.
Numerator Exclusions
None
Denominator Exceptions
None
Measure Population
Not Applicable
Measure Observations
Not Applicable
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements




Measure Set
None