eCQM Title | Preventive Care and Screening: Screening for Depression and Follow-Up Plan |
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eCQM Identifier (Measure Authoring Tool) | 2 | eCQM Version number | 9.1.000 |
NQF Number | 0418e | GUID | 9a031e24-3d9b-11e1-8634-00237d5bf174 |
Measurement Period | January 1, 20XX through December 31, 20XX | ||
Measure Steward | Centers for Medicare & Medicaid Services (CMS) | ||
Measure Developer | Quality Insights | ||
Endorsed By | National Quality Forum | ||
Description | |||
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Measure Scoring | Proportion | ||
Measure Type | Process | ||
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Definition | |||
Guidance | |||
Transmission Format | |||
Initial Population | |||
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Denominator Exclusions | |||
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Denominator Exceptions | |||
Supplemental Data Elements |
"Patient Age 12 Years or Older at Start of Measurement Period" and exists ( "Qualifying Encounter for Depression Screening" )
"Initial Population"
"Has Diagnosis of Bipolar Starting Before Qualifying Encounter" or "Has Diagnosis of Depression Starting Before Qualifying Encounter"
( "Patient Age 12 to 17 Years at Start of Measurement Period" and ( "Most Recent Adolescent Depression Screening Negative" is not null or "Follow up for Positive Adolescent Depression Screening" ) ) or ( "Patient Age 18 Years or Older at Start of Measurement Period" and ( "Most Recent Adult Depression Screening Negative" is not null or "Follow up for Positive Adult Depression Screening" ) )
( ( "Has No Adolescent Depression Screening Due to Medical Reason" or "Has No Adolescent Depression Screening Due to Patient Reason" ) and not "Has Adolescent Depression Screening" ) or ( ( "Has No Adult Depression Screening Due to Medical Reason" or "Has No Adult Depression Screening Due to Patient Reason" ) and not "Has Adult Depression Screening" )
["Intervention, Performed": "Additional evaluation for depression - adolescent"] AdditionalEvalAdolescent with "Encounter Associated with Most Recent Positive Adolescent Depression Screening" PositiveAdolescentScreeningEncounter such that AdditionalEvalAdolescent.authorDatetime same day as start of PositiveAdolescentScreeningEncounter.relevantPeriod
["Intervention, Performed": "Additional evaluation for depression - adult"] AdditionalEvalAdult with "Encounter Associated with Most Recent Positive Adult Depression Screening" PositiveAdultScreeningEncounter such that AdditionalEvalAdult.authorDatetime same day as start of PositiveAdultScreeningEncounter.relevantPeriod
"Initial Population"
( ( "Has No Adolescent Depression Screening Due to Medical Reason" or "Has No Adolescent Depression Screening Due to Patient Reason" ) and not "Has Adolescent Depression Screening" ) or ( ( "Has No Adult Depression Screening Due to Medical Reason" or "Has No Adult Depression Screening Due to Patient Reason" ) and not "Has Adult Depression Screening" )
"Has Diagnosis of Bipolar Starting Before Qualifying Encounter" or "Has Diagnosis of Depression Starting Before Qualifying Encounter"
"Qualifying Encounter for Depression Screening" QualifyingEncounter with "Most Recent Adolescent Depression Screening Positive" AdolescentScreening such that AdolescentScreening.authorDatetime 14 days or less before or on day of start of QualifyingEncounter.relevantPeriod
"Qualifying Encounter for Depression Screening" QualifyingEncounter with "Most Recent Adult Depression Screening Positive" AdolescentScreening such that AdolescentScreening.authorDatetime 14 days or less before or on day of start of QualifyingEncounter.relevantPeriod
exists ( "Additional Evaluation for Depression as Follow Up for Adolescent" ) or exists ( "Pharmacologic Depression Treatment as Follow Up for Adolescent" ) or exists ( "Referral for Positive Adolescent Depression Screen" ) or exists ( "Suicide Assessment as Follow Up for Adolescent" ) or exists ( "Recommended Follow up for Positive Adolescent Depression Screen" )
exists ( "Additional Evaluation for Depression as Follow Up for Adult" ) or exists ( "Pharmacologic Depression Treatment as Follow Up for Adult" ) or exists ( "Referral for Positive Adult Depression Screen" ) or exists ( "Suicide Assessment as Follow Up for Adult" ) or exists ( "Recommended Follow up for Positive Adult Depression Screen" )
exists ( ["Assessment, Performed": "Adolescent depression screening assessment"] AdolescentScreening with "Qualifying Encounter for Depression Screening" QualifyingEncounter such that AdolescentScreening.authorDatetime 14 days or less before or on day of start of QualifyingEncounter.relevantPeriod and AdolescentScreening.result is not null )
exists ( ["Assessment, Performed": "Adult depression screening assessment"] AdultScreening with "Qualifying Encounter for Depression Screening" QualifyingEncounter such that AdultScreening.authorDatetime 14 days or less before or on day of start of QualifyingEncounter.relevantPeriod and AdultScreening.result is not null )
exists ( ["Diagnosis": "Bipolar Diagnosis"] DiagnosisBipolar with "Qualifying Encounter for Depression Screening" QualifyingEncounter such that DiagnosisBipolar.prevalencePeriod overlaps before QualifyingEncounter.relevantPeriod )
exists ( ["Diagnosis": "Depression diagnosis"] DiagnosisDepression with "Qualifying Encounter for Depression Screening" QualifyingEncounter such that DiagnosisDepression.prevalencePeriod overlaps before QualifyingEncounter.relevantPeriod )
exists ( ["Assessment, Not Performed": "Adolescent depression screening assessment"] ScreeningNotPerformedAdolescent with "Qualifying Encounter for Depression Screening" QualifyingEncounter such that ScreeningNotPerformedAdolescent.negationRationale in "Medical or Other reason not done" and ScreeningNotPerformedAdolescent.authorDatetime during QualifyingEncounter.relevantPeriod )
exists ( ["Assessment, Not Performed": "Adolescent depression screening assessment"] ScreeningNotPerformedAdolescent with "Qualifying Encounter for Depression Screening" QualifyingEncounter such that ScreeningNotPerformedAdolescent.negationRationale in "Patient Reason refused" and ScreeningNotPerformedAdolescent.authorDatetime during QualifyingEncounter.relevantPeriod )
exists ( ["Assessment, Not Performed": "Adult depression screening assessment"] ScreeningNotPerfomedAdult with "Qualifying Encounter for Depression Screening" QualifyingEncounter such that ScreeningNotPerfomedAdult.negationRationale in "Medical or Other reason not done" and ScreeningNotPerfomedAdult.authorDatetime during QualifyingEncounter.relevantPeriod )
exists ( ["Assessment, Not Performed": "Adult depression screening assessment"] ScreeningNotPerformedAdult with "Qualifying Encounter for Depression Screening" QualifyingEncounter such that ScreeningNotPerformedAdult.negationRationale in "Patient Reason refused" and ScreeningNotPerformedAdult.authorDatetime during QualifyingEncounter.relevantPeriod )
"Patient Age 12 Years or Older at Start of Measurement Period" and exists ( "Qualifying Encounter for Depression Screening" )
Last(["Assessment, Performed": "Adolescent depression screening assessment"] LastAdolescentScreen with "Qualifying Encounter for Depression Screening" QualifyingEncounter such that LastAdolescentScreen.authorDatetime 14 days or less before or on day of start of QualifyingEncounter.relevantPeriod and LastAdolescentScreen.result is not null sort by authorDatetime )
"Most Recent Adolescent Depression Screening" RecentAdolescentScreening where RecentAdolescentScreening.result in "Negative Depression Screening"
"Most Recent Adolescent Depression Screening" RecentAdolescentScreening where RecentAdolescentScreening.result in "Positive Depression Screening"
Last(["Assessment, Performed": "Adult depression screening assessment"] LastAdultScreen with "Qualifying Encounter for Depression Screening" QualifyingEncounter such that LastAdultScreen.authorDatetime 14 days or less before or on day of start of QualifyingEncounter.relevantPeriod and LastAdultScreen.result is not null sort by authorDatetime )
"Most Recent Adult Depression Screening" RecentAdultScreening where RecentAdultScreening.result in "Negative Depression Screening"
"Most Recent Adult Depression Screening" RecentAdultScreening where RecentAdultScreening.result in "Positive Depression Screening"
( "Patient Age 12 to 17 Years at Start of Measurement Period" and ( "Most Recent Adolescent Depression Screening Negative" is not null or "Follow up for Positive Adolescent Depression Screening" ) ) or ( "Patient Age 18 Years or Older at Start of Measurement Period" and ( "Most Recent Adult Depression Screening Negative" is not null or "Follow up for Positive Adult Depression Screening" ) )
exists ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global.CalendarAgeInYearsAt(BirthDate.birthDatetime, start of "Measurement Period")< 18
exists ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global.CalendarAgeInYearsAt(BirthDate.birthDatetime, start of "Measurement Period")>= 12
exists ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global.CalendarAgeInYearsAt(BirthDate.birthDatetime, start of "Measurement Period")>= 18
["Medication, Order": "Depression medications - adolescent"] DepressionMedicationOrderAdolescent with "Encounter Associated with Most Recent Positive Adolescent Depression Screening" PositiveAdolescentScreeningEncounter such that DepressionMedicationOrderAdolescent.authorDatetime same day as start of PositiveAdolescentScreeningEncounter.relevantPeriod
["Medication, Order": "Depression medications - adult"] MedicationOrderAdult with "Encounter Associated with Most Recent Positive Adult Depression Screening" PositiveAdultScreeningEncounter such that MedicationOrderAdult.authorDatetime same day as start of PositiveAdultScreeningEncounter.relevantPeriod
["Encounter, Performed": "Depression Screening Encounter Codes"] ValidEncounter where ValidEncounter.relevantPeriod during "Measurement Period"
["Intervention, Performed": "Follow-up for depression - adolescent"] FollowupAdolescent with "Encounter Associated with Most Recent Positive Adolescent Depression Screening" PositiveAdolescentScreenEncounter such that FollowupAdolescent.authorDatetime same day as start of PositiveAdolescentScreenEncounter.relevantPeriod
["Intervention, Performed": "Follow-up for depression - adult"] FollowupAdult with "Encounter Associated with Most Recent Positive Adult Depression Screening" PositiveAdultScreenEncounter such that FollowupAdult.authorDatetime same day as start of PositiveAdultScreenEncounter.relevantPeriod
["Intervention, Order": "Referral for Depression Adolescent"] ReferralForAdolescent with "Encounter Associated with Most Recent Positive Adolescent Depression Screening" PositiveAdolescentScreenEncounter such that ReferralForAdolescent.authorDatetime same day as start of PositiveAdolescentScreenEncounter.relevantPeriod
["Intervention, Order": "Referral for Depression Adult"] ReferralForAdult with "Encounter Associated with Most Recent Positive Adult Depression Screening" PositiveAdultScreenEncounter such that ReferralForAdult.authorDatetime same day as start of PositiveAdultScreenEncounter.relevantPeriod
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
["Assessment, Performed": "Suicide Risk Assessment"] AssessSuicideRisk with "Encounter Associated with Most Recent Positive Adolescent Depression Screening" PositiveAdolescentScreenEncounter such that AssessSuicideRisk.authorDatetime same day as start of PositiveAdolescentScreenEncounter.relevantPeriod
["Assessment, Performed": "Suicide Risk Assessment"] AssessSuicideRisk with "Encounter Associated with Most Recent Positive Adult Depression Screening" PositiveAdultScreenEncounter such that AssessSuicideRisk.authorDatetime same day as start of PositiveAdultScreenEncounter.relevantPeriod
years between ToDate(BirthDateTime)and ToDate(AsOf)
DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezone from Value)
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
Measure Set |