eMeasure Title

Maternal Depression Screening

eMeasure Identifier (Measure Authoring Tool) 82 eMeasure Version number 4.0.000
NQF Number Not Applicable GUID 8e6c8479-99fd-4949-b0ad-24fa60fe4201
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward National Committee for Quality Assurance
Measure Developer National Committee for Quality Assurance
Endorsed By None
Description
The percentage of children who turned 6 months of age during the measurement year, who had a face-to-face visit between the clinician and the child during child's first 6 months, and who had a maternal depression screening for the mother at least once between 0 and 6 months of life.
Copyright
Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). 

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CPT(R) contained in the Measure specifications is copyright 2004-2015 American Medical Association. LOINC(R) copyright 2004-2015 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2015 International Health Terminology Standards Development Organisation. ICD-10 copyright 2015 World Health Organization. All Rights Reserved.
Disclaimer
These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

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Measure Scoring Proportion
Measure Type Process
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
Maternal depression, also known as post-partum depression, is one of the most common perinatal complications; however, the disorder often remains unrecognized, undiagnosed, and untreated (VanLandeghem, 2006). Studies suggest that over 10 percent of mothers experience depression six weeks after giving birth, whether it is minor or major. Three to 25 percent of women experience major depression during the year following childbirth (Gaynes BN, 2005; Kessler RC, 1994). The incidence of depression may be higher in women who already have young children (VanLandeghem, 2006; Gaynes BN, 2005). Maternal depression can greatly affect mothers, their baby, and their family's well-being. It can have lasting effects on a mother's self-esteem and confidence as a mother (Epperson, 1999). 

Screening is important, as mothers with post-partum depression who are not treated can have symptoms that carry over into the second year post-partum. Mothers that have had post-partum depression are also more likely to have a recurrence with subsequent children. (Epperson, 1999). There are effective treatments available, but less than half of post-partum depression cases are ever diagnosed (Gibson, 2010). Less than 50 percent of mothers with an infant child are currently being screened for post-partum depression (Gjerdingen, Crow, McGovern, Miner, Center, 2009). This measure encourages clinicians to screen new mothers for depression.
Clinical Recommendation Statement
U.S. Preventive Services Task Force (USPSTF) (2002)
The USPSTF recommends screening for depression in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and follow up for the general adult population*
Grade: B Recommendation
*NOTE: This recommendation applies to all adults.

Bright Futures (2008)
Health care professionals should screen mothers on the following topics:

Mothers of one week old infants:   
Discuss health and depression, family stress, uninvited advice, parent role.  
Differentiate between short-term "baby blues" and postpartum depression, and counsel and refer as appropriate:
It may be helpful to advise women that the "postpartum blues" are a different entity from depression. The "blues," with characteristic tearfulness, anxiety and low mood, are relatively common but are transient, peaking at 3-5 days after birth and resolving by 10-14 days.

Mothers of one month old infants:
Discuss maternal health (postpartum, checkup, depression, substance abuse)

Mothers of two month old children:
Discuss maternal health (maternal postpartum, checkup and resumption of activities, depression)
Grade: Expert Consensus

References
U.S. Preventive Services Task Force. Screening for Depression, May 2002. 

Hagan, JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove, IL: American Academy of Pediatrics
Improvement Notation
Higher score indicates better quality
Reference
Epperson, C Neill, MD.  Postpartum Major Depression: Detection and Treatment. American Family Physician. April 15, 1999.
Reference
Gaynes BN, G. et al. Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes. Summary, Evidence Report/Technology Assessment No. 119. (Prepared by the RTI-University of North Carolina Evidence based Practice Center under Contract No. 290-02-0016.) AHRQ Publication No. 05-E006-1. Rockville, MD: Agency for Healthcare Research and Quality. February 2005.
Reference
Gibson J. Screening for Postpartum Depression Not Worth the Time or Money. March 27, 2010.
Reference
Gjerdingen D, Crow S, McGovern P, Miner M, Center B. Postpartum Depression Screening at Well-Child Visits: Validity of a 2-Question Screen and the PHQ-9. Annals of Family Medicine 7:63-70 (2009).
Reference
Hagan, JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove, IL: American Academy of Pediatrics.
Reference
Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:8-19.
Reference
VanLandeghem K.  National Academy for State Health Policy.  Financing Strategies for Medicaid Reimbursement of Maternal Depression Screening by Pediatric Providers.  April 2006.
Definition
None
Guidance
The eMeasure specifies only patient's (baby) chart, looking for the newly allocated SNOMED codes that allow providers to record the screening and treatment of the mother, but the endorsed measure relies on notes from the patient's and mother's charts.
Transmission Format
TBD
Initial Population
Children with a visit who turned 6 months of age in the measurement period.
Denominator
Equals Initial Population
Denominator Exclusions
None
Numerator
Children with documentation of maternal screening or treatment for postpartum depression for the mother.
Numerator Exclusions
Not Applicable
Denominator Exceptions
None
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 Variables)

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables


Measure Set
None