AdultMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR
type: Measure
node role: treeRoot
id:
  v: AdultMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR
meta:
  profile:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm
    l: computable-measure-cqfm
  profile:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm
    l: publishable-measure-cqfm
  profile:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm
    l: executable-measure-cqfm
text:
  status:
    v: extensions
  div:
    v: Title: Adult Major Depressive Disorder (MDD): Suicide Risk AssessmentFHIR Id: AdultMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR Download cql: AdultMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR.cql Version: 0.0.004 Url: Adult Major Depressive Disorder (MDD): Suicide Risk AssessmentFHIR short-name identifier: CMS161FHIR version-independent identifier: urn:uuid:9e056df9-6c0c-4847-a88e-bc9932dd69bd version-specific identifier: urn:uuid:2c928085806c39a20180859994bf050e endorser (NQF) identifier: 0104e publisher (CMS) identifier: 161FHIR Effective Period: 2024-01-01 ..2024-12-31 Status: draft Date: 2023-10-27 08:12:31+0000 Approval Date: 2023-08-14 Last Review Date: 2023-08-14 Name: AdultMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR Publisher: Mathematica Author: Mathematica: https://www.mathematica.org/, American Medical Association (AMA): https://www.ama-assn.org/ Description: Percentage of all patient visits for those patients that are 17 years of age or older at the start of the measurement period in which a new or recurrent diagnosis of major depressive disorder (MDD) was identified and a suicide risk assessment was completed during the visit Use Context: code value program Purpose: UNKNOWN Copyright: Copyright 2023 Mathematica Inc. All Rights Reserved. The PCPI and American Medical Association's (AMA) significant past efforts and contributions to the development and updating of the Measure is acknowledged. Disclaimer: The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commerc…
contained: Library
  id:
    v: effective-data-requirements
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://hl7.org/fhir/v3/AdministrativeGender
        l: AdministrativeGender
      code:
        v: M
      display:
        v: Male
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://hl7.org/fhir/v3/AdministrativeGender
        l: AdministrativeGender
      code:
        v: F
      display:
        v: Female
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/v3-ActCode
        l: v3-ActCode
      code:
        v: AMB
      display:
        v: Ambulatory
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      type: http://snomed.info/id/225337009
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 225337009
      display:
        v: Suicide risk assessment (procedure)
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: SupplementalDataElements
    extension:
      url:
        v: name
        l: name
      value: String
        v: SDE Sex
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "SDE Sex": case when Patient.gender = 'male' then "M" when Patient.gender = 'female' then "F" else null end
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 0
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: AdultMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR
    extension:
      url:
        v: name
        l: name
      value: String
        v: SDE Sex
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "SDE Sex": SDE."SDE Sex"
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 1
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: AdultMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR
    extension:
      url:
        v: name
        l: name
      value: String
        v: Major Depressive Disorder Encounter
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "Major Depressive Disorder Encounter": ( ["Encounter": "Psych Visit Diagnostic Evaluation"] union ["Encounter": "Emergency Department Visit"] union ["Encounter": "Office Visit"] union ["Encounter": "Outpatient Consultation"] union ["Encounter": "Psych Visit Psychotherapy"] union ["Encounter": "Psychoanalysis"] union ["Encounter": "Telehealth Services"] ) ValidEncounter where ValidEncounter.status = 'finished' and ValidEncounter.class ~ "AMB" and ( ValidEncounter.reasonCode in "Major Depressive Disorder Active" or exists ( ( CQMCommon."EncounterDiagnosis" ( ValidEncounter ) ) EncounterDiagnosis where EncounterDiagnosis.code in "Major Depressive Disorder Active" ) )
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 2
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: AdultMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR
    extension:
      url:
        v: name
        l: name
      value: String
        v: New or Recurrent Major Depressive Disorder Encounter
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "New or Recurrent Major Depressive Disorder Encounter": "Major Depressive Disorder Encounter" NewOrRecurrentMDDEncounter without "Major Depressive Disorder Encounter" PriorMDDEpisodeEncounter such that ( PriorMDDEpisodeEncounter !~ NewOrRecurrentMDDEncounter and PriorMDDEpisodeEncounter.period ends 104 days or less before day of start of NewOrRecurrentMDDEncounter.period ) where NewOrRecurrentMDDEncounter.period during "Measurement Period"
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 3
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: AdultMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR
    extension:
      url:
        v: name
        l: name
      value: String
        v: Numerator
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "Numerator": "New or Recurrent Major Depressive Disorder Encounter" NewOrRecurrentMDDEncounter with ["Procedure": "Suicide risk assessment (procedure)"] SuicideRiskAssessment such that SuicideRiskAssessment.status = 'completed' and QICoreCommon."ToInterval" ( SuicideRiskAssessment.performed ) during NewOrRecurrentMDDEncounter.period

url:
  v: displaySequence
  l: displaySequence
value: Integer
  v: 4

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AdultMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Initial Population
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Initial Population": "New or Recurrent Major Depressive Disorder Encounter" NewOrRecurrentMDDEncounter where "AgeInYearsAt"(date from start of "Measurement Period") >= 17
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 5
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AdultMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Denominator
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Denominator": "Initial Population"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 6
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SupplementalDataElements
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Payer
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 7
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AdultMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Payer
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Payer": SDE."SDE Payer"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 8
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SupplementalDataElements
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Ethnicity
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 9
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AdultMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Ethnicity
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Ethnicity": SDE."SDE Ethnicity"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 10
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SupplementalDataElements
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Race
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 11
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AdultMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Race
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Race": SDE."SDE Race"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 12
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToConcept
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept. */ define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 13
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: CQMCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: EncounterDiagnosis
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Returns the Condition resource referenced by the `diagnosis.condition` element of the Encounter @deprecated: This function is deprecated. Use the fluent function `encounterDiagnosis()` instead. */ define function "EncounterDiagnosis"(Encounter Encounter ): Encounter.diagnosis D return singleton from ([Condition] C where C.id = D.condition.reference.getId())
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 14
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: QICoreCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: getId
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Returns the tail of the given uri (i.e. everything after the last slash in the URI). @comment: This function can be used to determine the logical id of a given resource. It can be used in a single-server environment to trace references. However, this function does not attempt to resolve or distinguish the base of the given url, and so cannot be used safely in multi-server environments. */ define fluent function getId(uri String): Last(Split(uri, '/'))
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 15
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToString
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToString(value uri): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 16
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToCode
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code. */ define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 17
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

v: active

coding:
  system:
    v: http://terminology.hl7.org/CodeSystem/library-type
    l: library-type
  code:
    v: module-definition

type:
  v: depends-on
display:
  v: Library SDE
resource:
  v: http://ecqi.healthit.gov/ecqms/Library/SupplementalDataElements|3.4.000
  l: http://ecqi.healthit.gov/ecqms/Library/SupplementalDataElements

type:
  v: depends-on
display:
  v: Library FHIRHelpers
resource:
  v: http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers|4.3.000
  l: http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers

type:
  v: depends-on
display:
  v: Library CQMCommon
resource:
  v: http://ecqi.healthit.gov/ecqms/Library/CQMCommon|1.4.000
  l: http://ecqi.healthit.gov/ecqms/Library/CQMCommon

type:
  v: depends-on
display:
  v: Library QICoreCommon
resource:
  v: http://ecqi.healthit.gov/ecqms/Library/QICoreCommon|1.5.000
  l: http://ecqi.healthit.gov/ecqms/Library/QICoreCommon

type:
  v: depends-on
display:
  v: Code system AdministrativeGender
resource:
  v: http://hl7.org/fhir/v3/AdministrativeGender
  l: AdministrativeGender

type:
  v: depends-on
display:
  v: Code system ActCode
resource:
  v: http://terminology.hl7.org/CodeSystem/v3-ActCode
  l: v3-ActCode

type:
  v: depends-on
display:
  v: Code system SNOMEDCT
resource:
  v: http://snomed.info/sct
  l: sct

type:
  v: depends-on
display:
  v: Value set Psych Visit Diagnostic Evaluation
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1492
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1492

type:
  v: depends-on
display:
  v: Value set Emergency Department Visit
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010

type:
  v: depends-on
display:
  v: Value set Office Visit
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001

type:
  v: depends-on
display:
  v: Value set Outpatient Consultation
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008

type:
  v: depends-on
display:
  v: Value set Psych Visit Psychotherapy
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1496
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1496

type:
  v: depends-on
display:
  v: Value set Psychoanalysis
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1141
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1141

type:
  v: depends-on
display:
  v: Value set Telehealth Services
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1031
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1031

type:
  v: depends-on
display:
  v: Value set Major Depressive Disorder Active
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1491
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1491

type:
  v: depends-on
display:
  v: Value set Payer Type
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591

name:
  v: Measurement Period
use:
  v: in
min:
  v: 0
max:
  v: 1
type:
  v: Period

name:
  v: SDE Sex
use:
  v: out
min:
  v: 0
max:
  v: 1
type:
  v: Coding

name:
  v: Numerator
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Resource

name:
  v: Denominator
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Resource

name:
  v: SDE Payer
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Resource

name:
  v: Initial Population
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Resource

name:
  v: SDE Ethnicity
use:
  v: out
min:
  v: 0
max:
  v: 1
type:
  v: Resource

name:
  v: SDE Race
use:
  v: out
min:
  v: 0
max:
  v: 1
type:
  v: Resource

type:
  v: Patient
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
  l: qicore-patient
must support:
  v: ethnicity
must support:
  v: race

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition
  l: qicore-condition
must support:
  v: id
must support:
  v: id.value
must support:
  v: code

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: condition
must support:
  v: condition.reference
must support:
  v: condition.reference.value
must support:
  v: status
must support:
  v: status.value
must support:
  v: class
must support:
  v: reasonCode
must support:
  v: period
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1492
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1492

type:
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v: AdultMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR

v: Adult Major Depressive Disorder (MDD): Suicide Risk AssessmentFHIR

v: draft

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v: 2023-10-27T08:12:31+00:00

v: Mathematica

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v: Percentage of all patient visits for those patients that are 17 years of age or older at the start of the measurement period in which a new or recurrent diagnosis of major depressive disorder (MDD) was identified and a suicide risk assessment was completed during the visit

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v: UNKNOWN

v: This eCQM is an episode-based measure and should be reported for each instance of a new or recurrent episode of major depressive disorder (MDD) during the measurement period. This measure should be reported for each eligible encounter during which a new or recurrent episode of MDD is identified in adults that turn 18 or older during the measurement period. As the guidelines state, it is important to assess for additional factors which may increase or decrease suicide risk, such as presence of additional symptoms (e.g., psychosis, severe anxiety, hopelessness, severe chronic pain); presence of substance abuse; history and seriousness of previous attempts, particularly, recent suicidal behavior; current stressors and potential protective factors (e.g., positive reasons for living, strong social support); family history of suicide or mental illness or recent exposure to suicide; impulsivity and potential for risk to others, including history of violence or violent or homicidal ideas, plans, or intentions; and putting one's affairs in order (e.g., giving away possessions, writing a will). In addition, although the measure focuses on the initial visit, it is critical that suicide risk be monitored especially for the 90 days following the initial visit and throughout MDD treatment. It is expected that a suicide risk assessment will be completed at the visit during which a new diagnosis is made or at the visit during which a recurrent episode is first identified (i.e., at the initial evaluation). For the purposes of this measure, an episode of MDD would be considered to be recurrent if a patient has not had an MDD-related encounter in the past 105 days. If there is a gap of 105 or more days between visits for MDD, that would imply a recurrent episode. The 105-day look-back period is an operational provision and not a clinical recommendation, or definition of relapse, remission, or recurrence. In recognition of the growing use of integrated and team-based care, the diagnosi…

v: Copyright 2023 Mathematica Inc. All Rights Reserved. The PCPI and American Medical Association's (AMA) significant past efforts and contributions to the development and updating of the Measure is acknowledged.

v: 2023-08-14

v: 2023-08-14

start:
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end:
  v: 2024-12-31

name:
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name:
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v: The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measure require a license agreement between the user and Mathematica. Neither Mathematica, the PCPI, nor the American Medical Association (AMA), nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor their members shall be responsible for any use of the Measure. Mathematica encourages use of the Measure by other health care professionals, where appropriate. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding may be contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party's use of Current Procedural Terminology (CPT[R]) or other proprietary code set contained in the Measure. Any other use of CPT or other coding by a third party is strictly prohibited. Mathematica, the AMA, and former members of the PCPI disclaim all liability for use or accuracy of any CPT(R) or other coding contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) is copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2022 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by…

v: This measure aims to improve rates of clinician assessment of suicide risk during an encounter where a new or recurrent episode of major depressive disorder (MDD) is identified. In an epidemiologic study of mental illness in the United States with a large, representative sample, 69% of respondents with lifetime suicide attempts had also met diagnostic criteria for MDD. When considering other mood disorders related to depression, such as dysthymia and bipolar disorders, this rate increases to 74% (Bolton & Robinson, 2010). In a study of individuals who had died by suicide and were enrolled in one of eight major health systems in the United States, individuals with a depressive disorder diagnosis had 7.20 increased odds of dying by suicide within one year, after adjusting for age and sociodemographic factors (Yeh et al., 2019). A recent meta-analysis (Moitra et al., 2021) presented similar findings in which depressive disorder conferred a predictive relative risk for suicide of 7.64 after adjusting for relevant factors. Suicide is associated with increased use of healthcare services, which provides an opportunity for intervention through assessment and intervention. Individuals who die by suicide are more likely to have any healthcare utilization (Ahmedani et al., 2019) and a higher frequency of healthcare visits than the general population (Chock, Bommersbach, Geske, & Bostwick, 2015). A study of individuals who died by suicide and were enrolled within one of eight health systems in the Mental Health Research Network in the United States found that 50% of these individuals had been seen in a healthcare setting within four weeks prior to death (Ahmedani et al., 2014). Better assessment and identification of suicide risk in the healthcare setting should lead to improved connection to treatment and reduction in suicide attempts and deaths by suicide. A recent analysis of depression severity and suicidal ideation symptom trajectories (Witt et al., 2021) found that suicid…

v: A careful and ongoing evaluation of suicide risk is necessary for all patients with major depressive disorder (American Psychiatric Association, 2010a). Such an assessment includes specific inquiry about suicidal thoughts, intent, plans, means, and behaviors; identification of specific psychiatric symptoms (e.g., psychosis, severe anxiety, substance use, hopelessness, insomnia, agitation) or general medical conditions that may increase the likelihood of acting on suicidal ideas; assessment of past and, particularly, recent suicidal behavior; delineation of current stressors and potential protective factors (e.g., positive reasons for living, strong social support); and identification of any family history of suicide or mental illness (American Psychiatric Association, 2010a; Department of Veterans Affairs and Department of Defense, 2019). As part of the assessment process, impulsivity and potential for risk to others should also be evaluated, including any history of violence or violent or homicidal ideas, plans, or intentions, or the availability of firearms (American Psychiatric Association, 2010a; Department of Veterans Affairs and Department of Defense, 2019). The patient's risk of harm to him- or herself and to others should also be monitored as treatment proceeds (American Psychiatric Association, 2010a). Guidelines for Selecting a Treatment Setting for Patients at Risk for Suicide or Suicidal Behaviors (from American Psychiatric Association’s Practice Guideline for Assessment and Treatment of Patients With Suicidal Behaviors, 2010b): ADMISSION GENERALLY INDICATED After a suicide attempt or aborted suicide attempt if: - Patient is psychotic - Attempt was violent, near-lethal, or premeditated - Precautions were taken to avoid rescue or discovery - Persistent plan and/or intent is present - Distress is increased or patient regrets surviving - Patient is male, older than age 45 years, especially with new onset of psychiatric illness or suicidal thinking - Patient…

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