Title: Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk AssessmentFHIR Id: ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR Download cql: ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR.cql Version: 0.0.003 Url: Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk AssessmentFHIR short-name identifier: CMS177FHIR version-independent identifier: urn:uuid:50d1dfcf-e2bf-41e8-bc1c-c607e5a09e79 version-specific identifier: urn:uuid:2c928085806c39a20180859de2340526 endorser (NQF) identifier: 1365e publisher (CMS) identifier: 177FHIR 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: ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR Publisher: Mathematica Author: Mathematica: https://www.mathematica.org/, American Medical Association (AMA): https://www.ama-assn.org/ Description: Percentage of patient visits for those patients aged 6 through 16 at the start of the measurement period with a diagnosis of major depressive disorder (MDD) with an assessment for suicide risk 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 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 (R) or [R]. Rationale: Research has shown that youth with major depressive disorder (MDD) are at a high risk for suicide attempts and completion - among the most significant and devastating sequelae of the disease (Fontanella et al., 2020). Suicide risk is a critical consideration in children and adolescents with MDD, and an important aspect of care that should be assessed at each visit and subsequently managed to minimize that risk. Additionally, the importance of the assessments is underscored by research (Fontanella et al., 2020; Luoma, Martin, & Pearson, 2002) that indicates that many individuals who die by suicide do make contact with primary care providers and mental health services beforehand. More specifically, approximately 15% of suicide victims aged 35 years or younger had seen a mental health professional within 1 month of suicide while approximately 23% had seen a primary care provider within 1 month of suicide (Luoma, Martin, & Pearson, 2002). A recent analysis of depression severity and suicidal ideation symptom trajectories (Witt et al., 2021) found that suicidal ideation among children and young adults (15-25 years) might not improve with depression symptom severity. This evidence suggests the potential utility of continued suicide risk screening even after improvements in depression symptoms. Better assessment and identification of suicide risk in the health care setting should lead to improved connection to treatment and reduction in suicide attempts and deaths by suicide. Clinical recommendation statement: The evaluation must include assessment for the presence of harm to self or others (American Academy of Child and Adolescent Psychiatry, 2007). Suicidal behavior exists along a continuum from passive thoughts of death to a clearly developed plan and intent to carry out that plan. Because depression is closely associated with suicidal thoughts and behavior, it is imperative to evaluate these symptoms at the initial and subsequent assessments. For this purpose, low burden tools to track suicidal ideation and behavior such as the Columbia-Suicidal Severity Rating Scale can be used. Also, it is crucial to evaluate the risk (e.g., age, sex, stressors, comorbid conditions, hopelessness, impulsivity) and protective factors (e.g., religious belief, concern not to hurt family) that might influence the desire to attempt suicide. The risk for suicidal behavior increases if there is a history of suicide attempts, comorbid psychiatric disorders (e.g., disruptive disorders, substance abuse), impulsivity and aggression, availability of lethal agents (e.g., firearms), exposure to negative events (e.g., physical or sexual abuse, violence), and a family history of suicidal behavior (American Academy of Child and Adolescent Psychiatry, 2007). A careful and ongoing evaluation of suicide risk is necessary for all patients with major depressive disorder (Category I). 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) 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 (Category I) (American Psychiatric Association, 2010, reaffirmed 2015). Guidance (Usage): This eCQM is an episode-based measure. An episode is defined as each eligible encounter for major depressive disorder (MDD) during the measurement period. A suicide risk assessment should be performed at every visit for MDD during the measurement period. In recognition of the growing use of integrated and team-based care, the diagnosis of depression and the assessment for suicide risk need not be performed by the same provider or clinician. Suicide risk assessments completed via telehealth services can also meet numerator performance. Use of a standardized tool(s) or instrument(s) to assess suicide risk will meet numerator performance, so long as the minimum criteria noted above is evaluated. Standardized tools can be mapped to the concept "Intervention, Performed": "Suicide risk assessment (procedure)" included in the numerator logic below, as no individual suicide risk assessment tool or instrument would satisfy the requirements alone. To ensure all patients with major depressive disorder (MDD) are assessed for suicide risk, there are two clinical quality measures addressing suicide risk assessment; CMS177 covers children and adolescents aged 6 through 16 at the start of the measurement period, and CMS161 - Adult Major Depressive Disorder (MDD): Suicide Risk Assessment covers the adult population aged 17 years and older at the start of the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS161v12. Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html). Population Criteria: 638504914ba3d47c885c02c6 Initial Population: All patient visits for those patients aged 6 through 16 at the start of the measurement period with a diagnosis of major depressive disorder Denominator: Equals Initial Population Denominator Exclusion: None Numerator: Patient visits with an assessment for suicide risk Numerator Exclusion: None Denominator Exception: None Libraries: ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR Related Artifact Dependencies: FHIRHelpers version: 4.3.000 CQMCommon version: 1.4.000 QICoreCommon version: 1.5.000 ActCode SNOMED CT (all versions) Office Visit Outpatient Consultation Psych Visit - Diagnostic Evaluation Psych Visit - Family Psychotherapy Psych Visit - Psychotherapy Psychoanalysis Group Psychotherapy Telehealth Services Major Depressive Disorder-Active Parameters: name use min max type Measurement Period In 0 1 Period Numerator Out 0 * Resource Denominator Out 0 * Resource Initial Population Out 0 * Resource DataRequirements: Type Elements Valueset Name Valueset Condition(QICoreCondition) id id.value code Encounter(QICoreEncounter) type condition condition.reference condition.reference.value status status.value class reasonCode period Office Visit Office Visit Encounter(QICoreEncounter) type condition condition.reference condition.reference.value status status.value class reasonCode period Outpatient Consultation Outpatient Consultation Encounter(QICoreEncounter) type condition condition.reference condition.reference.value status status.value class reasonCode period Psych Visit Diagnostic Evaluation Psych Visit - Diagnostic Evaluation Encounter(QICoreEncounter) type condition condition.reference condition.reference.value status status.value class reasonCode period Psych Visit for Family Psychotherapy Psych Visit - Family Psychotherapy Encounter(QICoreEncounter) type condition condition.reference condition.reference.value status status.value class reasonCode period Psych Visit Psychotherapy Psych Visit - Psychotherapy Encounter(QICoreEncounter) type condition condition.reference condition.reference.value status status.value class reasonCode period Psychoanalysis Psychoanalysis Encounter(QICoreEncounter) type condition condition.reference condition.reference.value status status.value class reasonCode period Group Psychotherapy Group Psychotherapy Encounter(QICoreEncounter) type condition condition.reference condition.reference.value status status.value class reasonCode period Telehealth Services Telehealth Services Procedure(QICoreProcedure) code status status.value performed Patient(QICorePatient) Direct Reference Codes: display code system Ambulatory AMB http://terminology.hl7.org/CodeSystem/v3-ActCode Suicide risk assessment (procedure) 225337009 http://snomed.info/sct Logic Definitions: Group Scoring Population Criteria Expression 638504914ba3d47c885c02c6 Group scoring: proportion Initial Population define "Initial Population": "Major Depressive Disorder Encounter" MDDEncounter where ( "AgeInYearsAt"(date from start of "Measurement Period") >= 6 and "AgeInYearsAt"(date from start of "Measurement Period") < 17 ) Denominator define "Denominator": "Initial Population" Denominator Exclusion None Numerator define "Numerator": "Major Depressive Disorder Encounter" MDDEncounter with ["Procedure": "Suicide risk assessment (procedure)"] SuicideRiskAssessment such that SuicideRiskAssessment.status = 'completed' and QICoreCommon."ToInterval" ( SuicideRiskAssessment.performed ) during MDDEncounter.period Numerator Exclusion None Denominator Exception None Library Name Name ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR Major Depressive Disorder Encounter define "Major Depressive Disorder Encounter": ( ["Encounter": "Office Visit"] union ["Encounter": "Outpatient Consultation"] union ["Encounter": "Psych Visit Diagnostic Evaluation"] union ["Encounter": "Psych Visit for Family Psychotherapy"] union ["Encounter": "Psych Visit Psychotherapy"] union ["Encounter": "Psychoanalysis"] union ["Encounter": "Group Psychotherapy"] 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" ) ) and ValidEncounter.period during "Measurement Period" Library Name Name ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR Numerator define "Numerator": "Major Depressive Disorder Encounter" MDDEncounter with ["Procedure": "Suicide risk assessment (procedure)"] SuicideRiskAssessment such that SuicideRiskAssessment.status = 'completed' and QICoreCommon."ToInterval" ( SuicideRiskAssessment.performed ) during MDDEncounter.period Library Name Name ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR Initial Population define "Initial Population": "Major Depressive Disorder Encounter" MDDEncounter where ( "AgeInYearsAt"(date from start of "Measurement Period") >= 6 and "AgeInYearsAt"(date from start of "Measurement Period") < 17 ) Library Name Name ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR Denominator define "Denominator": "Initial Population" Library Name Name FHIRHelpers ToConcept /* @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 } Library Name Name CQMCommon EncounterDiagnosis /* @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()) Library Name Name QICoreCommon getId /* @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, '/'))
define "Major Depressive Disorder Encounter": ( ["Encounter": "Office Visit"] union ["Encounter": "Outpatient Consultation"] union ["Encounter": "Psych Visit Diagnostic Evaluation"] union ["Encounter": "Psych Visit for Family Psychotherapy"] union ["Encounter": "Psych Visit Psychotherapy"] union ["Encounter": "Psychoanalysis"] union ["Encounter": "Group Psychotherapy"] 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" ) ) and ValidEncounter.period during "Measurement Period"
define "Numerator": "Major Depressive Disorder Encounter" MDDEncounter with ["Procedure": "Suicide risk assessment (procedure)"] SuicideRiskAssessment such that SuicideRiskAssessment.status = 'completed' and QICoreCommon."ToInterval" ( SuicideRiskAssessment.performed ) during MDDEncounter.period
define "Initial Population": "Major Depressive Disorder Encounter" MDDEncounter where ( "AgeInYearsAt"(date from start of "Measurement Period") >= 6 and "AgeInYearsAt"(date from start of "Measurement Period") < 17 )
define "Denominator": "Initial Population"
/* @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 }
/* @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())
/* @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, '/'))
Value set Psych Visit Diagnostic Evaluation
Value set Psych Visit for Family Psychotherapy
Value set Major Depressive Disorder Active
Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk AssessmentFHIR
Percentage of patient visits for those patients aged 6 through 16 at the start of the measurement period with a diagnosis of major depressive disorder (MDD) with an assessment for suicide risk
This eCQM is an episode-based measure. An episode is defined as each eligible encounter for major depressive disorder (MDD) during the measurement period. A suicide risk assessment should be performed at every visit for MDD during the measurement period. In recognition of the growing use of integrated and team-based care, the diagnosis of depression and the assessment for suicide risk need not be performed by the same provider or clinician. Suicide risk assessments completed via telehealth services can also meet numerator performance. Use of a standardized tool(s) or instrument(s) to assess suicide risk will meet numerator performance, so long as the minimum criteria noted above is evaluated. Standardized tools can be mapped to the concept "Intervention, Performed": "Suicide risk assessment (procedure)" included in the numerator logic below, as no individual suicide risk assessment tool or instrument would satisfy the requirements alone. To ensure all patients with major depressive disorder (MDD) are assessed for suicide risk, there are two clinical quality measures addressing suicide risk assessment; CMS177 covers children and adolescents aged 6 through 16 at the start of the measurement period, and CMS161 - Adult Major Depressive Disorder (MDD): Suicide Risk Assessment covers the adult population aged 17 years and older at the start of the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS161v12. Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html).
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.
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 (R) or [R].
Research has shown that youth with major depressive disorder (MDD) are at a high risk for suicide attempts and completion - among the most significant and devastating sequelae of the disease (Fontanella et al., 2020). Suicide risk is a critical consideration in children and adolescents with MDD, and an important aspect of care that should be assessed at each visit and subsequently managed to minimize that risk. Additionally, the importance of the assessments is underscored by research (Fontanella et al., 2020; Luoma, Martin, & Pearson, 2002) that indicates that many individuals who die by suicide do make contact with primary care providers and mental health services beforehand. More specifically, approximately 15% of suicide victims aged 35 years or younger had seen a mental health professional within 1 month of suicide while approximately 23% had seen a primary care provider within 1 month of suicide (Luoma, Martin, & Pearson, 2002). A recent analysis of depression severity and suicidal ideation symptom trajectories (Witt et al., 2021) found that suicidal ideation among children and young adults (15-25 years) might not improve with depression symptom severity. This evidence suggests the potential utility of continued suicide risk screening even after improvements in depression symptoms. Better assessment and identification of suicide risk in the health care setting should lead to improved connection to treatment and reduction in suicide attempts and deaths by suicide.
The evaluation must include assessment for the presence of harm to self or others (American Academy of Child and Adolescent Psychiatry, 2007). Suicidal behavior exists along a continuum from passive thoughts of death to a clearly developed plan and intent to carry out that plan. Because depression is closely associated with suicidal thoughts and behavior, it is imperative to evaluate these symptoms at the initial and subsequent assessments. For this purpose, low burden tools to track suicidal ideation and behavior such as the Columbia-Suicidal Severity Rating Scale can be used. Also, it is crucial to evaluate the risk (e.g., age, sex, stressors, comorbid conditions, hopelessness, impulsivity) and protective factors (e.g., religious belief, concern not to hurt family) that might influence the desire to attempt suicide. The risk for suicidal behavior increases if there is a history of suicide attempts, comorbid psychiatric disorders (e.g., disruptive disorders, substance abuse), impulsivity and aggression, availability of lethal agents (e.g., firearms), exposure to negative events (e.g., physical or sexual abuse, violence), and a family history of suicidal behavior (American Academy of Child and Adolescent Psychiatry, 2007). A careful and ongoing evaluation of suicide risk is necessary for all patients with major depressive disorder (Category I). 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) 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 (Category I) (American Psychiatric Association, 2010, reaffirmed 2015).
All patient visits for those patients aged 6 through 16 at the start of the measurement period with a diagnosis of major depressive disorder
Patient visits with an assessment for suicide risk