eCQM QICore Content Implementation Guide
2023.0.0 - CI Build
eCQM QICore Content Implementation Guide
2023.0.0 - CI Build
eCQM QICore Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2023.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/ecqm-content-qicore-2023/ and changes regularly. See the Directory of published versions
| Draft as of 2023-10-27 |
<Measure xmlns="http://hl7.org/fhir">
<id
value="ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR"/>
<meta>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"/>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm"/>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<table class="grid dict">
<tr>
<th scope="row"><b>Title: </b></th>
<td style="padding-left: 4px;">Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk AssessmentFHIR</td>
</tr>
<tr>
<th scope="row"><b>Id: </b></th>
<td style="padding-left: 4px;">ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR</td>
</tr>
<tr>
<th scope="row"><b>Download cql: </b></th>
<td style="padding-left: 4px;"><a href="Library-ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR.cql">ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR.cql</a></td>
</tr>
<tr>
<th scope="row"><b>Version: </b></th>
<td style="padding-left: 4px;">0.0.003</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="Measure-ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR.html">Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk AssessmentFHIR</a></td>
</tr>
<tr>
<th scope="row">
<b>
short-name identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>CMS177FHIR</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
version-independent identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>urn:uuid:50d1dfcf-e2bf-41e8-bc1c-c607e5a09e79</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
version-specific identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>urn:uuid:2c928085806c39a20180859de2340526</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
endorser (NQF) identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>1365e</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
publisher (CMS) identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>177FHIR</span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Effective Period: </b></th>
<td style="padding-left: 4px;">2024-01-01
..2024-12-31</td>
</tr>
<tr>
<th scope="row"><b>Status: </b></th>
<td style="padding-left: 4px;">draft</td>
</tr>
<tr>
<th scope="row"><b>Date: </b></th>
<td style="padding-left: 4px;">2023-10-27 08:12:31+0000</td>
</tr>
<tr>
<th scope="row"><b>Approval Date: </b></th>
<td style="padding-left: 4px;">2023-08-14</td>
</tr>
<tr>
<th scope="row"><b>Last Review Date: </b></th>
<td style="padding-left: 4px;">2023-08-14</td>
</tr>
<tr>
<th scope="row"><b>Name: </b></th>
<td style="padding-left: 4px;">ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR</td>
</tr>
<tr>
<th scope="row"><b>Publisher: </b></th>
<td style="padding-left: 4px;">Mathematica</td>
</tr>
<tr>
<th scope="row"><b>Author: </b></th>
<td style="padding-left: 4px;">Mathematica: <a href="https://www.mathematica.org/">https://www.mathematica.org/</a>, American Medical Association (AMA): <a href="https://www.ama-assn.org/">https://www.ama-assn.org/</a></td>
</tr>
<tr>
<th scope="row"><b>Description: </b></th>
<td style="padding-left: 4px;"><div><p>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</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Use Context: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>code</b></th>
<th><b>value</b></th>
</tr>
<tr>
<td>program</td>
<td/>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Purpose: </b></th>
<td style="padding-left: 4px;"><div><p>UNKNOWN</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Copyright: </b></th>
<td style="padding-left: 4px;"><div><p>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.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Disclaimer: </b></th>
<td style="padding-left: 4px;"><div><p>The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.</p>
<p>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.</p>
<p>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.</p>
<p>Mathematica encourages use of the Measure by other health care professionals, where appropriate.</p>
<p>THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.</p>
<p>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.</p>
<p>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.</p>
<p>Due to technical limitations, registered trademarks are indicated by (R) or [R].</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Rationale: </b></th>
<td style="padding-left: 4px;"><div><p>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.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Clinical recommendation statement: </b></th>
<td style="padding-left: 4px;"><div><p>The evaluation must include assessment for the presence of harm to self or others (American Academy of Child and Adolescent Psychiatry, 2007).</p>
<p>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).</p>
<p>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).</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Guidance (Usage): </b></th>
<td style="padding-left: 4px;">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).</td>
</tr>
<tr>
<th scope="row"><b>Population Criteria: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>638504914ba3d47c885c02c6</b></th>
</tr>
<tr>
<td>Initial Population:</td>
<td>All patient visits for those patients aged 6 through 16 at the start of the measurement period with a diagnosis of major depressive disorder</td>
</tr>
<tr>
<td>Denominator:</td>
<td>Equals Initial Population</td>
</tr>
<tr>
<td>Denominator Exclusion:</td>
<td>None</td>
</tr>
<tr>
<td>Numerator:</td>
<td>Patient visits with an assessment for suicide risk</td>
</tr>
<tr>
<td>Numerator Exclusion:</td>
<td>None</td>
</tr>
<tr>
<td>Denominator Exception:</td>
<td>None</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Libraries: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td><a href="Library-ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR.html">ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Related Artifact Dependencies: </b></th>
<td style="padding-left: 4px;">
<li><a href="Library-FHIRHelpers.html">FHIRHelpers</a> version: 4.3.000</li>
<li><a href="Library-CQMCommon.html">CQMCommon</a> version: 1.4.000</li>
<li><a href="Library-QICoreCommon.html">QICoreCommon</a> version: 1.5.000</li>
<li><a href="http://terminology.hl7.org/7.1.0/CodeSystem-v3-ActCode.html">ActCode</a></li>
<li><a href="http://hl7.org/fhir/R4/codesystem-snomedct.html">SNOMED CT (all versions)</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion">Office Visit</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1008/expansion">Outpatient Consultation</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1492/expansion">Psych Visit - Diagnostic Evaluation</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1018/expansion">Psych Visit - Family Psychotherapy</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1496/expansion">Psych Visit - Psychotherapy</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1141/expansion">Psychoanalysis</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1187/expansion">Group Psychotherapy</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1031/expansion">Telehealth Services</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1491/expansion">Major Depressive Disorder-Active</a></li>
</td>
</tr>
<tr>
<th scope="row"><b>Parameters:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>name</b></th>
<th><b>use</b></th>
<th><b>min</b></th>
<th><b>max</b></th>
<th><b>type</b></th>
</tr>
<tr>
<td>Measurement Period</td>
<td>In</td>
<td>0</td>
<td>1</td>
<td>Period</td>
</tr>
<tr>
<td>Numerator</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>Denominator</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>Initial Population</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>DataRequirements:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>Type</b></th>
<th><b>Elements</b></th>
<th><b>Valueset Name</b></th>
<th><b>Valueset</b></th>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
id
id.value
code
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
condition
condition.reference
condition.reference.value
status
status.value
class
reasonCode
period
</td>
<td>
Office Visit
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion">Office Visit</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
condition
condition.reference
condition.reference.value
status
status.value
class
reasonCode
period
</td>
<td>
Outpatient Consultation
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1008/expansion">Outpatient Consultation</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
condition
condition.reference
condition.reference.value
status
status.value
class
reasonCode
period
</td>
<td>
Psych Visit Diagnostic Evaluation
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1492/expansion">Psych Visit - Diagnostic Evaluation</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
condition
condition.reference
condition.reference.value
status
status.value
class
reasonCode
period
</td>
<td>
Psych Visit for Family Psychotherapy
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1018/expansion">Psych Visit - Family Psychotherapy</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
condition
condition.reference
condition.reference.value
status
status.value
class
reasonCode
period
</td>
<td>
Psych Visit Psychotherapy
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1496/expansion">Psych Visit - Psychotherapy</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
condition
condition.reference
condition.reference.value
status
status.value
class
reasonCode
period
</td>
<td>
Psychoanalysis
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1141/expansion">Psychoanalysis</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
condition
condition.reference
condition.reference.value
status
status.value
class
reasonCode
period
</td>
<td>
Group Psychotherapy
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1187/expansion">Group Psychotherapy</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
condition
condition.reference
condition.reference.value
status
status.value
class
reasonCode
period
</td>
<td>
Telehealth Services
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1031/expansion">Telehealth Services</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
status
status.value
performed
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Patient(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html">QICorePatient</a>)</td>
<td>
</td>
<td>
</td>
<td/>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Direct Reference Codes:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>display</b></th>
<th><b>code</b></th>
<th><b>system</b></th>
</tr>
<tr>
<td>Ambulatory</td>
<td>AMB</td>
<td><a href="http://terminology.hl7.org/7.1.0/CodeSystem-v3-ActCode.html">http://terminology.hl7.org/CodeSystem/v3-ActCode</a></td>
</tr>
<tr>
<td>Suicide risk assessment (procedure)</td>
<td>225337009</td>
<td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Logic Definitions:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>Group</b></th>
<th><b>Scoring</b></th>
<th><b>Population Criteria</b></th>
<th><b>Expression</b></th>
</tr>
<tr>
<td> 638504914ba3d47c885c02c6 </td>
<td>
<b>Group scoring:</b>
<span> proportion </span>
</td>
<tr>
<td/>
<td/>
<td>Initial Population</td>
<td>
<pre><code class="language-cql">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
)</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator</td>
<td>
<pre><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exclusion</td>
<td>
None
</td>
</tr>
<tr>
<td/>
<td/>
<td>Numerator</td>
<td>
<pre><code class="language-cql">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</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Numerator Exclusion</td>
<td>
None
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exception</td>
<td>
None
</td>
</tr>
</tr>
</table>
<table class="grid-dict">
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR</td>
<td>Major Depressive Disorder Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR</td>
<td>Numerator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR</td>
<td>Initial Population</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR</td>
<td>Denominator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>FHIRHelpers</td>
<td>ToConcept</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@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
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CQMCommon</td>
<td>EncounterDiagnosis</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@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())</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>QICoreCommon</td>
<td>getId</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@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, '/'))</code></pre>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</text>
<contained>
<Library>
<id value="effective-data-requirements"/>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="AMB"/>
<display value="Ambulatory"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="225337009"/>
<display value="Suicide risk assessment (procedure)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString
value="ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR"/>
</extension>
<extension url="name">
<valueString value="Major Depressive Disorder Encounter"/>
</extension>
<extension url="statement">
<valueString
value="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""/>
</extension>
<extension url="displaySequence">
<valueInteger value="0"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString
value="ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR"/>
</extension>
<extension url="name">
<valueString value="Numerator"/>
</extension>
<extension url="statement">
<valueString
value="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"/>
</extension>
<extension url="displaySequence">
<valueInteger value="1"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString
value="ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR"/>
</extension>
<extension url="name">
<valueString value="Initial Population"/>
</extension>
<extension url="statement">
<valueString
value="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
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString
value="ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator":
"Initial Population""/>
</extension>
<extension url="displaySequence">
<valueInteger value="3"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToConcept"/>
</extension>
<extension url="statement">
<valueString
value="/*
@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>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CQMCommon"/>
</extension>
<extension url="name">
<valueString value="EncounterDiagnosis"/>
</extension>
<extension url="statement">
<valueString
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())"/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="getId"/>
</extension>
<extension url="statement">
<valueString
value="/*
@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>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/library-type"/>
<code value="module-definition"/>
</coding>
</type>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource
value="http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers|4.3.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library CQMCommon"/>
<resource
value="http://ecqi.healthit.gov/ecqms/Library/CQMCommon|1.4.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library QICoreCommon"/>
<resource
value="http://ecqi.healthit.gov/ecqms/Library/QICoreCommon|1.5.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ActCode"/>
<resource value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system SNOMEDCT"/>
<resource value="http://snomed.info/sct"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Office Visit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Outpatient Consultation"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Psych Visit Diagnostic Evaluation"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1492"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Psych Visit for Family Psychotherapy"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1018"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Psych Visit Psychotherapy"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1496"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Psychoanalysis"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1141"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Group Psychotherapy"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1187"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Telehealth Services"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1031"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Major Depressive Disorder Active"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1491"/>
</relatedArtifact>
<parameter>
<name value="Measurement Period"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="Period"/>
</parameter>
<parameter>
<name value="Numerator"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Denominator"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Initial Population"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<mustSupport value="code"/>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="condition"/>
<mustSupport value="condition.reference"/>
<mustSupport value="condition.reference.value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="class"/>
<mustSupport value="reasonCode"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="condition"/>
<mustSupport value="condition.reference"/>
<mustSupport value="condition.reference.value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="class"/>
<mustSupport value="reasonCode"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="condition"/>
<mustSupport value="condition.reference"/>
<mustSupport value="condition.reference.value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="class"/>
<mustSupport value="reasonCode"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1492"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="condition"/>
<mustSupport value="condition.reference"/>
<mustSupport value="condition.reference.value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="class"/>
<mustSupport value="reasonCode"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1018"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="condition"/>
<mustSupport value="condition.reference"/>
<mustSupport value="condition.reference.value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="class"/>
<mustSupport value="reasonCode"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1496"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="condition"/>
<mustSupport value="condition.reference"/>
<mustSupport value="condition.reference.value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="class"/>
<mustSupport value="reasonCode"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1141"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="condition"/>
<mustSupport value="condition.reference"/>
<mustSupport value="condition.reference.value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="class"/>
<mustSupport value="reasonCode"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1187"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="condition"/>
<mustSupport value="condition.reference"/>
<mustSupport value="condition.reference.value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="class"/>
<mustSupport value="reasonCode"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1031"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"/>
<mustSupport value="code"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="performed"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://snomed.info/sct"/>
<code value="225337009"/>
<display value="Suicide risk assessment (procedure)"/>
</code>
</codeFilter>
<codeFilter>
<path value="status.value"/>
<code>
<code value="completed"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Patient"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
</dataRequirement>
</Library>
</contained>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem">
<valueReference>
<reference value="Device/cqf-tooling"/>
</valueReference>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements" id="effective-data-requirements">
<valueReference>
<reference value="#effective-data-requirements"/>
</valueReference>
</extension>
<url
value="http://ecqi.healthit.gov/ecqms/Measure/ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR"/>
<identifier>
<use value="usual"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="short-name"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/shortName"/>
<value value="CMS177FHIR"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="version-independent"/>
</coding>
</type>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:50d1dfcf-e2bf-41e8-bc1c-c607e5a09e79"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="version-specific"/>
</coding>
</type>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:2c928085806c39a20180859de2340526"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="endorser"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/nqfId"/>
<value value="1365e"/>
<assigner>
<display value="NQF"/>
</assigner>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="publisher"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/cmsId"/>
<value value="177FHIR"/>
<assigner>
<display value="CMS"/>
</assigner>
</identifier>
<version value="0.0.003"/>
<name
value="ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR"/>
<title
value="Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk AssessmentFHIR"/>
<status value="draft"/>
<experimental value="false"/>
<date value="2023-10-27T08:12:31+00:00"/>
<publisher value="Mathematica"/>
<contact>
<telecom>
<system value="url"/>
<value value="https://www.mathematica.org/"/>
</telecom>
</contact>
<description
value="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"/>
<useContext>
<code>
<system
value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
<code value="program"/>
</code>
<valueCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/quality-programs"/>
<code value="ep-ec"/>
<display value="EP/EC"/>
</coding>
</valueCodeableConcept>
</useContext>
<purpose value="UNKNOWN"/>
<usage
value="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
value="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."/>
<approvalDate value="2023-08-14"/>
<lastReviewDate value="2023-08-14"/>
<effectivePeriod>
<start value="2024-01-01"/>
<end value="2024-12-31"/>
</effectivePeriod>
<author>
<name value="Mathematica"/>
<telecom>
<system value="url"/>
<value value="https://www.mathematica.org/"/>
</telecom>
</author>
<author>
<name value="American Medical Association (AMA)"/>
<telecom>
<system value="url"/>
<value value="https://www.ama-assn.org/"/>
</telecom>
</author>
<library
value="http://ecqi.healthit.gov/ecqms/Library/ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR"/>
<disclaimer
value="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
value="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."/>
<clinicalRecommendationStatement
value="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)."/>
<group id="638504914ba3d47c885c02c6">
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
<valueCode value="Encounter"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
<code value="process"/>
<display value="Process"/>
</coding>
</valueCodeableConcept>
</extension>
<population id="EAADF858-A8F8-4AEA-A571-27CFCA95F745">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="initial-population"/>
<display value="Initial Population"/>
</coding>
</code>
<description
value="All patient visits for those patients aged 6 through 16 at the start of the measurement period with a diagnosis of major depressive disorder"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Initial Population"/>
</criteria>
</population>
<population id="FD251731-0487-4A1F-B7CC-D7D2696DB9EE">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator"/>
<display value="Denominator"/>
</coding>
</code>
<description value="Equals Initial Population"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator"/>
</criteria>
</population>
<population id="bdd33044-e6ec-4e09-9242-a4287f6ef930">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exclusion"/>
<display value="Denominator Exclusion"/>
</coding>
</code>
<criteria>
<language value="text/cql-identifier"/>
</criteria>
</population>
<population id="1B08534C-7722-4B76-B352-4E80C1FA732E">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="numerator"/>
<display value="Numerator"/>
</coding>
</code>
<description
value="Patient visits with an assessment for suicide risk"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Numerator"/>
</criteria>
</population>
<population id="72b56924-a46c-40ed-ac22-833cf82431cd">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="numerator-exclusion"/>
<display value="Numerator Exclusion"/>
</coding>
</code>
<criteria>
<language value="text/cql-identifier"/>
</criteria>
</population>
<population id="b0964fc5-57da-4671-9136-e449641e8c9f">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exception"/>
<display value="Denominator Exception"/>
</coding>
</code>
<criteria>
<language value="text/cql-identifier"/>
</criteria>
</population>
</group>
</Measure>
IG © 2023+ cqframework. Package gov.healthit.ecqi.ecqms#2023.0.0 based on FHIR 4.0.1. Generated 2026-05-13
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