Title: Preventive Care and Screening: Screening for Depression and Follow-Up PlanFHIR Id: PCSDepressionScreenAndFollowUpFHIR Download cql: PCSDepressionScreenAndFollowUpFHIR.cql Version: 0.1.000 Url: Preventive Care and Screening: Screening for Depression and Follow-Up PlanFHIR short-name identifier: CMS2FHIR version-independent identifier: urn:uuid:deb30835-dbec-4f11-aab0-3a282040e37c version-specific identifier: urn:uuid:872451cb-46ce-477d-9df1-ad7526d9aeff publisher (CMS) identifier: 2FHIR Effective Period: 2024-01-01 ..2024-12-31 Status: draft Date: 2023-08-28 19:19:59+0000 Approval Date: 2023-08-28 Last Review Date: 2023-08-28 Name: PCSDepressionScreenAndFollowUpFHIR Publisher: Centers for Medicare & Medicaid Services (CMS) Author: Mathematica: https://www.mathematica.org/ Description: Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of or up to two days after the date of the qualifying encounter Use Context: code value program Purpose: UNKNOWN Copyright: Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. 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. Disclaimer: These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]. Rationale: Depression affects more than two hundred sixty million people across the world and is a leading cause of disability, with a variety of depressive disorders that are independent risk factors for chronic diseases, such as cardiovascular disease and diabetes, lending screening for depression as paramount to identify depressive disorders that can affect the most vulnerable populations (Constantini et al., 2021). Results from a 2018 U.S. survey indicated that 14.4 percent of adolescents (3.5 million adolescents) had a major depressive episode (MDE) in the past year, with nine percent of adolescents (2.4 million adolescents) having one MDE with severe impairment (Substance Abuse and Mental Health Services Administration, 2019). The odds of a diagnosis of depression are believed to be 2.6 times greater for children and adolescents exposed to trauma as compared to those unexposed or less exposed (Vibhakar et al., 2019). Children and teens with major depressive disorder (MDD) have been found to have difficulty carrying out their daily activities, relating to others, growing up healthy, and are at an increased risk of suicide (Siu on behalf of the U.S. Preventive Services Task Force [USPSTF], 2016). The same 2018 study indicated that 7.2 percent of adults aged 18 or older (17.7 million adults) had at least one MDE with 4.7 percent of adults (11.5 million adults) having one MDE with severe impairment in the past year (Substance Abuse and Mental Health Services Administration, 2019). Moreover, it is estimated 22.9 percent of adult patients with chronic pain (2.2 million adults) were diagnosed with comorbid depression from 2011 to 2015, with an upward trend of prevalence among Black Americans, patients aged 65 to 84 years old, Medicare and Medicaid insured patients, and patients from zip code areas with low annual household incomes (Orhurhu et al., 2019). Depression and other mood disorders, such as bipolar disorder and anxiety disorders, especially during the perinatal period, can have devastating effects on women, infants, and families (American College of Obstetricians and Gynecologists, 2018). It's estimated that the global prevalence of antenatal (or perinatal) depression ranges from 15 to 65 percent, with current or previous exposure to abuse and violence, lack of social support, and family history of mental disorders being risk factors. Depressive symptoms measured during pregnancy have been shown to influence the quality of the postpartum mother-infant relationship (Hazell Raine et al., 2020). Additionally, the risk of low birth weight and preterm birth is higher among infants born from depressed mothers (Dadi, Miller, Bisetegn, & Mwanri, 2020). Negative outcomes associated with depression make it crucial to screen in order to identify and treat depression in its early stages. Multiple social costs of depression have been identified, such as reduced educational achievements, poor financial success and role performance, higher amount of days out of role, and increased risk of job loss (Costantini et al., 2021). Depression also imposes significant economic burden through direct and indirect costs, supporting the need for regular depression screening. "In the United States, an estimated $22.8 billion was spent on depression treatment in 2009, and lost productivity cost an additional estimated $23 billion in 2011" (Siu & USPSTF, 2016, p. 383-384). Numerous studies have found significant disparities in depression prevalence and treatment among racial/ethnic minorities. One study revealed that Indigenous adults are at a high risk for posttraumatic stress disorder, depression, suicide, substance use disorder, and concurrent behavioral health disorders secondary to these initial health problems (Ka’apu and Burnette, 2019). Additionally, though rates of depression are lower among Blacks and Hispanics than among whites, depression among Blacks and Hispanics is likely to be more recurrent. Furthermore, 48 percent of whites receive mental health services, compared to just 31 percent of Blacks and Hispanics, and 22 percent of Asians (American Psychiatric Association, 2017). Asian Americans and Black Americans are also significantly more likely to utilize emergency rooms for depression treatment, which contributes to inconsistent follow-up care (Lee et al., 2014). While primary care providers (PCPs) serve as the first line of defense in the detection of depression, studies show that PCPs fail to recognize up to 46 percent of depressed patients (Borner et al., 2010). "In nationally representative U.S. surveys, about eight percent of adolescents reported having major depression in the past year. Only 36 percent to 44 percent of children and adolescents with depression receive treatment, suggesting that the majority of depressed youth are undiagnosed and untreated" (Siu on behalf of USPSTF, 2016, p. 360 & p. 364). Furthermore, evidence supports that screening for depression in pregnant and postpartum women is of moderate net benefit, and treatment options for positive depression screening should be available for patients twelve and older including pregnant and postpartum women. This measure seeks to align with USPSTF clinical guideline recommendations as well as the Healthy People 2030 recommendation to increase the proportion of adolescents and adults who are screened and receive treatment for depression (U.S. Preventative Services Task Force, 2016) and makes an important contribution to the quality domain of community and population health. Clinical recommendation statement: Adolescent Recommendation (12-18 years): "The USPSTF recommends screening for MDD in adolescents aged 12 to 18 years. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (B recommendation)" (Siu on behalf of USPSTF, 2016, p. 360). Adult Recommendation (18 years and older): "The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (B recommendation)" (Siu & USPSTF, 2016, p. 380). “The USPSTF recommends that clinicians provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions. (B recommendation)” (U.S. Preventive Services Task Force, 2019). The American College of Obstetricians and Gynecologists (ACOG) provides the following recommendation: "All obstetrician–gynecologists and other obstetric care providers should complete a full assessment of mood and emotional well-being (including screening for postpartum depression and anxiety with a validated instrument) during the comprehensive postpartum visit for each patient" (American College of Obstetricians and Gynecologists, 2018). The Institute for Clinical Systems Improvement (ICSI) health care guideline, Adult Depression in Primary Care, provides the following recommendations: "Clinicians should routinely screen all adults for depression using a standardized instrument." "Clinicians should establish and maintain follow-up with patients." "Clinicians should screen and monitor depression in pregnant and post-partum women" (Trangle et al., 2016, p. 8-10). Guidance (Usage): The intent of the measure is to screen for new cases of depression in patients who have never had a diagnosis of bipolar disorder. Patients who have ever been diagnosed with bipolar disorder prior to the qualifying encounter used to evaluate the numerator will be excluded from the measure regardless of whether the diagnosis is active or not. A depression screen is completed on the date of the encounter or up to 14 calendar days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan must be documented on the date of or up to two calendar days after the date of the encounter, such as referral to a provider for additional evaluation, pharmacological interventions, or other interventions for the treatment of depression. An example to illustrate the follow-up plan documentation timing: if the encounter is on a Monday from 3-4 pm (day 0) and the patient screens positive, the clinician has through anytime on Wednesday (day 2) to complete follow-up plan documentation. This measure does not require documentation of a specific score, just whether results of the normalized and validated depression screening tool used are considered positive or negative. Each standardized screening tool provides guidance on whether a particular score is considered positive for depression. This eCQM is a patient-based measure. Depression screening is required once per measurement period, not at all encounters. Screening Tools: - An age-appropriate, standardized, and validated depression screening tool must be used for numerator compliance. - The name of the age-appropriate standardized depression screening tool utilized must be documented in the medical record. - The depression screening must be reviewed and addressed by the provider, filing the code, on the date of the encounter. Positive pre-screening results indicating a patient is at high risk for self-harm should receive more urgent intervention as determined by the provider practice. - The screening should occur during a qualifying encounter or up to 14 calendar days prior to the date of the qualifying encounter. - The measure assesses the most recent depression screening completed either during the qualifying encounter or within the 14 calendar days prior to that encounter. Therefore, a clinician would not be able to complete another screening at the time of the encounter to count towards a follow-up, because that would serve as the most recent screening. In order to satisfy the follow-up requirement for a patient screening positively, the eligible clinician would need to provide one of the aforementioned follow-up actions, which does not include use of a standardized depression screening tool. Follow-Up Plan: The follow-up plan MUST still be provided for and discussed with the patient during the qualifying encounter used to evaluate the numerator. However, documentation of the follow-up plan can occur up to two calendar days after the qualifying encounter, in accordance with the policies of an eligible clinician or provider’s practice or health system. All services should be documented during, or as soon as practicable, after the qualifying encounter in order to maintain an accurate medical record. The follow-up plan must be related to a positive depression screening, for example: "Patient referred for psychiatric evaluation due to positive depression screening." Examples of a follow-up plan include but are not limited to: - Referral to a provider or program for further evaluation for depression, for example, referral to a psychiatrist, psychiatric nurse practitioner, psychologist, clinical social worker, mental health counselor, or other mental health service such as family or group therapy, support group, depression management program, or other service for treatment of depression - Other interventions designed to treat depression such as behavioral health evaluation, psychotherapy, pharmacological interventions, or additional treatment options Should a patient screen positive for depression, a clinician should: - Only order pharmacological intervention when appropriate and after sufficient diagnostic evaluation. However, for the purposes of this measure, additional screening and assessment during the qualifying encounter will not qualify as a follow-up plan. - Opt to complete a suicide risk assessment when appropriate and based on individual patient characteristics. However, for the purposes of this measure, a suicide risk assessment or additional screening using a standardized tool will not qualify as a follow-up plan. This FHIR-based measure has been derived from the QDM-based-based measure: CMS2v13. Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/quicore/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: 6435b80cd4d7050edabb0334 Initial Population: All patients aged 12 years and older at the beginning of the measurement period with at least one qualifying encounter during the measurement period Denominator: Equals Initial Population Denominator Exclusion: Patients who have ever been diagnosed with bipolar disorder at any time prior to the qualifying encounter Numerator: Patients screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized tool AND if positive, a follow-up plan is documented on the date of or up to two days after the date of the qualifying encounter Numerator Exclusion: None Denominator Exception: Patient Reason(s) Patient refuses to participate in or complete the depression screening OR Medical Reason(s) Documentation of medical reason for not screening patient for depression (e.g., cognitive, functional, or motivational limitations that may impact accuracy of results; patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient's health status) Supplemental Data Guidance : Supplemental Data Elements: SDE Ethnicity SDE Payer SDE Race SDE Sex Libraries: PCSDepressionScreenAndFollowUpFHIR Related Artifact Dependencies: Library/SupplementalDataElements|3.4.000 Library/FHIRHelpers|4.3.000 Library/QICoreCommon|1.5.000 Library/FHIRHelpers|4.3.000 Library/FHIRHelpers|4.3.000 LOINC SNOMED CT (all versions) Condition Category Codes US Core Condition Category Extension Codes Condition Clinical Status Codes Encounter to Screen for Depression Physical Therapy Evaluation Telephone Visits Adolescent Depression Medications Referral for Adolescent Depression Follow Up for Adolescent Depression Adult Depression Medications Referral for Adult Depression Follow Up for Adult Depression Payer Bipolar Disorder Medical Reason Parameters: name use min max type Measurement Period In 0 1 Period SDE Sex Out 0 1 Coding Numerator Out 0 1 boolean Denominator Out 0 1 boolean SDE Payer Out 0 * Resource Initial Population Out 0 1 boolean SDE Ethnicity Out 0 1 Resource Denominator Exclusions Out 0 1 boolean SDE Race Out 0 1 Resource Denominator Exceptions Out 0 1 boolean DataRequirements: Type Elements Valueset Name Valueset Patient(QICorePatient) Patient(http://hl7.org/fhir/Patient) gender gender.value birthDate birthDate.value Patient(QICorePatient) Encounter(QICoreEncounter) type Encounter to Screen for Depression Encounter to Screen for Depression Encounter(QICoreEncounter) type Physical Therapy Evaluation Physical Therapy Evaluation Encounter(QICoreEncounter) type Telephone Visits Telephone Visits Patient(QICorePatient) Observation(QICoreObservation) code effective value status status.value MedicationRequest(QICoreMedicationRequest) medication Adolescent Depression Medications Adolescent Depression Medications MedicationRequest(QICoreMedicationRequest) medication Adolescent Depression Medications Adolescent Depression Medications ServiceRequest(QICoreServiceRequest) code status status.value doNotPerform doNotPerform.value Referral for Adolescent Depression Referral for Adolescent Depression Procedure(QICoreProcedure) code status status.value Follow Up for Adolescent Depression Follow Up for Adolescent Depression Observation(QICoreObservation) code effective value status status.value MedicationRequest(QICoreMedicationRequest) medication Adult Depression Medications Adult Depression Medications MedicationRequest(QICoreMedicationRequest) medication Adult Depression Medications Adult Depression Medications ServiceRequest(QICoreServiceRequest) code status status.value doNotPerform doNotPerform.value Referral for Adult Depression Referral for Adult Depression Procedure(QICoreProcedure) code status status.value Follow Up for Adult Depression Follow Up for Adult Depression Coverage(QICoreCoverage) type period Payer Type Payer uri(http://hl7.org/fhir/uri) value Patient(QICorePatient) url extension Patient(QICorePatient) url extension Condition(http://hl7.org/fhir/Condition) clinicalStatus Condition(QICoreCondition) code clinicalStatus Bipolar Disorder Bipolar Disorder Patient(QICorePatient) url extension Patient(QICorePatient) url extension Observation(QICoreObservationNotDone) code issued issued.value extension status status.value Observation(QICoreObservation) code effective value status status.value Observation(QICoreObservationNotDone) code issued issued.value extension status status.value Observation(QICoreObservation) code effective value status status.value Coverage(QICoreCoverage) type period Payer Type Payer Patient(QICorePatient) url extension Patient(QICorePatient) url extension Direct Reference Codes: display code system Adolescent depression screening assessment 73831-0 http://loinc.org Depression screening negative (finding) 428171000124102 http://snomed.info/sct Depression screening positive (finding) 428181000124104 http://snomed.info/sct Adult depression screening assessment 73832-8 http://loinc.org Problem List Item problem-list-item http://terminology.hl7.org/CodeSystem/condition-category Health Concern health-concern http://hl7.org/fhir/us/core/CodeSystem/condition-category active http://terminology.hl7.org/CodeSystem/condition-clinical recurrence http://terminology.hl7.org/CodeSystem/condition-clinical relapse http://terminology.hl7.org/CodeSystem/condition-clinical remission http://terminology.hl7.org/CodeSystem/condition-clinical Depression screening declined (situation) 720834000 http://snomed.info/sct Logic Definitions: Group Scoring Population Criteria Expression 6435b80cd4d7050edabb0334 Group scoring: proportion Initial Population define "Initial Population": "Patient Age 12 Years or Older at Start of Measurement Period" and exists ( "Qualifying Encounter During Measurement Period" ) Denominator define "Denominator": "Initial Population" Denominator Exclusion define "Denominator Exclusions": exists "History of Bipolar Diagnosis Before Qualifying Encounter" Numerator define "Numerator": ( "Patient Age 12 to 16 Years at Start of Measurement Period" and ( "Has Most Recent Adolescent Screening Negative" or exists "Most Recent Adolescent Depression Screening Positive and Follow Up Provided" ) ) or ( "Patient Age 17 Years at Start of Measurement Period" and ( "Has Most Recent Adolescent Screening Negative" or exists "Most Recent Adolescent Depression Screening Positive and Follow Up Provided" or "Has Most Recent Adult Screening Negative" or exists "Most Recent Adult Depression Screening Positive and Follow Up Provided" ) ) or ( "Patient Age 18 Years or Older at Start of Measurement Period" and ( "Has Most Recent Adult Screening Negative" or exists "Most Recent Adult Depression Screening Positive and Follow Up Provided" ) ) Numerator Exclusion None Denominator Exception define "Denominator Exceptions": ( exists "Medical or Patient Reason for Not Screening Adolescent for Depression" and not "Has Adolescent Depression Screening" ) or ( exists "Medical or Patient Reason for Not Screening Adult for Depression" and not "Has Adult Depression Screening" ) Library Name Name SupplementalDataElements SDE Sex define "SDE Sex": case when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' } when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' } else null end Library Name Name PCSDepressionScreenAndFollowUpFHIR SDE Sex define "SDE Sex": SDE."SDE Sex" Library Name Name PCSDepressionScreenAndFollowUpFHIR Patient Age 12 to 16 Years at Start of Measurement Period define "Patient Age 12 to 16 Years at Start of Measurement Period": AgeInYearsAt(date from start of "Measurement Period") in Interval[12, 16] Library Name Name PCSDepressionScreenAndFollowUpFHIR Qualifying Encounter During Measurement Period define "Qualifying Encounter During Measurement Period": ( [Encounter: "Encounter to Screen for Depression"] union [Encounter: "Physical Therapy Evaluation"] union [Encounter: "Telephone Visits"] ) QualifyingEncounter where QualifyingEncounter.period during day of "Measurement Period" and QualifyingEncounter.status = 'finished' Library Name Name PCSDepressionScreenAndFollowUpFHIR Most Recent Adolescent Depression Screening define "Most Recent Adolescent Depression Screening": Last([Observation: "Adolescent depression screening assessment"] AdolescentDepressionScreening with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that AdolescentDepressionScreening.effective.toInterval() 14 days or less on or before day of start of QualifyingEncounter.period and AdolescentDepressionScreening.value is not null and AdolescentDepressionScreening.status = 'final' sort by start of effective.toInterval() ) Library Name Name PCSDepressionScreenAndFollowUpFHIR Has Most Recent Adolescent Screening Negative define "Has Most Recent Adolescent Screening Negative": ( "Most Recent Adolescent Depression Screening" AdolescentScreen where AdolescentScreen.value ~ "Depression screening negative (finding)" ) is not null Library Name Name PCSDepressionScreenAndFollowUpFHIR Follow Up Intervention for Positive Adolescent Depression Screening define "Follow Up Intervention for Positive Adolescent Depression Screening": ( ( [MedicationRequest: "Adolescent Depression Medications"] AdolescentMed where AdolescentMed.status in { 'active', 'completed' } and AdolescentMed.intent = 'order' and AdolescentMed.doNotPerform is not true ) union ( [ServiceRequest: "Referral for Adolescent Depression"] AdolescentReferral where AdolescentReferral.status in { 'active', 'completed' } and AdolescentReferral.doNotPerform is not true ) union ( [Procedure: "Follow Up for Adolescent Depression"] AdolescentFollowUp where AdolescentFollowUp.status = 'completed' ) ) Library Name Name PCSDepressionScreenAndFollowUpFHIR Most Recent Adolescent Depression Screening Positive and Follow Up Provided define "Most Recent Adolescent Depression Screening Positive and Follow Up Provided": from "Most Recent Adolescent Depression Screening" LastAdolescentScreen, "Follow Up Intervention for Positive Adolescent Depression Screening" FollowUpPositiveAdolescentScreen, "Qualifying Encounter During Measurement Period" QualifyingEncounter where LastAdolescentScreen.effective.toInterval ( ) starts 14 days or less on or before day of start of QualifyingEncounter.period and LastAdolescentScreen.value ~ "Depression screening positive (finding)" and ( start of FollowUpPositiveAdolescentScreen.performed.toInterval ( ) during QualifyingEncounter.period or FollowUpPositiveAdolescentScreen.authoredOn 2 days or less on or after day of end of QualifyingEncounter.period ) and ( Coalesce(start of FollowUpPositiveAdolescentScreen.performed.toInterval(), FollowUpPositiveAdolescentScreen.authoredOn) during day of "Measurement Period" ) Library Name Name PCSDepressionScreenAndFollowUpFHIR Patient Age 17 Years at Start of Measurement Period define "Patient Age 17 Years at Start of Measurement Period": AgeInYearsAt(date from start of "Measurement Period") = 17 Library Name Name PCSDepressionScreenAndFollowUpFHIR Most Recent Adult Depression Screening define "Most Recent Adult Depression Screening": Last([Observation: "Adult depression screening assessment"] AdultDepressionScreening with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that AdultDepressionScreening.effective.toInterval() 14 days or less on or before day of start of QualifyingEncounter.period and AdultDepressionScreening.value is not null and AdultDepressionScreening.status = 'final' sort by start of effective.toInterval() ) Library Name Name PCSDepressionScreenAndFollowUpFHIR Has Most Recent Adult Screening Negative define "Has Most Recent Adult Screening Negative": ( "Most Recent Adult Depression Screening" AdultScreen where AdultScreen.value ~ "Depression screening negative (finding)" ) is not null Library Name Name PCSDepressionScreenAndFollowUpFHIR Follow Up Intervention for Positive Adult Depression Screening define "Follow Up Intervention for Positive Adult Depression Screening": ( ( [MedicationRequest: "Adult Depression Medications"] AdultMed where AdultMed.status in { 'active', 'completed' } and AdultMed.intent = 'order' and AdultMed.doNotPerform is not true ) union ( [ServiceRequest: "Referral for Adult Depression"] AdultReferral where AdultReferral.status in { 'active', 'completed' } and AdultReferral.doNotPerform is not true ) union ( [Procedure: "Follow Up for Adult Depression"] AdultFollowUp where AdultFollowUp.status = 'completed' ) ) Library Name Name PCSDepressionScreenAndFollowUpFHIR Most Recent Adult Depression Screening Positive and Follow Up Provided define "Most Recent Adult Depression Screening Positive and Follow Up Provided": from "Most Recent Adult Depression Screening" LastAdultScreen, "Follow Up Intervention for Positive Adult Depression Screening" FollowUpPositiveAdultScreen, "Qualifying Encounter During Measurement Period" QualifyingEncounter where LastAdultScreen.effective.toInterval ( ) starts 14 days or less on or before day of start of QualifyingEncounter.period and LastAdultScreen.value ~ "Depression screening positive (finding)" and ( start of FollowUpPositiveAdultScreen.performed.toInterval ( ) during QualifyingEncounter.period or FollowUpPositiveAdultScreen.authoredOn 2 days or less on or after day of end of QualifyingEncounter.period ) and ( Coalesce(start of FollowUpPositiveAdultScreen.performed.toInterval(), FollowUpPositiveAdultScreen.authoredOn) during day of "Measurement Period" ) Library Name Name PCSDepressionScreenAndFollowUpFHIR Patient Age 18 Years or Older at Start of Measurement Period define "Patient Age 18 Years or Older at Start of Measurement Period": AgeInYearsAt(date from start of "Measurement Period") >= 18 Library Name Name PCSDepressionScreenAndFollowUpFHIR Numerator define "Numerator": ( "Patient Age 12 to 16 Years at Start of Measurement Period" and ( "Has Most Recent Adolescent Screening Negative" or exists "Most Recent Adolescent Depression Screening Positive and Follow Up Provided" ) ) or ( "Patient Age 17 Years at Start of Measurement Period" and ( "Has Most Recent Adolescent Screening Negative" or exists "Most Recent Adolescent Depression Screening Positive and Follow Up Provided" or "Has Most Recent Adult Screening Negative" or exists "Most Recent Adult Depression Screening Positive and Follow Up Provided" ) ) or ( "Patient Age 18 Years or Older at Start of Measurement Period" and ( "Has Most Recent Adult Screening Negative" or exists "Most Recent Adult Depression Screening Positive and Follow Up Provided" ) ) Library Name Name PCSDepressionScreenAndFollowUpFHIR Patient Age 12 Years or Older at Start of Measurement Period define "Patient Age 12 Years or Older at Start of Measurement Period": AgeInYearsAt(date from start of "Measurement Period") >= 12 Library Name Name PCSDepressionScreenAndFollowUpFHIR Initial Population define "Initial Population": "Patient Age 12 Years or Older at Start of Measurement Period" and exists ( "Qualifying Encounter During Measurement Period" ) Library Name Name PCSDepressionScreenAndFollowUpFHIR Denominator define "Denominator": "Initial Population" Library Name Name SupplementalDataElements SDE Payer define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period } Library Name Name PCSDepressionScreenAndFollowUpFHIR SDE Payer define "SDE Payer": SDE."SDE Payer" Library Name Name SupplementalDataElements SDE Ethnicity define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text } Library Name Name PCSDepressionScreenAndFollowUpFHIR SDE Ethnicity define "SDE Ethnicity": SDE."SDE Ethnicity" Library Name Name PCSDepressionScreenAndFollowUpFHIR History of Bipolar Diagnosis Before Qualifying Encounter define "History of Bipolar Diagnosis Before Qualifying Encounter": [Condition: "Bipolar Disorder"] BipolarDiagnosis with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that ( BipolarDiagnosis.isProblemListItem ( ) or BipolarDiagnosis.isHealthConcern ( ) ) and BipolarDiagnosis.prevalenceInterval ( ) starts before QualifyingEncounter.period and ( BipolarDiagnosis.isActive ( ) or BipolarDiagnosis.clinicalStatus ~ QICoreCommon."remission" ) Library Name Name PCSDepressionScreenAndFollowUpFHIR Denominator Exclusions define "Denominator Exclusions": exists "History of Bipolar Diagnosis Before Qualifying Encounter" Library Name Name SupplementalDataElements SDE Race define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text } Library Name Name PCSDepressionScreenAndFollowUpFHIR SDE Race define "SDE Race": SDE."SDE Race" Library Name Name PCSDepressionScreenAndFollowUpFHIR Medical or Patient Reason for Not Screening Adolescent for Depression define "Medical or Patient Reason for Not Screening Adolescent for Depression": [ObservationNotDone: code ~ "Adolescent depression screening assessment"] NoAdolescentScreen with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that NoAdolescentScreen.issued during QualifyingEncounter.period where ( NoAdolescentScreen.notDoneReason ~ "Depression screening declined (situation)" or NoAdolescentScreen.notDoneReason in "Medical Reason" ) and NoAdolescentScreen.status = 'cancelled' Library Name Name PCSDepressionScreenAndFollowUpFHIR Has Adolescent Depression Screening define "Has Adolescent Depression Screening": exists ( [Observation: "Adolescent depression screening assessment"] AdolescentScreening with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that AdolescentScreening.effective.toInterval ( ) 14 days or less on or before day of start of QualifyingEncounter.period and AdolescentScreening.value is not null and AdolescentScreening.status = 'final' ) Library Name Name PCSDepressionScreenAndFollowUpFHIR Medical or Patient Reason for Not Screening Adult for Depression define "Medical or Patient Reason for Not Screening Adult for Depression": [ObservationNotDone: code ~ "Adult depression screening assessment"] NoAdultScreen with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that NoAdultScreen.issued during QualifyingEncounter.period where ( NoAdultScreen.notDoneReason ~ "Depression screening declined (situation)" or NoAdultScreen.notDoneReason in "Medical Reason" ) and NoAdultScreen.status = 'cancelled' Library Name Name PCSDepressionScreenAndFollowUpFHIR Has Adult Depression Screening define "Has Adult Depression Screening": exists ( [Observation: "Adult depression screening assessment"] AdultScreening with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that AdultScreening.effective.toInterval ( ) 14 days or less on or before day of start of QualifyingEncounter.period and AdultScreening.value is not null and AdultScreening.status = 'final' ) Library Name Name PCSDepressionScreenAndFollowUpFHIR Denominator Exceptions define "Denominator Exceptions": ( exists "Medical or Patient Reason for Not Screening Adolescent for Depression" and not "Has Adolescent Depression Screening" ) or ( exists "Medical or Patient Reason for Not Screening Adult for Depression" and not "Has Adult Depression Screening" )
Adolescent depression screening assessment
Depression screening declined (situation)
define "SDE Sex": case when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' } when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' } else null end
Patient Age 12 to 16 Years at Start of Measurement Period
define "Patient Age 12 to 16 Years at Start of Measurement Period": AgeInYearsAt(date from start of "Measurement Period") in Interval[12, 16]
Qualifying Encounter During Measurement Period
define "Qualifying Encounter During Measurement Period": ( [Encounter: "Encounter to Screen for Depression"] union [Encounter: "Physical Therapy Evaluation"] union [Encounter: "Telephone Visits"] ) QualifyingEncounter where QualifyingEncounter.period during day of "Measurement Period" and QualifyingEncounter.status = 'finished'
Most Recent Adolescent Depression Screening
define "Most Recent Adolescent Depression Screening": Last([Observation: "Adolescent depression screening assessment"] AdolescentDepressionScreening with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that AdolescentDepressionScreening.effective.toInterval() 14 days or less on or before day of start of QualifyingEncounter.period and AdolescentDepressionScreening.value is not null and AdolescentDepressionScreening.status = 'final' sort by start of effective.toInterval() )
Has Most Recent Adolescent Screening Negative
define "Has Most Recent Adolescent Screening Negative": ( "Most Recent Adolescent Depression Screening" AdolescentScreen where AdolescentScreen.value ~ "Depression screening negative (finding)" ) is not null
Follow Up Intervention for Positive Adolescent Depression Screening
define "Follow Up Intervention for Positive Adolescent Depression Screening": ( ( [MedicationRequest: "Adolescent Depression Medications"] AdolescentMed where AdolescentMed.status in { 'active', 'completed' } and AdolescentMed.intent = 'order' and AdolescentMed.doNotPerform is not true ) union ( [ServiceRequest: "Referral for Adolescent Depression"] AdolescentReferral where AdolescentReferral.status in { 'active', 'completed' } and AdolescentReferral.doNotPerform is not true ) union ( [Procedure: "Follow Up for Adolescent Depression"] AdolescentFollowUp where AdolescentFollowUp.status = 'completed' ) )
Most Recent Adolescent Depression Screening Positive and Follow Up Provided
define "Most Recent Adolescent Depression Screening Positive and Follow Up Provided": from "Most Recent Adolescent Depression Screening" LastAdolescentScreen, "Follow Up Intervention for Positive Adolescent Depression Screening" FollowUpPositiveAdolescentScreen, "Qualifying Encounter During Measurement Period" QualifyingEncounter where LastAdolescentScreen.effective.toInterval ( ) starts 14 days or less on or before day of start of QualifyingEncounter.period and LastAdolescentScreen.value ~ "Depression screening positive (finding)" and ( start of FollowUpPositiveAdolescentScreen.performed.toInterval ( ) during QualifyingEncounter.period or FollowUpPositiveAdolescentScreen.authoredOn 2 days or less on or after day of end of QualifyingEncounter.period ) and ( Coalesce(start of FollowUpPositiveAdolescentScreen.performed.toInterval(), FollowUpPositiveAdolescentScreen.authoredOn) during day of "Measurement Period" )
Patient Age 17 Years at Start of Measurement Period
define "Patient Age 17 Years at Start of Measurement Period": AgeInYearsAt(date from start of "Measurement Period") = 17
define "Most Recent Adult Depression Screening": Last([Observation: "Adult depression screening assessment"] AdultDepressionScreening with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that AdultDepressionScreening.effective.toInterval() 14 days or less on or before day of start of QualifyingEncounter.period and AdultDepressionScreening.value is not null and AdultDepressionScreening.status = 'final' sort by start of effective.toInterval() )
Has Most Recent Adult Screening Negative
define "Has Most Recent Adult Screening Negative": ( "Most Recent Adult Depression Screening" AdultScreen where AdultScreen.value ~ "Depression screening negative (finding)" ) is not null
Follow Up Intervention for Positive Adult Depression Screening
define "Follow Up Intervention for Positive Adult Depression Screening": ( ( [MedicationRequest: "Adult Depression Medications"] AdultMed where AdultMed.status in { 'active', 'completed' } and AdultMed.intent = 'order' and AdultMed.doNotPerform is not true ) union ( [ServiceRequest: "Referral for Adult Depression"] AdultReferral where AdultReferral.status in { 'active', 'completed' } and AdultReferral.doNotPerform is not true ) union ( [Procedure: "Follow Up for Adult Depression"] AdultFollowUp where AdultFollowUp.status = 'completed' ) )
Most Recent Adult Depression Screening Positive and Follow Up Provided
define "Most Recent Adult Depression Screening Positive and Follow Up Provided": from "Most Recent Adult Depression Screening" LastAdultScreen, "Follow Up Intervention for Positive Adult Depression Screening" FollowUpPositiveAdultScreen, "Qualifying Encounter During Measurement Period" QualifyingEncounter where LastAdultScreen.effective.toInterval ( ) starts 14 days or less on or before day of start of QualifyingEncounter.period and LastAdultScreen.value ~ "Depression screening positive (finding)" and ( start of FollowUpPositiveAdultScreen.performed.toInterval ( ) during QualifyingEncounter.period or FollowUpPositiveAdultScreen.authoredOn 2 days or less on or after day of end of QualifyingEncounter.period ) and ( Coalesce(start of FollowUpPositiveAdultScreen.performed.toInterval(), FollowUpPositiveAdultScreen.authoredOn) during day of "Measurement Period" )
Patient Age 18 Years or Older at Start of Measurement Period
define "Patient Age 18 Years or Older at Start of Measurement Period": AgeInYearsAt(date from start of "Measurement Period") >= 18
define "Numerator": ( "Patient Age 12 to 16 Years at Start of Measurement Period" and ( "Has Most Recent Adolescent Screening Negative" or exists "Most Recent Adolescent Depression Screening Positive and Follow Up Provided" ) ) or ( "Patient Age 17 Years at Start of Measurement Period" and ( "Has Most Recent Adolescent Screening Negative" or exists "Most Recent Adolescent Depression Screening Positive and Follow Up Provided" or "Has Most Recent Adult Screening Negative" or exists "Most Recent Adult Depression Screening Positive and Follow Up Provided" ) ) or ( "Patient Age 18 Years or Older at Start of Measurement Period" and ( "Has Most Recent Adult Screening Negative" or exists "Most Recent Adult Depression Screening Positive and Follow Up Provided" ) )
Patient Age 12 Years or Older at Start of Measurement Period
define "Patient Age 12 Years or Older at Start of Measurement Period": AgeInYearsAt(date from start of "Measurement Period") >= 12
define "Initial Population": "Patient Age 12 Years or Older at Start of Measurement Period" and exists ( "Qualifying Encounter During Measurement Period" )
define "Denominator": "Initial Population"
define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period }
define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text }
define "SDE Ethnicity": SDE."SDE Ethnicity"
History of Bipolar Diagnosis Before Qualifying Encounter
define "History of Bipolar Diagnosis Before Qualifying Encounter": [Condition: "Bipolar Disorder"] BipolarDiagnosis with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that ( BipolarDiagnosis.isProblemListItem ( ) or BipolarDiagnosis.isHealthConcern ( ) ) and BipolarDiagnosis.prevalenceInterval ( ) starts before QualifyingEncounter.period and ( BipolarDiagnosis.isActive ( ) or BipolarDiagnosis.clinicalStatus ~ QICoreCommon."remission" )
define "Denominator Exclusions": exists "History of Bipolar Diagnosis Before Qualifying Encounter"
define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text }
Medical or Patient Reason for Not Screening Adolescent for Depression
define "Medical or Patient Reason for Not Screening Adolescent for Depression": [ObservationNotDone: code ~ "Adolescent depression screening assessment"] NoAdolescentScreen with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that NoAdolescentScreen.issued during QualifyingEncounter.period where ( NoAdolescentScreen.notDoneReason ~ "Depression screening declined (situation)" or NoAdolescentScreen.notDoneReason in "Medical Reason" ) and NoAdolescentScreen.status = 'cancelled'
define "Has Adolescent Depression Screening": exists ( [Observation: "Adolescent depression screening assessment"] AdolescentScreening with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that AdolescentScreening.effective.toInterval ( ) 14 days or less on or before day of start of QualifyingEncounter.period and AdolescentScreening.value is not null and AdolescentScreening.status = 'final' )
Medical or Patient Reason for Not Screening Adult for Depression
define "Medical or Patient Reason for Not Screening Adult for Depression": [ObservationNotDone: code ~ "Adult depression screening assessment"] NoAdultScreen with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that NoAdultScreen.issued during QualifyingEncounter.period where ( NoAdultScreen.notDoneReason ~ "Depression screening declined (situation)" or NoAdultScreen.notDoneReason in "Medical Reason" ) and NoAdultScreen.status = 'cancelled'
define "Has Adult Depression Screening": exists ( [Observation: "Adult depression screening assessment"] AdultScreening with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that AdultScreening.effective.toInterval ( ) 14 days or less on or before day of start of QualifyingEncounter.period and AdultScreening.value is not null and AdultScreening.status = 'final' )
define "Denominator Exceptions": ( exists "Medical or Patient Reason for Not Screening Adolescent for Depression" and not "Has Adolescent Depression Screening" ) or ( exists "Medical or Patient Reason for Not Screening Adult for Depression" and not "Has Adult Depression Screening" )
Code system USCoreConditionCategoryExtensionCodes
Code system ConditionClinicalStatusCodes
Value set Encounter to Screen for Depression
Value set Adolescent Depression Medications
Value set Referral for Adolescent Depression
Value set Follow Up for Adolescent Depression
Value set Follow Up for Adult Depression
Preventive Care and Screening: Screening for Depression and Follow-Up PlanFHIR
Centers for Medicare & Medicaid Services (CMS)
Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of or up to two days after the date of the qualifying encounter
The intent of the measure is to screen for new cases of depression in patients who have never had a diagnosis of bipolar disorder. Patients who have ever been diagnosed with bipolar disorder prior to the qualifying encounter used to evaluate the numerator will be excluded from the measure regardless of whether the diagnosis is active or not. A depression screen is completed on the date of the encounter or up to 14 calendar days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan must be documented on the date of or up to two calendar days after the date of the encounter, such as referral to a provider for additional evaluation, pharmacological interventions, or other interventions for the treatment of depression. An example to illustrate the follow-up plan documentation timing: if the encounter is on a Monday from 3-4 pm (day 0) and the patient screens positive, the clinician has through anytime on Wednesday (day 2) to complete follow-up plan documentation. This measure does not require documentation of a specific score, just whether results of the normalized and validated depression screening tool used are considered positive or negative. Each standardized screening tool provides guidance on whether a particular score is considered positive for depression. This eCQM is a patient-based measure. Depression screening is required once per measurement period, not at all encounters. Screening Tools: - An age-appropriate, standardized, and validated depression screening tool must be used for numerator compliance. - The name of the age-appropriate standardized depression screening tool utilized must be documented in the medical record. - The depression screening must be reviewed and addressed by the provider, filing the code, on the date of the encounter. Positive pre-screening results indicating a patient is at high risk for self-harm should receive more urgent intervention as determined by the provider practice. - The screening should occur during a qualifying encounter or up to 14 calendar days prior to the date of the qualifying encounter. - The measure assesses the most recent depression screening completed either during the qualifying encounter or within the 14 calendar days prior to that encounter. Therefore, a clinician would not be able to complete another screening at the time of the encounter to count towards a follow-up, because that would serve as the most recent screening. In order to satisfy the follow-up requirement for a patient screening positively, the eligible clinician would need to provide one of the aforementioned follow-up actions, which does not include use of a standardized depression screening tool. Follow-Up Plan: The follow-up plan MUST still be provided for and discussed with the patient during the qualifying encounter used to evaluate the numerator. However, documentation of the follow-up plan can occur up to two calendar days after the qualifying encounter, in accordance with the policies of an eligible clinician or provider’s practice or health system. All services should be documented during, or as soon as practicable, after the qualifying encounter in order to maintain an accurate medical record. The follow-up plan must be related to a positive depression screening, for example: "Patient referred for psychiatric evaluation due to positive depression screening." Examples of a follow-up plan include but are not limited to: - Referral to a provider or program for further evaluation for depression, for example, referral to a psychiatrist, psychiatric nurse practitioner, psychologist, clinical social worker, mental health counselor, or other mental health service such as family or group therapy, support group, depression management program, or other service for treatment of depression - Other interventions designed to treat depression such as behavioral health evaluation, psychotherapy, pharmacological interventions, or additional treatment options Should a patient screen positive for depression, a clinician should: - Only order pharmacological intervention when appropriate and after sufficient diagnostic evaluation. However, for the purposes of this measure, additional screening and assessment during the qualifying encounter will not qualify as a follow-up plan. - Opt to complete a suicide risk assessment when appropriate and based on individual patient characteristics. However, for the purposes of this measure, a suicide risk assessment or additional screening using a standardized tool will not qualify as a follow-up plan. This FHIR-based measure has been derived from the QDM-based-based measure: CMS2v13. Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/quicore/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).
Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. 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.
These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Depression affects more than two hundred sixty million people across the world and is a leading cause of disability, with a variety of depressive disorders that are independent risk factors for chronic diseases, such as cardiovascular disease and diabetes, lending screening for depression as paramount to identify depressive disorders that can affect the most vulnerable populations (Constantini et al., 2021). Results from a 2018 U.S. survey indicated that 14.4 percent of adolescents (3.5 million adolescents) had a major depressive episode (MDE) in the past year, with nine percent of adolescents (2.4 million adolescents) having one MDE with severe impairment (Substance Abuse and Mental Health Services Administration, 2019). The odds of a diagnosis of depression are believed to be 2.6 times greater for children and adolescents exposed to trauma as compared to those unexposed or less exposed (Vibhakar et al., 2019). Children and teens with major depressive disorder (MDD) have been found to have difficulty carrying out their daily activities, relating to others, growing up healthy, and are at an increased risk of suicide (Siu on behalf of the U.S. Preventive Services Task Force [USPSTF], 2016). The same 2018 study indicated that 7.2 percent of adults aged 18 or older (17.7 million adults) had at least one MDE with 4.7 percent of adults (11.5 million adults) having one MDE with severe impairment in the past year (Substance Abuse and Mental Health Services Administration, 2019). Moreover, it is estimated 22.9 percent of adult patients with chronic pain (2.2 million adults) were diagnosed with comorbid depression from 2011 to 2015, with an upward trend of prevalence among Black Americans, patients aged 65 to 84 years old, Medicare and Medicaid insured patients, and patients from zip code areas with low annual household incomes (Orhurhu et al., 2019). Depression and other mood disorders, such as bipolar disorder and anxiety disorders, especially during the perinatal period, can have devastating effects on women, infants, and families (American College of Obstetricians and Gynecologists, 2018). It's estimated that the global prevalence of antenatal (or perinatal) depression ranges from 15 to 65 percent, with current or previous exposure to abuse and violence, lack of social support, and family history of mental disorders being risk factors. Depressive symptoms measured during pregnancy have been shown to influence the quality of the postpartum mother-infant relationship (Hazell Raine et al., 2020). Additionally, the risk of low birth weight and preterm birth is higher among infants born from depressed mothers (Dadi, Miller, Bisetegn, & Mwanri, 2020). Negative outcomes associated with depression make it crucial to screen in order to identify and treat depression in its early stages. Multiple social costs of depression have been identified, such as reduced educational achievements, poor financial success and role performance, higher amount of days out of role, and increased risk of job loss (Costantini et al., 2021). Depression also imposes significant economic burden through direct and indirect costs, supporting the need for regular depression screening. "In the United States, an estimated $22.8 billion was spent on depression treatment in 2009, and lost productivity cost an additional estimated $23 billion in 2011" (Siu & USPSTF, 2016, p. 383-384). Numerous studies have found significant disparities in depression prevalence and treatment among racial/ethnic minorities. One study revealed that Indigenous adults are at a high risk for posttraumatic stress disorder, depression, suicide, substance use disorder, and concurrent behavioral health disorders secondary to these initial health problems (Ka’apu and Burnette, 2019). Additionally, though rates of depression are lower among Blacks and Hispanics than among whites, depression among Blacks and Hispanics is likely to be more recurrent. Furthermore, 48 percent of whites receive mental health services, compared to just 31 percent of Blacks and Hispanics, and 22 percent of Asians (American Psychiatric Association, 2017). Asian Americans and Black Americans are also significantly more likely to utilize emergency rooms for depression treatment, which contributes to inconsistent follow-up care (Lee et al., 2014). While primary care providers (PCPs) serve as the first line of defense in the detection of depression, studies show that PCPs fail to recognize up to 46 percent of depressed patients (Borner et al., 2010). "In nationally representative U.S. surveys, about eight percent of adolescents reported having major depression in the past year. Only 36 percent to 44 percent of children and adolescents with depression receive treatment, suggesting that the majority of depressed youth are undiagnosed and untreated" (Siu on behalf of USPSTF, 2016, p. 360 & p. 364). Furthermore, evidence supports that screening for depression in pregnant and postpartum women is of moderate net benefit, and treatment options for positive depression screening should be available for patients twelve and older including pregnant and postpartum women. This measure seeks to align with USPSTF clinical guideline recommendations as well as the Healthy People 2030 recommendation to increase the proportion of adolescents and adults who are screened and receive treatment for depression (U.S. Preventative Services Task Force, 2016) and makes an important contribution to the quality domain of community and population health.
Adolescent Recommendation (12-18 years): "The USPSTF recommends screening for MDD in adolescents aged 12 to 18 years. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (B recommendation)" (Siu on behalf of USPSTF, 2016, p. 360). Adult Recommendation (18 years and older): "The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (B recommendation)" (Siu & USPSTF, 2016, p. 380). “The USPSTF recommends that clinicians provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions. (B recommendation)” (U.S. Preventive Services Task Force, 2019). The American College of Obstetricians and Gynecologists (ACOG) provides the following recommendation: "All obstetrician–gynecologists and other obstetric care providers should complete a full assessment of mood and emotional well-being (including screening for postpartum depression and anxiety with a validated instrument) during the comprehensive postpartum visit for each patient" (American College of Obstetricians and Gynecologists, 2018). The Institute for Clinical Systems Improvement (ICSI) health care guideline, Adult Depression in Primary Care, provides the following recommendations: 1. "Clinicians should routinely screen all adults for depression using a standardized instrument." 2. "Clinicians should establish and maintain follow-up with patients." 3. "Clinicians should screen and monitor depression in pregnant and post-partum women" (Trangle et al., 2016, p. 8-10).
All patients aged 12 years and older at the beginning of the measurement period with at least one qualifying encounter during the measurement period
Patients who have ever been diagnosed with bipolar disorder at any time prior to the qualifying encounter
Patients screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized tool AND if positive, a follow-up plan is documented on the date of or up to two days after the date of the qualifying encounter
Patient Reason(s) Patient refuses to participate in or complete the depression screening OR Medical Reason(s) Documentation of medical reason for not screening patient for depression (e.g., cognitive, functional, or motivational limitations that may impact accuracy of results; patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient's health status)