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

## : Depression Remission at Twelve MonthsFHIR - XML Representation

Draft as of 2023-08-28

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    <Measure xmlns="http://hl7.org/fhir">
      <id value="DepressionRemissionatTwelveMonthsFHIR"/>
      <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;">Depression Remission at Twelve MonthsFHIR</td>
                </tr>

                <tr>
                    <th scope="row"><b>Id: </b></th>
                    <td style="padding-left: 4px;">DepressionRemissionatTwelveMonthsFHIR</td>
                </tr>

                    <tr>
                        <th scope="row"><b>Download cql: </b></th>
                        <td style="padding-left: 4px;"><a href="Library-DepressionRemissionatTwelveMonthsFHIR.cql">DepressionRemissionatTwelveMonthsFHIR.cql</a></td>
                    </tr>

                <tr>
                    <th scope="row"><b>Version: </b></th>
                    <td style="padding-left: 4px;">0.0.001</td>
                </tr>

                <tr>
                    <th scope="row"><b>Url: </b></th>
                    <td style="padding-left: 4px;"><a href="Measure-DepressionRemissionatTwelveMonthsFHIR.html">Depression Remission at Twelve MonthsFHIR</a></td>
                </tr>

                <tr>
                    <th scope="row">
                        <b>

                                    short-name identifier:

                        </b>
                    </th>

                    <td style="padding-left: 4px;">

                            <p style="margin-bottom: 5px;">
                                <span>CMS159FHIR</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:5df972fb-27e0-4b59-b5f8-b041e6ffc947</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:2c928084808a9589018094b0efb804a6</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>0710e</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>159FHIR</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;">2023-08-28 17:12:47+0000</td>
                </tr>

                <tr>
                    <th scope="row"><b>Approval Date: </b></th>
                    <td style="padding-left: 4px;">2023-08-28</td>
                </tr>

                <tr>
                    <th scope="row"><b>Last Review Date: </b></th>
                    <td style="padding-left: 4px;">2023-08-28</td>
                </tr>

                <tr>
                    <th scope="row"><b>Name: </b></th>
                    <td style="padding-left: 4px;">DepressionRemissionatTwelveMonthsFHIR</td>
                </tr>

                <tr>
                    <th scope="row"><b>Publisher: </b></th>
                    <td style="padding-left: 4px;">MN Community Measurement</td>
                </tr>

            <tr>
                <th scope="row"><b>Author: </b></th>
                <td style="padding-left: 4px;">Telligen: <a href="https://www.telligen.com/">https://www.telligen.com/</a></td>
            </tr>

                <tr>
                    <th scope="row"><b>Description: </b></th>
                    <td style="padding-left: 4px;"><div><p>The percentage of adolescent patients 12 to 17 years of age and adult patients 18 years of age or older with major depression or dysthymia who reached remission 12 months (+/- 60 days) after an index event</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 MN Community Measurement, 2023. All rights reserved.</p>
    <p>Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. Mathematica disclaims all liability for use or accuracy of any third party codes contained in the specifications.</p>
    <p>CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) 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 copyright 2022 World Health Organization. All Rights Reserved.</p>
    </div></td>
                </tr>

                <tr>
                    <th scope="row"><b>Disclaimer: </b></th>
                    <td style="padding-left: 4px;"><div><p>The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications.</p>
    <p>THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.</p>
    <p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p>
    </div></td>
                </tr>

            <tr>
                <th scope="row"><b>Rationale: </b></th>
                <td style="padding-left: 4px;"><div><p>Adults:
    Depression is a common and treatable mental disorder. During 2013-2016, 8.1% of American adults age 20 and over had depression in a given 2 week period. Women (10.4%) were almost twice as likely as men (5.5%) to have had depression. The prevalence of depression among adults decreased as family income levels increased. About 80% of adults with depression reported at least some difficulty with work, home, or social activities because of their depression symptoms (Brody, Pratt, and Hughes, 2018).</p>
    <p>Depression is a risk factor for development of chronic illnesses such as diabetes and coronary heart disease and adversely affects the course, complications and management of chronic medical illness. Both maladaptive health risk behaviors and psychobiological factors associated with depression may explain depression's negative effect on outcomes of chronic illness (Katon, 2011).</p>
    <p>Adolescents and Adults:
    The Centers for Disease Control and Prevention states that during 2009-2012 an estimated 7.6% of the U.S. population aged 12 and over had depression, including 3% of Americans with severe depressive symptoms. Almost 43% of persons with severe depressive symptoms reported serious difficulties in work, home and social activities, yet only 35% reported having contact with a mental health professional in the past year (Pratt and Brody, 2014).</p>
    <p>Depression is associated with higher mortality rates in all age groups. Depression is also a leading cause of medical disability, and depressed people lose 5.6 hours of productive work every week when they are depressed, 50% of which is due to absenteeism and short-term disability (Stewart et al., 2003).</p>
    <p>Adolescents:
    In 2014, an estimated 2.8 million adolescents age 12 to 17 in the United States had at least one major depressive episode (MDE) in the past year (Center for Behavioral Health Statistics and Quality, 2015). The 2013 Youth Risk Behavior Survey of students grades 9 to 12 indicated that during the past 12 months 39.1% (F) and 20.8% (M) indicated feeling sad or hopeless almost every day for at least 2 weeks, planned suicide attempt 16.9% (F) and 10.3% (M), with attempted suicide 10.6% (F) and 5.4% (M) (Kann et al., 2014). Adolescent-onset depression is associated with chronic depression in adulthood. Many mental health conditions (anxiety, bipolar, depression, eating disorders, and substance abuse) are evident by age 14. The 12-month prevalence of MDEs increased from 8.7% in 2005 to 11.3% in 2014 in adolescents and from 8.8% to 9.6% in young adults (both P &lt; .001). The increase was larger and statistically significant only in the age range of 12 to 20 years. The trends remained significant after adjustment for substance use disorders and sociodemographic factors (Mojtabai, Olfson, and Han 2016). Mental health care contacts overall did not change over time; however, the use of specialty mental health providers increased in adolescents and young adults, and the use of prescription medications and inpatient hospitalizations increased in adolescents (Mojtabai, Olfson, and Han 2016).</p>
    </div></td>
            </tr>

            <tr>
                <th scope="row"><b>Clinical recommendation statement: </b></th>
                <td style="padding-left: 4px;"><div><p>Adults:</p>
    <p>Recommendations and algorithm notations supporting depression outcomes and duration of treatment according to Institute for Clinical Systems Improvement Health Care Guideline (Trangle et al., 2016):</p>
    <p>Recommendation: Clinicians should establish and maintain follow-up with patients. Appropriate, reliable follow-up is highly correlated with improved response and remission scores. It is also correlated with the improved safety and efficacy of medications and helps prevent relapse (Trangle et al., 2016).</p>
    <p>Proactive follow-up contacts (in person, telephone) based on the collaborative care model have been shown to significantly lower depression severity (Unutzer et al., 2002). In the available clinical effectiveness trials conducted in real clinical practice settings, even the addition of a care manager leads to modest remission rates (Trivedi et al., 2006; Unutzer et al., 2002). Interventions are critical to educating the patient regarding the importance of preventing relapse, safety and efficacy of medications, and management of potential side effects. Establish and maintain initial follow-up contact intervals (office, phone, other) (Hunkeler et al., 2000; Simon et al., 2000).</p>
    <p>The Patient Health Questionnaire-9 (PHQ-9) is an effective monitoring and management tool, and should be used routinely for subsequent visits to monitor treatment outcomes and severity. It can also help the clinician decide if/how to modify the treatment plan (Duffy et al., 2008; Lowe et al., 2004). Using a measurement-based approach to depression care, PHQ-9 results and side effect evaluation should be combined with treatment algorithms to drive patients toward remission. A five-point drop in PHQ-9 score is considered the minimal clinically significant difference (Trivedi, 2009).</p>
    <p>The goals of treatment should be to achieve remission, reduce relapse and recurrence, and return to previous level of occupational and psychosocial function.</p>
    <p>If using a PHQ-9 tool, remission translates to PHQ-9 score of less than 5 (Kroenke, 2001). Results from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study showed that remission rates lowered with more treatment steps, but the overall cumulative rate was 67% (Rush et al., 2006).</p>
    <p>Response and remission take time. In the STAR*D study, longer times than expected were needed to reach response or remission. In fact, one-third of those who ultimately responded did so after six weeks. Of those who achieved remission by Quick Inventory of Depressive Symptomatology, 50% did so only at or after six weeks of treatment (Trivedi et al., 2006). If the primary care clinician is seeing some improvement, continue working with that patient to augment or increase dosage to reach remission. This can take up to three months.</p>
    <p>This measure assesses achievement of remission, which is a desired outcome of effective depression treatment and monitoring.</p>
    <p>Adult Depression in Primary Care - Guideline Aims (Trangle et al., 2016):</p>
    <ul>
    <li>Increase the percentage of patients with major depression or persistent depressive disorder who have improvement in outcomes from treatment for major depression or persistent depressive disorder.</li>
    <li>Increase the percentage of patients with major depression or persistent depressive disorder who have follow-up to assess for outcomes from treatment.</li>
    <li>Improve communication between the primary care physician and the mental health care clinician (if patient is co-managed).</li>
    </ul>
    <p>Adolescents:</p>
    <p>Recommendations supporting depression outcomes and duration of treatment according to American Academy of Child and Adolescent Psychiatry guideline (Birmaher et al., 2007):</p>
    <ul>
    <li>Treatment of depressive disorders should always include an acute and continuation phase; some children may also require maintenance treatment. The main goal of the acute phase is to achieve response and ultimately full symptomatic remission (definitions below).</li>
    <li>Each phase of treatment should include psychoeducation, supportive management, and family and school involvement.</li>
    <li>Education, support, and case management appear to be sufficient treatment for the management of depressed children and adolescents with an uncomplicated or brief depression or with mild psychosocial impairment.</li>
    <li>For children and adolescents who do not respond to supportive psychotherapy or who have more complicated depressions, a trial with specific types of psychotherapy and/or antidepressants is indicated.</li>
    </ul>
    <p>Recommendations supporting depression outcomes and duration of treatment according to Guidelines for Adolescent Depression in Primary Care (Zuckerbrot et al., 2018 (Part I), Zuckerbrot et al., 2018 (Part II)):</p>
    <ul>
    <li>Mild depression: consider a period of active support and monitoring before starting other evidence-based treatment</li>
    <li>Moderate or severe major clinical depression or complicating factors:
    -- consultation with mental health specialist with agreed upon roles
    -- evidence based treatment (cognitive behavioral therapy or interpersonal psychotherapy and/or antidepressant selective serotonin reuptake inhibitors)</li>
    <li>Monitor for adverse effects during antidepressant therapy
    -- clinical worsening, suicidality, unusual changes in behavior</li>
    <li>Systematic and regular tracking of goals and outcomes
    -- improvement in functioning status and resolution of depressive symptoms
    Regardless of the length of treatment, all patients should be monitored on a monthly basis for 6 to 12 months after the full resolution of symptoms.</li>
    </ul>
    </div></td>
            </tr>

                <tr>
                    <th scope="row"><b>Guidance (Usage): </b></th>
                    <td style="padding-left: 4px;">When an index assessment is conducted with PHQ-9M, the follow-up assessment can use either a PHQ-9M or PHQ-9.

    This eCQM is a patient-based measure.

    This FHIR-based measure has been derived from the QDM-based measure: CMS159v12.

    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>638501ed4ba3d47c885c02b0</b></th>
                                        </tr>

                                        <tr>
                                            <td>Initial Population:</td>

                                                <td>Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older with a diagnosis of major depression or dysthymia and an initial PHQ-9 or PHQ-9M score greater than nine during the index event. Patients may be assessed using PHQ-9 or PHQ-9M on the same date or up to 7 days prior to the encounter (index event).</td>

                                        </tr>

                                        <tr>
                                            <td>Denominator:</td>

                                                <td>Equals Initial Population</td>

                                        </tr>

                                        <tr>
                                            <td>Denominator Exclusion:</td>

                                                <td>1: Patients who died any time prior to the end of the measure assessment period
    2: Patients who received hospice or palliative care services between the start of the denominator period and the end of the measurement assessment period
    3: Patients with a diagnosis of bipolar disorder any time prior to the end of the measure assessment period
    4: Patients with a diagnosis of personality disorder emotionally labile any time prior to the end of the measure assessment period
    5: Patients with a diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period
    6: Patients with a diagnosis of pervasive developmental disorder any time prior to the end of the measure assessment period</td>

                                        </tr>

                                        <tr>
                                            <td>Numerator:</td>

                                                <td>Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older who achieved remission at twelve months as demonstrated by the most recent twelve month (+/- 60 days) PHQ-9 or PHQ-9M score of less than five</td>

                                        </tr>

                                        <tr>
                                            <td>Numerator Exclusion:</td>

                                                <td>None</td>

                                        </tr>

                                        <tr>
                                            <td>Denominator Exception:</td>

                                                <td>None</td>

                                        </tr>

                                      <tr><b>Stratifier Criteria: </b></tr>

                                            <tr>
                                                <td>:</td>

                                                    <td>Ages 12 to 17 at the time of the index assessment</td>

                                            </tr>

                                            <tr>
                                                <td>:</td>

                                                    <td>Ages 18 and older at the time of the index assessment</td>

                                            </tr>

                                </table>

                        </td>
                    </tr>

                <tr>
                    <th scope="row">
                        <b> Supplemental Data Guidance
                            : </b></th>
                    <td style="padding-left: 4px;">  </td>
                </tr>

                <tr>
                    <th scope="row"><b> Supplemental Data Elements: </b></th>
                    <td style="padding-left: 4px;">

                                    SDE Ethnicity

                                    SDE Payer

                                    SDE Race

                                    SDE Sex

                    </td>
                </tr>

                <tr>
                    <th scope="row"><b>Libraries: </b></th>
                    <td style="padding-left: 4px;">
                        <table class="grid-dict">

                                <tr>
                                    <td><a href="Library-DepressionRemissionatTwelveMonthsFHIR.html">DepressionRemissionatTwelveMonthsFHIR</a></td>
                                </tr>

                        </table>
                    </td>
                </tr>

                    <tr>
                        <th scope="row"><b>Related Artifact Dependencies: </b></th>
                        <td style="padding-left: 4px;">

                                <li><code>Library/SupplementalDataElements|3.4.000</code></li>

                                <li><code>Library/FHIRHelpers|4.3.000</code></li>

                                <li><code>Library/QICoreCommon|1.5.000</code></li>

                                <li><code>Library/FHIRHelpers|4.3.000</code></li>

                                <li><code>Library/FHIRHelpers|4.3.000</code></li>

                                <li><a href="http://terminology.hl7.org/7.1.0/CodeSystem-condition-clinical.html">Condition Clinical Status Codes</a></li>

                                <li><a href="http://terminology.hl7.org/7.1.0/CodeSystem-condition-ver-status.html">ConditionVerificationStatus</a></li>

                                <li><a href="http://hl7.org/fhir/R4/codesystem-snomedct.html">SNOMED CT (all versions)</a></li>

                                <li><a href="http://tx.fhir.org/r4/ValueSet/x-loinc2.82">LOINC</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.67.1.101.1.263/expansion">PHQ 9 and PHQ 9M Tools</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1080.5/expansion">Contact or Office Visit</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.113883.3.67.1.101.3.2444/expansion">Major Depression Including Remission</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.67.1.101.1.254/expansion">Dysthymia</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a></li>

                                <li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1003-20210820">Hospice Encounter</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion">Hospice Care Ambulatory</a></li>

                                <li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1165-20220818">Hospice Diagnosis</a></li>

                                <li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1167-20220820">Palliative Care Diagnosis</a></li>

                                <li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090-20210224">Palliative Care Encounter</a></li>

                                <li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135-20210224">Palliative Care Intervention</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.67.1.101.1.128/expansion">Bipolar Disorder</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.67.1.101.1.246/expansion">Personality Disorder Emotionally Labile</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1104/expansion">Schizophrenia or Psychotic Disorder</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1152/expansion">Pervasive Developmental Disorder</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>SDE Sex</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>1</td>
                                        <td>Coding</td>
                                    </tr>

                                    <tr>
                                        <td>Numerator</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>1</td>
                                        <td>boolean</td>
                                    </tr>

                                    <tr>
                                        <td>Stratification 2</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>1</td>
                                        <td>boolean</td>
                                    </tr>

                                    <tr>
                                        <td>Stratification 1</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>1</td>
                                        <td>boolean</td>
                                    </tr>

                                    <tr>
                                        <td>Denominator</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>1</td>
                                        <td>boolean</td>
                                    </tr>

                                    <tr>
                                        <td>SDE Payer</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>1</td>
                                        <td>boolean</td>
                                    </tr>

                                    <tr>
                                        <td>SDE Ethnicity</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>1</td>
                                        <td>Resource</td>
                                    </tr>

                                    <tr>
                                        <td>Denominator Exclusions</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>1</td>
                                        <td>boolean</td>
                                    </tr>

                                    <tr>
                                        <td>SDE Race</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>1</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>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>

                                    <tr>
                                        <td>Patient(<code>http://hl7.org/fhir/Patient</code>)</td>
                                        <td>

                                                gender

                                                gender.value

                                                birthDate

                                                birthDate.value

                                                deceased

                                        </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>

                                    <tr>
                                        <td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
                                        <td>

                                                code

                                                value

                                                status

                                                status.value

                                                effective

                                        </td>
                                        <td>

                                                     PHQ 9 and PHQ 9M Tools

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.67.1.101.1.263/expansion">PHQ 9 and PHQ 9M Tools</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<code>http://hl7.org/fhir/Condition</code>)</td>
                                        <td>

                                                clinicalStatus

                                        </td>
                                        <td>

                                        </td>
                                        <td/>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Major Depression Including Remission

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.113883.3.67.1.101.3.2444/expansion">Major Depression Including Remission</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Dysthymia

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.67.1.101.1.254/expansion">Dysthymia</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

                                                period

                                                status

                                                status.value

                                        </td>
                                        <td>

                                                     Contact or Office Visit

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1080.5/expansion">Contact or Office Visit</a></td>
                                    </tr>

                                    <tr>
                                        <td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
                                        <td>

                                                code

                                                value

                                                status

                                                status.value

                                                effective

                                        </td>
                                        <td>

                                                     PHQ 9 and PHQ 9M Tools

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.67.1.101.1.263/expansion">PHQ 9 and PHQ 9M Tools</a></td>
                                    </tr>

                                    <tr>
                                        <td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
                                        <td>

                                                code

                                                effective

                                                status

                                                status.value

                                        </td>
                                        <td>

                                                     PHQ 9 and PHQ 9M Tools

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.67.1.101.1.263/expansion">PHQ 9 and PHQ 9M Tools</a></td>
                                    </tr>

                                    <tr>
                                        <td>Observation(<code>http://hl7.org/fhir/Observation</code>)</td>
                                        <td>

                                                value

                                                effective

                                        </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>

                                    <tr>
                                        <td>Coverage(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html">QICoreCoverage</a>)</td>
                                        <td>

                                                type

                                                period

                                        </td>
                                        <td>

                                                     Payer Type

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a></td>
                                    </tr>

                                    <tr>
                                        <td>uri(<code>http://hl7.org/fhir/uri</code>)</td>
                                        <td>

                                                value

                                        </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>

                                                url

                                                extension

                                        </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>

                                                url

                                                extension

                                        </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

                                                hospitalization

                                                hospitalization.dischargeDisposition

                                                period

                                                status

                                                status.value

                                        </td>
                                        <td>

                                                     Encounter Inpatient

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</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

                                                period

                                                status

                                                status.value

                                        </td>
                                        <td>

                                                     Hospice Encounter

                                        </td>
                                        <td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1003-20210820">Hospice Encounter</a></td>
                                    </tr>

                                    <tr>
                                        <td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
                                        <td>

                                                code

                                                value

                                                effective

                                                status

                                                status.value

                                        </td>
                                        <td>

                                        </td>
                                        <td/>
                                    </tr>

                                    <tr>
                                        <td>ServiceRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html">QICoreServiceRequest</a>)</td>
                                        <td>

                                                code

                                                authoredOn

                                                authoredOn.value

                                                status

                                                status.value

                                                intent

                                                intent.value

                                        </td>
                                        <td>

                                                     Hospice Care Ambulatory

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion">Hospice Care Ambulatory</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

                                                performed

                                                status

                                                status.value

                                        </td>
                                        <td>

                                                     Hospice Care Ambulatory

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion">Hospice Care Ambulatory</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                                verificationStatus

                                        </td>
                                        <td>

                                                     Hospice Diagnosis

                                        </td>
                                        <td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1165-20220818">Hospice Diagnosis</a></td>
                                    </tr>

                                    <tr>
                                        <td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
                                        <td>

                                                code

                                                effective

                                                status

                                                status.value

                                        </td>
                                        <td>

                                        </td>
                                        <td/>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                                verificationStatus

                                        </td>
                                        <td>

                                                     Palliative Care Diagnosis

                                        </td>
                                        <td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1167-20220820">Palliative Care Diagnosis</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

                                                period

                                                status

                                                status.value

                                        </td>
                                        <td>

                                                     Palliative Care Encounter

                                        </td>
                                        <td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090-20210224">Palliative Care Encounter</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

                                                performed

                                                status

                                                status.value

                                        </td>
                                        <td>

                                                     Palliative Care Intervention

                                        </td>
                                        <td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135-20210224">Palliative Care Intervention</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Bipolar Disorder

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.67.1.101.1.128/expansion">Bipolar Disorder</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Personality Disorder Emotionally Labile

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.67.1.101.1.246/expansion">Personality Disorder Emotionally Labile</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Schizophrenia or Psychotic Disorder

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1104/expansion">Schizophrenia or Psychotic Disorder</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Pervasive Developmental Disorder

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1152/expansion">Pervasive Developmental Disorder</a></td>
                                    </tr>

                                    <tr>
                                        <td>Patient(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html">QICorePatient</a>)</td>
                                        <td>

                                                url

                                                extension

                                        </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>

                                                url

                                                extension

                                        </td>
                                        <td>

                                        </td>
                                        <td/>
                                    </tr>

                                    <tr>
                                        <td>Coverage(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html">QICoreCoverage</a>)</td>
                                        <td>

                                                type

                                                period

                                        </td>
                                        <td>

                                                     Payer Type

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a></td>
                                    </tr>

                                    <tr>
                                        <td>Patient(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html">QICorePatient</a>)</td>
                                        <td>

                                                url

                                                extension

                                        </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>

                                                url

                                                extension

                                        </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/>
                                            <td>active</td>
                                            <td><a href="http://terminology.hl7.org/7.1.0/CodeSystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
                                        </tr>

                                        <tr>
                                            <td/>
                                            <td>recurrence</td>
                                            <td><a href="http://terminology.hl7.org/7.1.0/CodeSystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
                                        </tr>

                                        <tr>
                                            <td/>
                                            <td>relapse</td>
                                            <td><a href="http://terminology.hl7.org/7.1.0/CodeSystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
                                        </tr>

                                        <tr>
                                            <td/>
                                            <td>unconfirmed</td>
                                            <td><a href="http://terminology.hl7.org/7.1.0/CodeSystem-condition-ver-status.html">http://terminology.hl7.org/CodeSystem/condition-ver-status</a></td>
                                        </tr>

                                        <tr>
                                            <td/>
                                            <td>refuted</td>
                                            <td><a href="http://terminology.hl7.org/7.1.0/CodeSystem-condition-ver-status.html">http://terminology.hl7.org/CodeSystem/condition-ver-status</a></td>
                                        </tr>

                                        <tr>
                                            <td/>
                                            <td>entered-in-error</td>
                                            <td><a href="http://terminology.hl7.org/7.1.0/CodeSystem-condition-ver-status.html">http://terminology.hl7.org/CodeSystem/condition-ver-status</a></td>
                                        </tr>

                                        <tr>
                                            <td>Discharge to home for hospice care (procedure)</td>
                                            <td>428361000124107</td>
                                            <td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
                                        </tr>

                                        <tr>
                                            <td>Discharge to healthcare facility for hospice care (procedure)</td>
                                            <td>428371000124100</td>
                                            <td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
                                        </tr>

                                        <tr>
                                            <td>Hospice care [Minimum Data Set]</td>
                                            <td>45755-6</td>
                                            <td><a href="https://loinc.org/">http://loinc.org</a></td>
                                        </tr>

                                        <tr>
                                            <td>Yes (qualifier value)</td>
                                            <td>373066001</td>
                                            <td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
                                        </tr>

                                        <tr>
                                            <td>Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)</td>
                                            <td>71007-9</td>
                                            <td><a href="https://loinc.org/">http://loinc.org</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> 638501ed4ba3d47c885c02b0 </td>
                                    <td>

                                            <b>Group scoring:</b>

                                                <span>  proportion </span>

                                    </td>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Initial Population</td>
                                        <td>

                                                <pre><code class="language-cql">define &quot;Initial Population&quot;:
      AgeInYearsAt(start of(&quot;Index Depression Assessment&quot;.effective.toInterval())) &gt;= 12</code></pre>

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Denominator</td>
                                        <td>

                                                <pre><code class="language-cql">define &quot;Denominator&quot;:
      &quot;Initial Population&quot;</code></pre>

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Denominator Exclusion</td>
                                        <td>

                                                <pre><code class="language-cql">define &quot;Denominator Exclusions&quot;:
      &quot;Has Hospice Services in the Measure Assessment Period&quot;
        or &quot;Has Palliative Care in the Measure Assessment Period&quot;
        or &quot;Patient Expired&quot;
        or &quot;Has Mental Health Disorder Diagnoses&quot;</code></pre>

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Numerator</td>
                                        <td>

                                                <pre><code class="language-cql">define &quot;Numerator&quot;:
      Last([Observation: &quot;PHQ 9 and PHQ 9M Tools&quot;] DepressionAssessment
          where ToDate(start of DepressionAssessment.effective.toInterval()) during &quot;Measure Assessment Period&quot;
            and DepressionAssessment.status in { 'final', 'amended', 'corrected' }
          sort by start of effective.toInterval()
      ).value &lt; 5</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>
                                        <td/>
                                        <td/>
                                        <td/>
                                        <td>

                                                <pre><code class="language-cql"/></pre>

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td/>
                                        <td>

                                                <pre><code class="language-cql"/></pre>

                                        </td>
                                    </tr>

                                </tr>
                            </table>

                    <table class="grid-dict">

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>SupplementalDataElements</td>

                                    <td>SDE Sex</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Sex&quot;:
      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</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>SDE Sex</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Sex&quot;:
      SDE.&quot;SDE Sex&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>Depression Assessments Greater than 9</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Depression Assessments Greater than 9&quot;:
      [Observation: &quot;PHQ 9 and PHQ 9M Tools&quot;] DepressionAssessment
        where DepressionAssessment.value &gt; 9
          and DepressionAssessment.status in { 'final', 'amended', 'corrected' }</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>Depression Diagnoses</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Depression Diagnoses&quot;:
      ( [Condition: &quot;Major Depression Including Remission&quot;]
        union [Condition: &quot;Dysthymia&quot;] ) Depression
        where Depression.isActive ( )
          and not ( Depression.verificationStatus ~ QICoreCommon.&quot;unconfirmed&quot;
              or Depression.verificationStatus ~ QICoreCommon.&quot;refuted&quot;
              or Depression.verificationStatus ~ QICoreCommon.&quot;entered-in-error&quot;
          )</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>Denominator Identification Period</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Denominator Identification Period&quot;:
      Interval[start of &quot;Measurement Period&quot; - 14 months, start of &quot;Measurement Period&quot; - 2 months )</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>Depression Encounter</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Depression Encounter&quot;:
      [Encounter: &quot;Contact or Office Visit&quot;] ValidEncounter
        with &quot;Depression Diagnoses&quot; Depression
          such that ValidEncounter.period overlaps Depression.prevalenceInterval ( )
            and ValidEncounter.period ends during &quot;Denominator Identification Period&quot;
            and ValidEncounter.status = 'finished'</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>Index Depression Assessment</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Index Depression Assessment&quot;:
      First(&quot;Depression Assessments Greater than 9&quot; DepressionAssessment
          with &quot;Depression Encounter&quot; DepressionEncounter
            such that DepressionAssessment.effective.toInterval() during day of Interval[ToDate((start of DepressionEncounter.period) - 7 days),
            end of DepressionEncounter.period]
          sort by start of effective.toInterval()
      )</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>Measure Assessment Period</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Measure Assessment Period&quot;:
      &quot;Index Depression Assessment&quot; FirstIndexAssessment
        let YearAfterIndexAssessment: date from start of FirstIndexAssessment.effective.toInterval ( ) + 12 months
        return Interval[YearAfterIndexAssessment - 60 days, YearAfterIndexAssessment + 60 days]</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>Numerator</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Numerator&quot;:
      Last([Observation: &quot;PHQ 9 and PHQ 9M Tools&quot;] DepressionAssessment
          where ToDate(start of DepressionAssessment.effective.toInterval()) during &quot;Measure Assessment Period&quot;
            and DepressionAssessment.status in { 'final', 'amended', 'corrected' }
          sort by start of effective.toInterval()
      ).value &lt; 5</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>Stratification 2</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Stratification 2&quot;:
      &quot;Index Depression Assessment&quot; IndexAssessment
        return AgeInYearsAt(date from start of IndexAssessment.effective.toInterval()) &gt;= 18</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>Stratification 1</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Stratification 1&quot;:
      &quot;Index Depression Assessment&quot; IndexAssessment
        return AgeInYearsAt(date from start of IndexAssessment.effective.toInterval()) in Interval[12, 17]</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>Initial Population</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Initial Population&quot;:
      AgeInYearsAt(start of(&quot;Index Depression Assessment&quot;.effective.toInterval())) &gt;= 12</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>Denominator</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Denominator&quot;:
      &quot;Initial Population&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>SupplementalDataElements</td>

                                    <td>SDE Payer</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Payer&quot;:
      [Coverage: type in &quot;Payer Type&quot;] Payer
        return {
          code: Payer.type,
          period: Payer.period
        }</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>SDE Payer</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Payer&quot;:
      SDE.&quot;SDE Payer&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>SupplementalDataElements</td>

                                    <td>SDE Ethnicity</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Ethnicity&quot;:
      Patient.ethnicity E
        return Tuple {
          codes: { E.ombCategory } union E.detailed,
          display: E.text
        }</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>SDE Ethnicity</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Ethnicity&quot;:
      SDE.&quot;SDE Ethnicity&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>Has Hospice Services in the Measure Assessment Period</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Hospice Services in the Measure Assessment Period&quot;:
      exists ( [Encounter: &quot;Encounter Inpatient&quot;] InpatientEncounter
          where ( InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to home for hospice care (procedure)&quot;
              or InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to healthcare facility for hospice care (procedure)&quot;
          )
            and InpatientEncounter.period ends during day of Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
            and InpatientEncounter.status = 'finished'
      )
        or exists ( [Encounter: &quot;Hospice Encounter&quot;] HospiceEncounter
            where HospiceEncounter.period overlaps day of Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
              and not ( HospiceEncounter.status in { 'cancelled', 'entered-in-error', 'unknown' } )
        )
        or exists ( [Observation: &quot;Hospice care [Minimum Data Set]&quot;] HospiceAssessment
            where HospiceAssessment.value ~ &quot;Yes (qualifier value)&quot;
              and HospiceAssessment.effective.toInterval ( ) overlaps day of Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
              and HospiceAssessment.status in { 'final', 'amended', 'corrected' }
        )
        or exists ( [ServiceRequest: code in &quot;Hospice Care Ambulatory&quot;] HospiceOrder
            where HospiceOrder.authoredOn during day of Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
              and HospiceOrder.status in { 'active', 'completed' }
              and HospiceOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        )
        or exists ( [Procedure: &quot;Hospice Care Ambulatory&quot;] HospicePerformed
            where HospicePerformed.performed.toInterval ( ) overlaps day of Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
              and not ( HospicePerformed.status in { 'not-done', 'entered-in-error', 'unknown' } )
        )
        or exists ( [Condition: &quot;Hospice Diagnosis&quot;] HospiceCareDiagnosis
            where HospiceCareDiagnosis.prevalenceInterval ( ) overlaps day of Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
              and HospiceCareDiagnosis.isActive ( )
              and not ( HospiceCareDiagnosis.verificationStatus ~ QICoreCommon.&quot;unconfirmed&quot;
                  or HospiceCareDiagnosis.verificationStatus ~ QICoreCommon.&quot;refuted&quot;
                  or HospiceCareDiagnosis.verificationStatus ~ QICoreCommon.&quot;entered-in-error&quot;
              )
        )</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>Has Palliative Care in the Measure Assessment Period</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Palliative Care in the Measure Assessment Period&quot;:
      exists ( [Observation: &quot;Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)&quot;] PalliativeAssessment
          where PalliativeAssessment.effective.toInterval ( ) overlaps Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
            and PalliativeAssessment.status in { 'final', 'amended', 'corrected' }
      )
        or exists ( [Condition: &quot;Palliative Care Diagnosis&quot;] PalliativeDiagnosis
            where PalliativeDiagnosis.prevalenceInterval ( ) overlaps Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
              and PalliativeDiagnosis.isActive ( )
              and not ( PalliativeDiagnosis.verificationStatus ~ QICoreCommon.&quot;unconfirmed&quot;
                  or PalliativeDiagnosis.verificationStatus ~ QICoreCommon.&quot;refuted&quot;
                  or PalliativeDiagnosis.verificationStatus ~ QICoreCommon.&quot;entered-in-error&quot;
              )
        )
        or exists ( [Encounter: &quot;Palliative Care Encounter&quot;] PalliativeEncounter
            where PalliativeEncounter.period overlaps Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
              and PalliativeEncounter.status = 'finished'
        )
        or exists ( [Procedure: &quot;Palliative Care Intervention&quot;] PalliativeIntervention
            where PalliativeIntervention.performed.toInterval ( ) overlaps Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
              and not ( PalliativeIntervention.status in { 'not-done', 'entered-in-error', 'unknown' } )
        )</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>Patient Expired</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Patient Expired&quot;:
      Patient.deceased on or before end of &quot;Measure Assessment Period&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>Has Mental Health Disorder Diagnoses</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Mental Health Disorder Diagnoses&quot;:
      exists ( ( [Condition: &quot;Bipolar Disorder&quot;]
          union [Condition: &quot;Personality Disorder Emotionally Labile&quot;]
          union [Condition: &quot;Schizophrenia or Psychotic Disorder&quot;]
          union [Condition: &quot;Pervasive Developmental Disorder&quot;] ) MentalHealthDisorderDiagnoses
          where ToDate(start of MentalHealthDisorderDiagnoses.prevalenceInterval()) on or before end of &quot;Measure Assessment Period&quot;
            and MentalHealthDisorderDiagnoses.isActive ( )
            and not ( MentalHealthDisorderDiagnoses.verificationStatus ~ QICoreCommon.&quot;unconfirmed&quot;
                or MentalHealthDisorderDiagnoses.verificationStatus ~ QICoreCommon.&quot;refuted&quot;
                or MentalHealthDisorderDiagnoses.verificationStatus ~ QICoreCommon.&quot;entered-in-error&quot;
            )
      )</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>Denominator Exclusions</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Denominator Exclusions&quot;:
      &quot;Has Hospice Services in the Measure Assessment Period&quot;
        or &quot;Has Palliative Care in the Measure Assessment Period&quot;
        or &quot;Patient Expired&quot;
        or &quot;Has Mental Health Disorder Diagnoses&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>SupplementalDataElements</td>

                                    <td>SDE Race</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Race&quot;:
      Patient.race R
        return Tuple {
          codes: R.ombCategory union R.detailed,
          display: R.text
        }</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>DepressionRemissionatTwelveMonthsFHIR</td>

                                    <td>SDE Race</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Race&quot;:
      SDE.&quot;SDE Race&quot;</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/condition-clinical"/>
              <code value="active"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
              <code value="recurrence"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
              <code value="relapse"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
              <code value="unconfirmed"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
              <code value="refuted"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
              <code value="entered-in-error"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system value="http://snomed.info/sct"/>
              <code value="428361000124107"/>
              <display value="Discharge to home for hospice care (procedure)"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system value="http://snomed.info/sct"/>
              <code value="428371000124100"/>
              <display
                       value="Discharge to healthcare facility for hospice care (procedure)"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="45755-6"/>
              <display value="Hospice care [Minimum Data Set]"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system value="http://snomed.info/sct"/>
              <code value="373066001"/>
              <display value="Yes (qualifier value)"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="71007-9"/>
              <display
                       value="Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="SupplementalDataElements"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Sex"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Sex&quot;:
      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"/>
            </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="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Sex"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Sex&quot;:
      SDE.&quot;SDE Sex&quot;"/>
            </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="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Depression Assessments Greater than 9"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Depression Assessments Greater than 9&quot;:
      [Observation: &quot;PHQ 9 and PHQ 9M Tools&quot;] DepressionAssessment
        where DepressionAssessment.value &gt; 9
          and DepressionAssessment.status in { 'final', 'amended', 'corrected' }"/>
            </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="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Depression Diagnoses"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Depression Diagnoses&quot;:
      ( [Condition: &quot;Major Depression Including Remission&quot;]
        union [Condition: &quot;Dysthymia&quot;] ) Depression
        where Depression.isActive ( )
          and not ( Depression.verificationStatus ~ QICoreCommon.&quot;unconfirmed&quot;
              or Depression.verificationStatus ~ QICoreCommon.&quot;refuted&quot;
              or Depression.verificationStatus ~ QICoreCommon.&quot;entered-in-error&quot;
          )"/>
            </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="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Denominator Identification Period"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Denominator Identification Period&quot;:
      Interval[start of &quot;Measurement Period&quot; - 14 months, start of &quot;Measurement Period&quot; - 2 months )"/>
            </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="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Depression Encounter"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Depression Encounter&quot;:
      [Encounter: &quot;Contact or Office Visit&quot;] ValidEncounter
        with &quot;Depression Diagnoses&quot; Depression
          such that ValidEncounter.period overlaps Depression.prevalenceInterval ( )
            and ValidEncounter.period ends during &quot;Denominator Identification Period&quot;
            and ValidEncounter.status = 'finished'"/>
            </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="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Index Depression Assessment"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Index Depression Assessment&quot;:
      First(&quot;Depression Assessments Greater than 9&quot; DepressionAssessment
          with &quot;Depression Encounter&quot; DepressionEncounter
            such that DepressionAssessment.effective.toInterval() during day of Interval[ToDate((start of DepressionEncounter.period) - 7 days),
            end of DepressionEncounter.period]
          sort by start of effective.toInterval()
      )"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="6"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Measure Assessment Period"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Measure Assessment Period&quot;:
      &quot;Index Depression Assessment&quot; FirstIndexAssessment
        let YearAfterIndexAssessment: date from start of FirstIndexAssessment.effective.toInterval ( ) + 12 months
        return Interval[YearAfterIndexAssessment - 60 days, YearAfterIndexAssessment + 60 days]"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="7"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Numerator"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Numerator&quot;:
      Last([Observation: &quot;PHQ 9 and PHQ 9M Tools&quot;] DepressionAssessment
          where ToDate(start of DepressionAssessment.effective.toInterval()) during &quot;Measure Assessment Period&quot;
            and DepressionAssessment.status in { 'final', 'amended', 'corrected' }
          sort by start of effective.toInterval()
      ).value &lt; 5"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="8"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Stratification 2"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Stratification 2&quot;:
      &quot;Index Depression Assessment&quot; IndexAssessment
        return AgeInYearsAt(date from start of IndexAssessment.effective.toInterval()) &gt;= 18"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="9"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Stratification 1"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Stratification 1&quot;:
      &quot;Index Depression Assessment&quot; IndexAssessment
        return AgeInYearsAt(date from start of IndexAssessment.effective.toInterval()) in Interval[12, 17]"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="10"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Initial Population"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Initial Population&quot;:
      AgeInYearsAt(start of(&quot;Index Depression Assessment&quot;.effective.toInterval())) &gt;= 12"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="11"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Denominator"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Denominator&quot;:
      &quot;Initial Population&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="12"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="SupplementalDataElements"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Payer"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Payer&quot;:
      [Coverage: type in &quot;Payer Type&quot;] Payer
        return {
          code: Payer.type,
          period: Payer.period
        }"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="13"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Payer"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Payer&quot;:
      SDE.&quot;SDE Payer&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="14"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="SupplementalDataElements"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Ethnicity"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Ethnicity&quot;:
      Patient.ethnicity E
        return Tuple {
          codes: { E.ombCategory } union E.detailed,
          display: E.text
        }"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="15"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Ethnicity"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Ethnicity&quot;:
      SDE.&quot;SDE Ethnicity&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="16"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString
                           value="Has Hospice Services in the Measure Assessment Period"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Has Hospice Services in the Measure Assessment Period&quot;:
      exists ( [Encounter: &quot;Encounter Inpatient&quot;] InpatientEncounter
          where ( InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to home for hospice care (procedure)&quot;
              or InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to healthcare facility for hospice care (procedure)&quot;
          )
            and InpatientEncounter.period ends during day of Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
            and InpatientEncounter.status = 'finished'
      )
        or exists ( [Encounter: &quot;Hospice Encounter&quot;] HospiceEncounter
            where HospiceEncounter.period overlaps day of Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
              and not ( HospiceEncounter.status in { 'cancelled', 'entered-in-error', 'unknown' } )
        )
        or exists ( [Observation: &quot;Hospice care [Minimum Data Set]&quot;] HospiceAssessment
            where HospiceAssessment.value ~ &quot;Yes (qualifier value)&quot;
              and HospiceAssessment.effective.toInterval ( ) overlaps day of Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
              and HospiceAssessment.status in { 'final', 'amended', 'corrected' }
        )
        or exists ( [ServiceRequest: code in &quot;Hospice Care Ambulatory&quot;] HospiceOrder
            where HospiceOrder.authoredOn during day of Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
              and HospiceOrder.status in { 'active', 'completed' }
              and HospiceOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        )
        or exists ( [Procedure: &quot;Hospice Care Ambulatory&quot;] HospicePerformed
            where HospicePerformed.performed.toInterval ( ) overlaps day of Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
              and not ( HospicePerformed.status in { 'not-done', 'entered-in-error', 'unknown' } )
        )
        or exists ( [Condition: &quot;Hospice Diagnosis&quot;] HospiceCareDiagnosis
            where HospiceCareDiagnosis.prevalenceInterval ( ) overlaps day of Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
              and HospiceCareDiagnosis.isActive ( )
              and not ( HospiceCareDiagnosis.verificationStatus ~ QICoreCommon.&quot;unconfirmed&quot;
                  or HospiceCareDiagnosis.verificationStatus ~ QICoreCommon.&quot;refuted&quot;
                  or HospiceCareDiagnosis.verificationStatus ~ QICoreCommon.&quot;entered-in-error&quot;
              )
        )"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="17"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString
                           value="Has Palliative Care in the Measure Assessment Period"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Has Palliative Care in the Measure Assessment Period&quot;:
      exists ( [Observation: &quot;Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)&quot;] PalliativeAssessment
          where PalliativeAssessment.effective.toInterval ( ) overlaps Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
            and PalliativeAssessment.status in { 'final', 'amended', 'corrected' }
      )
        or exists ( [Condition: &quot;Palliative Care Diagnosis&quot;] PalliativeDiagnosis
            where PalliativeDiagnosis.prevalenceInterval ( ) overlaps Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
              and PalliativeDiagnosis.isActive ( )
              and not ( PalliativeDiagnosis.verificationStatus ~ QICoreCommon.&quot;unconfirmed&quot;
                  or PalliativeDiagnosis.verificationStatus ~ QICoreCommon.&quot;refuted&quot;
                  or PalliativeDiagnosis.verificationStatus ~ QICoreCommon.&quot;entered-in-error&quot;
              )
        )
        or exists ( [Encounter: &quot;Palliative Care Encounter&quot;] PalliativeEncounter
            where PalliativeEncounter.period overlaps Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
              and PalliativeEncounter.status = 'finished'
        )
        or exists ( [Procedure: &quot;Palliative Care Intervention&quot;] PalliativeIntervention
            where PalliativeIntervention.performed.toInterval ( ) overlaps Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]
              and not ( PalliativeIntervention.status in { 'not-done', 'entered-in-error', 'unknown' } )
        )"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="18"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Patient Expired"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Patient Expired&quot;:
      Patient.deceased on or before end of &quot;Measure Assessment Period&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="19"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Has Mental Health Disorder Diagnoses"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Has Mental Health Disorder Diagnoses&quot;:
      exists ( ( [Condition: &quot;Bipolar Disorder&quot;]
          union [Condition: &quot;Personality Disorder Emotionally Labile&quot;]
          union [Condition: &quot;Schizophrenia or Psychotic Disorder&quot;]
          union [Condition: &quot;Pervasive Developmental Disorder&quot;] ) MentalHealthDisorderDiagnoses
          where ToDate(start of MentalHealthDisorderDiagnoses.prevalenceInterval()) on or before end of &quot;Measure Assessment Period&quot;
            and MentalHealthDisorderDiagnoses.isActive ( )
            and not ( MentalHealthDisorderDiagnoses.verificationStatus ~ QICoreCommon.&quot;unconfirmed&quot;
                or MentalHealthDisorderDiagnoses.verificationStatus ~ QICoreCommon.&quot;refuted&quot;
                or MentalHealthDisorderDiagnoses.verificationStatus ~ QICoreCommon.&quot;entered-in-error&quot;
            )
      )"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="20"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Denominator Exclusions"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Denominator Exclusions&quot;:
      &quot;Has Hospice Services in the Measure Assessment Period&quot;
        or &quot;Has Palliative Care in the Measure Assessment Period&quot;
        or &quot;Patient Expired&quot;
        or &quot;Has Mental Health Disorder Diagnoses&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="21"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="SupplementalDataElements"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Race"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Race&quot;:
      Patient.race R
        return Tuple {
          codes: R.ombCategory union R.detailed,
          display: R.text
        }"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="22"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="DepressionRemissionatTwelveMonthsFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Race"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Race&quot;:
      SDE.&quot;SDE Race&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="23"/>
            </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 SDE"/>
            <resource value="Library/SupplementalDataElements|3.4.000"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Library FHIRHelpers"/>
            <resource value="Library/FHIRHelpers|4.3.000"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Library QICoreCommon"/>
            <resource value="Library/QICoreCommon|1.5.000"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Library FHIRHelpers"/>
            <resource value="Library/FHIRHelpers|4.3.000"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Library FHIRHelpers"/>
            <resource value="Library/FHIRHelpers|4.3.000"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Code system ConditionClinicalStatusCodes"/>
            <resource
                      value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Code system ConditionVerificationStatusCodes"/>
            <resource
                      value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
          </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="Code system LOINC"/>
            <resource value="http://loinc.org"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set PHQ 9 and PHQ 9M Tools"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.67.1.101.1.263"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Contact or Office Visit"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1080.5"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Major Depression Including Remission"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.113883.3.67.1.101.3.2444"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Dysthymia"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.67.1.101.1.254"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Payer Type"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Encounter Inpatient"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Hospice Encounter"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Hospice Care Ambulatory"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Hospice Diagnosis"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Palliative Care Diagnosis"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Palliative Care Encounter"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Palliative Care Intervention"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Bipolar Disorder"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.67.1.101.1.128"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Personality Disorder Emotionally Labile"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.67.1.101.1.246"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Schizophrenia or Psychotic Disorder"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1104"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Pervasive Developmental Disorder"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1152"/>
          </relatedArtifact>
          <parameter>
            <name value="Measurement Period"/>
            <use value="in"/>
            <min value="0"/>
            <max value="1"/>
            <type value="Period"/>
          </parameter>
          <parameter>
            <name value="SDE Sex"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="Coding"/>
          </parameter>
          <parameter>
            <name value="Numerator"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="boolean"/>
          </parameter>
          <parameter>
            <name value="Stratification 2"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="boolean"/>
          </parameter>
          <parameter>
            <name value="Stratification 1"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="boolean"/>
          </parameter>
          <parameter>
            <name value="Denominator"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="boolean"/>
          </parameter>
          <parameter>
            <name value="SDE Payer"/>
            <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="1"/>
            <type value="boolean"/>
          </parameter>
          <parameter>
            <name value="SDE Ethnicity"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="Resource"/>
          </parameter>
          <parameter>
            <name value="Denominator Exclusions"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="boolean"/>
          </parameter>
          <parameter>
            <name value="SDE Race"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="Resource"/>
          </parameter>
          <dataRequirement>
            <type value="Patient"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
          </dataRequirement>
          <dataRequirement>
            <type value="Patient"/>
            <profile value="http://hl7.org/fhir/Patient"/>
            <mustSupport value="gender"/>
            <mustSupport value="gender.value"/>
            <mustSupport value="birthDate"/>
            <mustSupport value="birthDate.value"/>
            <mustSupport value="deceased"/>
          </dataRequirement>
          <dataRequirement>
            <type value="Patient"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
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                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="value"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <mustSupport value="effective"/>
            <codeFilter>
              <path value="code"/>
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                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.67.1.101.1.263"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Condition"/>
            <profile value="http://hl7.org/fhir/Condition"/>
            <mustSupport value="clinicalStatus"/>
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            <type value="Condition"/>
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                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1080.5"/>
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            <mustSupport value="effective"/>
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              <path value="code"/>
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                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.67.1.101.1.263"/>
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                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.67.1.101.1.263"/>
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            <type value="Observation"/>
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            <mustSupport value="effective"/>
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            <type value="Patient"/>
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                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
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          <dataRequirement>
            <type value="Coverage"/>
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                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
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                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
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            <type value="uri"/>
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            <type value="Patient"/>
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                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
            <mustSupport value="url"/>
            <mustSupport value="extension"/>
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          <dataRequirement>
            <type value="Patient"/>
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                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
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            <type value="Encounter"/>
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                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
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            <mustSupport value="hospitalization"/>
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          <dataRequirement>
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              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003"/>
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          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
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            <mustSupport value="effective"/>
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            <mustSupport value="status.value"/>
            <codeFilter>
              <path value="code"/>
              <code>
                <system value="http://loinc.org"/>
                <code value="45755-6"/>
                <display value="Hospice care [Minimum Data Set]"/>
              </code>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="ServiceRequest"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"/>
            <mustSupport value="code"/>
            <mustSupport value="authoredOn"/>
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            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Procedure"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"/>
            <mustSupport value="code"/>
            <mustSupport value="performed"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"/>
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          </dataRequirement>
          <dataRequirement>
            <type value="Condition"/>
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                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
            <mustSupport value="code"/>
            <mustSupport value="verificationStatus"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="effective"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <codeFilter>
              <path value="code"/>
              <code>
                <system value="http://loinc.org"/>
                <code value="71007-9"/>
                <display
                         value="Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"/>
              </code>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Condition"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
            <mustSupport value="code"/>
            <mustSupport value="verificationStatus"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Procedure"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"/>
            <mustSupport value="code"/>
            <mustSupport value="performed"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Condition"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
            <mustSupport value="code"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.67.1.101.1.128"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Condition"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
            <mustSupport value="code"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.67.1.101.1.246"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Condition"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
            <mustSupport value="code"/>
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              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1104"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Condition"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
            <mustSupport value="code"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1152"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Patient"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
            <mustSupport value="url"/>
            <mustSupport value="extension"/>
          </dataRequirement>
          <dataRequirement>
            <type value="Patient"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
            <mustSupport value="url"/>
            <mustSupport value="extension"/>
          </dataRequirement>
          <dataRequirement>
            <type value="Coverage"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
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              <path value="type"/>
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                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Patient"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
            <mustSupport value="url"/>
            <mustSupport value="extension"/>
          </dataRequirement>
          <dataRequirement>
            <type value="Patient"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
            <mustSupport value="url"/>
            <mustSupport value="extension"/>
          </dataRequirement>
        </Library>
      </contained>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance" id="supplementalDataGuidance">
        <extension url="guidance"/>
        <extension url="usage">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
              <code value="supplemental-data"/>
              <display value="Supplemental Data"/>
            </coding>
            <text value="Supplemental Data Guidance"/>
          </valueCodeableConcept>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements">
        <valueReference>
          <reference value="#effective-data-requirements"/>
        </valueReference>
      </extension>
      <url
           value="http://ecqi.healthit.gov/ecqms/Measure/DepressionRemissionatTwelveMonthsFHIR"/>
      <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="CMS159FHIR"/>
      </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:5df972fb-27e0-4b59-b5f8-b041e6ffc947"/>
      </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:2c928084808a9589018094b0efb804a6"/>
      </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="0710e"/>
        <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="159FHIR"/>
        <assigner>
          <display value="CMS"/>
        </assigner>
      </identifier>
      <version value="0.0.001"/>
      <name value="DepressionRemissionatTwelveMonthsFHIR"/>
      <title value="Depression Remission at Twelve MonthsFHIR"/>
      <status value="draft"/>
      <experimental value="false"/>
      <date value="2023-08-28T17:12:47+00:00"/>
      <publisher value="MN Community Measurement"/>
      <contact>
        <telecom>
          <system value="url"/>
          <value value="www.mncm.org"/>
        </telecom>
      </contact>
      <description
                   value="The percentage of adolescent patients 12 to 17 years of age and adult patients 18 years of age or older with major depression or dysthymia who reached remission 12 months (+/- 60 days) after an index event"/>
      <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="When an index assessment is conducted with PHQ-9M, the follow-up assessment can use either a PHQ-9M or PHQ-9.

    This eCQM is a patient-based measure.

    This FHIR-based measure has been derived from the QDM-based measure: CMS159v12.

    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 MN Community Measurement, 2023. All rights reserved.

    Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. Mathematica disclaims all liability for use or accuracy of any third party codes contained in the specifications.

    CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) 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 copyright 2022 World Health Organization. All Rights Reserved."/>
      <approvalDate value="2023-08-28"/>
      <lastReviewDate value="2023-08-28"/>
      <effectivePeriod>
        <start value="2024-01-01"/>
        <end value="2024-12-31"/>
      </effectivePeriod>
      <author>
        <name value="Telligen"/>
        <telecom>
          <system value="url"/>
          <value value="https://www.telligen.com/"/>
        </telecom>
      </author>
      <library
               value="http://ecqi.healthit.gov/ecqms/Library/DepressionRemissionatTwelveMonthsFHIR"/>
      <disclaimer
                  value="The performance measure is not a clinical guideline and does not establish a standard of medical care, and has 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
                 value="Adults:
    Depression is a common and treatable mental disorder. During 2013-2016, 8.1% of American adults age 20 and over had depression in a given 2 week period. Women (10.4%) were almost twice as likely as men (5.5%) to have had depression. The prevalence of depression among adults decreased as family income levels increased. About 80% of adults with depression reported at least some difficulty with work, home, or social activities because of their depression symptoms (Brody, Pratt, and Hughes, 2018).

    Depression is a risk factor for development of chronic illnesses such as diabetes and coronary heart disease and adversely affects the course, complications and management of chronic medical illness. Both maladaptive health risk behaviors and psychobiological factors associated with depression may explain depression's negative effect on outcomes of chronic illness (Katon, 2011).

    Adolescents and Adults:
    The Centers for Disease Control and Prevention states that during 2009-2012 an estimated 7.6% of the U.S. population aged 12 and over had depression, including 3% of Americans with severe depressive symptoms. Almost 43% of persons with severe depressive symptoms reported serious difficulties in work, home and social activities, yet only 35% reported having contact with a mental health professional in the past year (Pratt and Brody, 2014).

    Depression is associated with higher mortality rates in all age groups. Depression is also a leading cause of medical disability, and depressed people lose 5.6 hours of productive work every week when they are depressed, 50% of which is due to absenteeism and short-term disability (Stewart et al., 2003).

    Adolescents:
    In 2014, an estimated 2.8 million adolescents age 12 to 17 in the United States had at least one major depressive episode (MDE) in the past year (Center for Behavioral Health Statistics and Quality, 2015). The 2013 Youth Risk Behavior Survey of students grades 9 to 12 indicated that during the past 12 months 39.1% (F) and 20.8% (M) indicated feeling sad or hopeless almost every day for at least 2 weeks, planned suicide attempt 16.9% (F) and 10.3% (M), with attempted suicide 10.6% (F) and 5.4% (M) (Kann et al., 2014). Adolescent-onset depression is associated with chronic depression in adulthood. Many mental health conditions (anxiety, bipolar, depression, eating disorders, and substance abuse) are evident by age 14. The 12-month prevalence of MDEs increased from 8.7% in 2005 to 11.3% in 2014 in adolescents and from 8.8% to 9.6% in young adults (both P &lt; .001). The increase was larger and statistically significant only in the age range of 12 to 20 years. The trends remained significant after adjustment for substance use disorders and sociodemographic factors (Mojtabai, Olfson, and Han 2016). Mental health care contacts overall did not change over time; however, the use of specialty mental health providers increased in adolescents and young adults, and the use of prescription medications and inpatient hospitalizations increased in adolescents (Mojtabai, Olfson, and Han 2016)."/>
      <clinicalRecommendationStatement
                                       value="Adults:

    Recommendations and algorithm notations supporting depression outcomes and duration of treatment according to Institute for Clinical Systems Improvement Health Care Guideline (Trangle et al., 2016):

    Recommendation: Clinicians should establish and maintain follow-up with patients. Appropriate, reliable follow-up is highly correlated with improved response and remission scores. It is also correlated with the improved safety and efficacy of medications and helps prevent relapse (Trangle et al., 2016).

    Proactive follow-up contacts (in person, telephone) based on the collaborative care model have been shown to significantly lower depression severity (Unutzer et al., 2002). In the available clinical effectiveness trials conducted in real clinical practice settings, even the addition of a care manager leads to modest remission rates (Trivedi et al., 2006; Unutzer et al., 2002). Interventions are critical to educating the patient regarding the importance of preventing relapse, safety and efficacy of medications, and management of potential side effects. Establish and maintain initial follow-up contact intervals (office, phone, other) (Hunkeler et al., 2000; Simon et al., 2000).

    The Patient Health Questionnaire-9 (PHQ-9) is an effective monitoring and management tool, and should be used routinely for subsequent visits to monitor treatment outcomes and severity. It can also help the clinician decide if/how to modify the treatment plan (Duffy et al., 2008; Lowe et al., 2004). Using a measurement-based approach to depression care, PHQ-9 results and side effect evaluation should be combined with treatment algorithms to drive patients toward remission. A five-point drop in PHQ-9 score is considered the minimal clinically significant difference (Trivedi, 2009).

    The goals of treatment should be to achieve remission, reduce relapse and recurrence, and return to previous level of occupational and psychosocial function.

    If using a PHQ-9 tool, remission translates to PHQ-9 score of less than 5 (Kroenke, 2001). Results from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study showed that remission rates lowered with more treatment steps, but the overall cumulative rate was 67% (Rush et al., 2006).

    Response and remission take time. In the STAR*D study, longer times than expected were needed to reach response or remission. In fact, one-third of those who ultimately responded did so after six weeks. Of those who achieved remission by Quick Inventory of Depressive Symptomatology, 50% did so only at or after six weeks of treatment (Trivedi et al., 2006). If the primary care clinician is seeing some improvement, continue working with that patient to augment or increase dosage to reach remission. This can take up to three months.

    This measure assesses achievement of remission, which is a desired outcome of effective depression treatment and monitoring.

    Adult Depression in Primary Care - Guideline Aims (Trangle et al., 2016):
    - Increase the percentage of patients with major depression or persistent depressive disorder who have improvement in outcomes from treatment for major depression or persistent depressive disorder.
    - Increase the percentage of patients with major depression or persistent depressive disorder who have follow-up to assess for outcomes from treatment.
    - Improve communication between the primary care physician and the mental health care clinician (if patient is co-managed).

    Adolescents:

    Recommendations supporting depression outcomes and duration of treatment according to American Academy of Child and Adolescent Psychiatry guideline (Birmaher et al., 2007):
    - Treatment of depressive disorders should always include an acute and continuation phase; some children may also require maintenance treatment. The main goal of the acute phase is to achieve response and ultimately full symptomatic remission (definitions below).
    - Each phase of treatment should include psychoeducation, supportive management, and family and school involvement.
    - Education, support, and case management appear to be sufficient treatment for the management of depressed children and adolescents with an uncomplicated or brief depression or with mild psychosocial impairment.
    - For children and adolescents who do not respond to supportive psychotherapy or who have more complicated depressions, a trial with specific types of psychotherapy and/or antidepressants is indicated.

    Recommendations supporting depression outcomes and duration of treatment according to Guidelines for Adolescent Depression in Primary Care (Zuckerbrot et al., 2018 (Part I), Zuckerbrot et al., 2018 (Part II)):
    - Mild depression: consider a period of active support and monitoring before starting other evidence-based treatment
    - Moderate or severe major clinical depression or complicating factors:
      -- consultation with mental health specialist with agreed upon roles
      -- evidence based treatment (cognitive behavioral therapy or interpersonal psychotherapy and/or antidepressant selective serotonin reuptake inhibitors)
    - Monitor for adverse effects during antidepressant therapy
      -- clinical worsening, suicidality, unusual changes in behavior
    - Systematic and regular tracking of goals and outcomes
      -- improvement in functioning status and resolution of depressive symptoms
    Regardless of the length of treatment, all patients should be monitored on a monthly basis for 6 to 12 months after the full resolution of symptoms."/>
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