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 - JSON Representation

Draft as of 2023-08-28

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    {
      "resourceType" : "Measure",
      "id" : "DepressionRemissionatTwelveMonthsFHIR",
      "meta" : {
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          🔗 "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"🔗 ,
          "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm"🔗 ,
          "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"
        ]
      },
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n    <table class=\"grid dict\">\n        \n            <tr>\n                <th scope=\"row\"><b>Title: </b></th>\n                <td style=\"padding-left: 4px;\">Depression Remission at Twelve MonthsFHIR</td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Id: </b></th>\n                <td style=\"padding-left: 4px;\">DepressionRemissionatTwelveMonthsFHIR</td>\n            </tr>\n            \n                <tr>\n                    <th scope=\"row\"><b>Download cql: </b></th>\n                    <td style=\"padding-left: 4px;\"><a href=\"Library-DepressionRemissionatTwelveMonthsFHIR.cql\">DepressionRemissionatTwelveMonthsFHIR.cql</a></td>\n                </tr>\n            \n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Version: </b></th>\n                <td style=\"padding-left: 4px;\">0.0.001</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Url: </b></th>\n                <td style=\"padding-left: 4px;\"><a href=\"Measure-DepressionRemissionatTwelveMonthsFHIR.html\">Depression Remission at Twelve MonthsFHIR</a></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                short-name identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>CMS159FHIR</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                version-independent identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>urn:uuid:5df972fb-27e0-4b59-b5f8-b041e6ffc947</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                version-specific identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>urn:uuid:2c928084808a9589018094b0efb804a6</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                endorser (NQF) identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>0710e</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                publisher (CMS) identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>159FHIR</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Effective Period: </b></th>\n                <td style=\"padding-left: 4px;\">2024-01-01\n                    ..2024-12-31</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Status: </b></th>\n                <td style=\"padding-left: 4px;\">draft</td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Date: </b></th>\n                <td style=\"padding-left: 4px;\">2023-08-28 17:12:47+0000</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Approval Date: </b></th>\n                <td style=\"padding-left: 4px;\">2023-08-28</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Last Review Date: </b></th>\n                <td style=\"padding-left: 4px;\">2023-08-28</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Name: </b></th>\n                <td style=\"padding-left: 4px;\">DepressionRemissionatTwelveMonthsFHIR</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Publisher: </b></th>\n                <td style=\"padding-left: 4px;\">MN Community Measurement</td>\n            </tr>\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Author: </b></th>\n            <td style=\"padding-left: 4px;\">Telligen: <a href=\"https://www.telligen.com/\">https://www.telligen.com/</a></td>\n        </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Description: </b></th>\n                <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>\n</div></td>\n            </tr>\n        \n\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Use Context: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    <table class=\"grid-dict\">\n                        <tr>\n                            <th><b>code</b></th>\n                            <th><b>value</b></th>\n                        </tr>\n                        \n                            <tr>\n                                <td>program</td>\n                                <td/>\n                            </tr>\n                        \n                    </table>\n                </td>\n            </tr>\n        \n\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Purpose: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>UNKNOWN</p>\n</div></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Copyright: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>Copyright MN Community Measurement, 2023. All rights reserved.</p>\n<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>\n<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>\n</div></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Disclaimer: </b></th>\n                <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>\n<p>THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.</p>\n<p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p>\n</div></td>\n            </tr>\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Rationale: </b></th>\n            <td style=\"padding-left: 4px;\"><div><p>Adults:\nDepression 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>\n<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>\n<p>Adolescents and Adults:\nThe 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>\n<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>\n<p>Adolescents:\nIn 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>\n</div></td>\n        </tr>\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Clinical recommendation statement: </b></th>\n            <td style=\"padding-left: 4px;\"><div><p>Adults:</p>\n<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>\n<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>\n<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>\n<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>\n<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>\n<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>\n<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>\n<p>This measure assesses achievement of remission, which is a desired outcome of effective depression treatment and monitoring.</p>\n<p>Adult Depression in Primary Care - Guideline Aims (Trangle et al., 2016):</p>\n<ul>\n<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>\n<li>Increase the percentage of patients with major depression or persistent depressive disorder who have follow-up to assess for outcomes from treatment.</li>\n<li>Improve communication between the primary care physician and the mental health care clinician (if patient is co-managed).</li>\n</ul>\n<p>Adolescents:</p>\n<p>Recommendations supporting depression outcomes and duration of treatment according to American Academy of Child and Adolescent Psychiatry guideline (Birmaher et al., 2007):</p>\n<ul>\n<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>\n<li>Each phase of treatment should include psychoeducation, supportive management, and family and school involvement.</li>\n<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>\n<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>\n</ul>\n<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>\n<ul>\n<li>Mild depression: consider a period of active support and monitoring before starting other evidence-based treatment</li>\n<li>Moderate or severe major clinical depression or complicating factors:\n-- consultation with mental health specialist with agreed upon roles\n-- evidence based treatment (cognitive behavioral therapy or interpersonal psychotherapy and/or antidepressant selective serotonin reuptake inhibitors)</li>\n<li>Monitor for adverse effects during antidepressant therapy\n-- clinical worsening, suicidality, unusual changes in behavior</li>\n<li>Systematic and regular tracking of goals and outcomes\n-- improvement in functioning status and resolution of depressive symptoms\nRegardless 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>\n</ul>\n</div></td>\n        </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Guidance (Usage): </b></th>\n                <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.\n\nThis eCQM is a patient-based measure.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS159v12. \n\nPlease 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>\n            </tr>\n        \n\n        \n            \n                <tr>\n                    <th scope=\"row\"><b>Population Criteria: </b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                            <table class=\"grid-dict\">\n                                \n                                    <tr>\n                                        <th><b>638501ed4ba3d47c885c02b0</b></th>\n                                    </tr>\n                                \n                                \n                                    <tr>\n                                        <td>Initial Population:</td>\n                                        \n                                            <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>\n                                        \n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator:</td>\n                                        \n                                            <td>Equals Initial Population</td>\n                                        \n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator Exclusion:</td>\n                                        \n                                            <td>1: Patients who died any time prior to the end of the measure assessment period\n2: Patients who received hospice or palliative care services between the start of the denominator period and the end of the measurement assessment period\n3: Patients with a diagnosis of bipolar disorder any time prior to the end of the measure assessment period\n4: Patients with a diagnosis of personality disorder emotionally labile any time prior to the end of the measure assessment period\n5: Patients with a diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period\n6: Patients with a diagnosis of pervasive developmental disorder any time prior to the end of the measure assessment period</td>\n                                        \n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Numerator:</td>\n                                        \n                                            <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>\n                                        \n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Numerator Exclusion:</td>\n                                        \n                                            <td>None</td>\n                                        \n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator Exception:</td>\n                                        \n                                            <td>None</td>\n                                        \n                                    </tr>\n                                \n                                \n                                  <tr><b>Stratifier Criteria: </b></tr>\n                                    \n                                        <tr>\n                                            <td>:</td>\n                                            \n                                                <td>Ages 12 to 17 at the time of the index assessment</td>\n                                            \n                                        </tr>\n                                    \n                                        <tr>\n                                            <td>:</td>\n                                            \n                                                <td>Ages 18 and older at the time of the index assessment</td>\n                                            \n                                        </tr>\n                                    \n                                \n                            </table>\n                        \n                    </td>\n                </tr>\n            \n        \n\n        \n            <tr>\n                <th scope=\"row\">\n                    <b> Supplemental Data Guidance\n                        : </b></th>\n                <td style=\"padding-left: 4px;\">  </td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b> Supplemental Data Elements: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    \n                        \n                            \n                                SDE Ethnicity\n                            \n                        \n                    \n                        \n                            \n                                SDE Payer\n                            \n                        \n                    \n                        \n                            \n                                SDE Race\n                            \n                        \n                    \n                        \n                            \n                                SDE Sex\n                            \n                        \n                    \n                </td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Libraries: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    <table class=\"grid-dict\">\n                        \n                            <tr>\n                                <td><a href=\"Library-DepressionRemissionatTwelveMonthsFHIR.html\">DepressionRemissionatTwelveMonthsFHIR</a></td>\n                            </tr>\n                        \n                    </table>\n                </td>\n            </tr>\n        \n\n        \n\n        \n            \n                <tr>\n                    <th scope=\"row\"><b>Related Artifact Dependencies: </b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                            <li><code>Library/SupplementalDataElements|3.4.000</code></li>\n                        \n                            <li><code>Library/FHIRHelpers|4.3.000</code></li>\n                        \n                            <li><code>Library/QICoreCommon|1.5.000</code></li>\n                        \n                            <li><code>Library/FHIRHelpers|4.3.000</code></li>\n                        \n                            <li><code>Library/FHIRHelpers|4.3.000</code></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/7.1.0/CodeSystem-condition-clinical.html\">Condition Clinical Status Codes</a></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/7.1.0/CodeSystem-condition-ver-status.html\">ConditionVerificationStatus</a></li>\n                        \n                            <li><a href=\"http://hl7.org/fhir/R4/codesystem-snomedct.html\">SNOMED CT (all versions)</a></li>\n                        \n                            <li><a href=\"http://tx.fhir.org/r4/ValueSet/x-loinc2.82\">LOINC</a></li>\n                        \n                            <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>\n                        \n                            <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>\n                        \n                            <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>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.67.1.101.1.254/expansion\">Dysthymia</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion\">Payer</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</a></li>\n                        \n                            <li><a href=\"https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1003-20210820\">Hospice Encounter</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion\">Hospice Care Ambulatory</a></li>\n                        \n                            <li><a href=\"https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1165-20220818\">Hospice Diagnosis</a></li>\n                        \n                            <li><a href=\"https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1167-20220820\">Palliative Care Diagnosis</a></li>\n                        \n                            <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>\n                        \n                            <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>\n                        \n                            <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>\n                        \n                            <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>\n                        \n                            <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>\n                        \n                            <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>\n                        \n                    </td>\n                </tr>\n                <tr>\n                    <th scope=\"row\"><b>Parameters:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>name</b></th>\n                                <th><b>use</b></th>\n                                <th><b>min</b></th>\n                                <th><b>max</b></th>\n                                <th><b>type</b></th>\n                            </tr>\n                            \n                                <tr>\n                                    <td>Measurement Period</td>\n                                    <td>In</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Period</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Sex</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Coding</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Numerator</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Stratification 2</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Stratification 1</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Denominator</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Payer</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Initial Population</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Ethnicity</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Denominator Exclusions</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Race</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                        </table>\n                    </td>\n                </tr>\n\n                <tr>\n                    <th scope=\"row\"><b>DataRequirements:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>Type</b></th>\n                                <th><b>Elements</b></th>\n                                <th><b>Valueset Name</b></th>\n                                <th><b>Valueset</b></th>\n                            </tr>\n                            \n                                <tr>\n                                    <td>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Patient(<code>http://hl7.org/fhir/Patient</code>)</td>\n                                    <td>\n                                        \n                                            gender\n                                        \n                                            gender.value\n                                        \n                                            birthDate\n                                        \n                                            birthDate.value\n                                        \n                                            deceased\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            value\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            effective\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 PHQ 9 and PHQ 9M Tools\n                                            \n                                        \n                                    </td>\n                                    <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>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition(<code>http://hl7.org/fhir/Condition</code>)</td>\n                                    <td>\n                                        \n                                            clinicalStatus\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Major Depression Including Remission\n                                            \n                                        \n                                    </td>\n                                    <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>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Dysthymia\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.67.1.101.1.254/expansion\">Dysthymia</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Contact or Office Visit\n                                            \n                                        \n                                    </td>\n                                    <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>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            value\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            effective\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 PHQ 9 and PHQ 9M Tools\n                                            \n                                        \n                                    </td>\n                                    <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>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            effective\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 PHQ 9 and PHQ 9M Tools\n                                            \n                                        \n                                    </td>\n                                    <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>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<code>http://hl7.org/fhir/Observation</code>)</td>\n                                    <td>\n                                        \n                                            value\n                                        \n                                            effective\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Coverage(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html\">QICoreCoverage</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Payer Type\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion\">Payer</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>uri(<code>http://hl7.org/fhir/uri</code>)</td>\n                                    <td>\n                                        \n                                            value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n                                    <td>\n                                        \n                                            url\n                                        \n                                            extension\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n                                    <td>\n                                        \n                                            url\n                                        \n                                            extension\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            hospitalization\n                                        \n                                            hospitalization.dischargeDisposition\n                                        \n                                            period\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Encounter Inpatient\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Hospice Encounter\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1003-20210820\">Hospice Encounter</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            value\n                                        \n                                            effective\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>ServiceRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html\">QICoreServiceRequest</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            authoredOn\n                                        \n                                            authoredOn.value\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            intent\n                                        \n                                            intent.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Hospice Care Ambulatory\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion\">Hospice Care Ambulatory</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Procedure(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html\">QICoreProcedure</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            performed\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Hospice Care Ambulatory\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion\">Hospice Care Ambulatory</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            verificationStatus\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Hospice Diagnosis\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1165-20220818\">Hospice Diagnosis</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            effective\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            verificationStatus\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Palliative Care Diagnosis\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1167-20220820\">Palliative Care Diagnosis</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Palliative Care Encounter\n                                            \n                                        \n                                    </td>\n                                    <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>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Procedure(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html\">QICoreProcedure</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            performed\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Palliative Care Intervention\n                                            \n                                        \n                                    </td>\n                                    <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>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Bipolar Disorder\n                                            \n                                        \n                                    </td>\n                                    <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>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Personality Disorder Emotionally Labile\n                                            \n                                        \n                                    </td>\n                                    <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>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Schizophrenia or Psychotic Disorder\n                                            \n                                        \n                                    </td>\n                                    <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>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Pervasive Developmental Disorder\n                                            \n                                        \n                                    </td>\n                                    <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>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n                                    <td>\n                                        \n                                            url\n                                        \n                                            extension\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n                                    <td>\n                                        \n                                            url\n                                        \n                                            extension\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Coverage(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html\">QICoreCoverage</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Payer Type\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion\">Payer</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n                                    <td>\n                                        \n                                            url\n                                        \n                                            extension\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n                                    <td>\n                                        \n                                            url\n                                        \n                                            extension\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                        </table>\n                    </td>\n                </tr>\n\n                \n                    <tr>\n                        <th scope=\"row\"><b>Direct Reference Codes:</b></th>\n                        <td style=\"padding-left: 4px;\">\n                            <table class=\"grid-dict\">\n                                <tr>\n                                    <th><b>display</b></th>\n                                    <th><b>code</b></th>\n                                    <th><b>system</b></th>\n                                </tr>\n                                \n                                    <tr>\n                                        <td/>\n                                        <td>active</td>\n                                        <td><a href=\"http://terminology.hl7.org/7.1.0/CodeSystem-condition-clinical.html\">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td/>\n                                        <td>recurrence</td>\n                                        <td><a href=\"http://terminology.hl7.org/7.1.0/CodeSystem-condition-clinical.html\">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td/>\n                                        <td>relapse</td>\n                                        <td><a href=\"http://terminology.hl7.org/7.1.0/CodeSystem-condition-clinical.html\">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td/>\n                                        <td>unconfirmed</td>\n                                        <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>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td/>\n                                        <td>refuted</td>\n                                        <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>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td/>\n                                        <td>entered-in-error</td>\n                                        <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>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Discharge to home for hospice care (procedure)</td>\n                                        <td>428361000124107</td>\n                                        <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Discharge to healthcare facility for hospice care (procedure)</td>\n                                        <td>428371000124100</td>\n                                        <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Hospice care [Minimum Data Set]</td>\n                                        <td>45755-6</td>\n                                        <td><a href=\"https://loinc.org/\">http://loinc.org</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Yes (qualifier value)</td>\n                                        <td>373066001</td>\n                                        <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)</td>\n                                        <td>71007-9</td>\n                                        <td><a href=\"https://loinc.org/\">http://loinc.org</a></td>\n                                    </tr>\n                                \n                            </table>\n                        </td>\n                    </tr>\n                \n\n                \n                <tr>\n                    <th scope=\"row\"><b>Logic Definitions:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>Group</b></th>\n                                <th><b>Scoring</b></th>\n                                <th><b>Population Criteria</b></th>\n                                <th><b>Expression</b></th>\n                            </tr>\n                            <tr>\n                                \n                                <td> 638501ed4ba3d47c885c02b0 </td>\n                                <td>\n                                    \n                                        <b>Group scoring:</b>\n                                        \n                                            <span>  proportion </span>\n                                        \n                                    \n\n                                    \n\n                                    \n\n                                    \n\n                                    \n\n                                    \n\n                                    \n\n                                    \n\n                                </td>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Initial Population</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  AgeInYearsAt(start of(&quot;Index Depression Assessment&quot;.effective.toInterval())) &gt;= 12</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Denominator</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Denominator&quot;:\n  &quot;Initial Population&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Denominator Exclusion</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Denominator Exclusions&quot;:\n  &quot;Has Hospice Services in the Measure Assessment Period&quot;\n    or &quot;Has Palliative Care in the Measure Assessment Period&quot;\n    or &quot;Patient Expired&quot;\n    or &quot;Has Mental Health Disorder Diagnoses&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Numerator</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Numerator&quot;:\n  Last([Observation: &quot;PHQ 9 and PHQ 9M Tools&quot;] DepressionAssessment\n      where ToDate(start of DepressionAssessment.effective.toInterval()) during &quot;Measure Assessment Period&quot;\n        and DepressionAssessment.status in { 'final', 'amended', 'corrected' }\n      sort by start of effective.toInterval()\n  ).value &lt; 5</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Numerator Exclusion</td>\n                                    <td>\n                                        \n                                            None\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Denominator Exception</td>\n                                    <td>\n                                        \n                                            None\n                                        \n                                    </td>\n                                </tr>\n                                \n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td/>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\"/></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td/>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\"/></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                            \n                            </tr>\n                        </table>\n                \n\n                <table class=\"grid-dict\">\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElements</td>\n                            \n                            \n                                <td>SDE Sex</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Sex&quot;:\n  case\n      when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }\n      when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }\n      else null\n    end</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>SDE Sex</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Sex&quot;:\n  SDE.&quot;SDE Sex&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>Depression Assessments Greater than 9</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Depression Assessments Greater than 9&quot;:\n  [Observation: &quot;PHQ 9 and PHQ 9M Tools&quot;] DepressionAssessment\n    where DepressionAssessment.value &gt; 9\n      and DepressionAssessment.status in { 'final', 'amended', 'corrected' }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>Depression Diagnoses</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Depression Diagnoses&quot;:\n  ( [Condition: &quot;Major Depression Including Remission&quot;]\n    union [Condition: &quot;Dysthymia&quot;] ) Depression\n    where Depression.isActive ( )\n      and not ( Depression.verificationStatus ~ QICoreCommon.&quot;unconfirmed&quot;\n          or Depression.verificationStatus ~ QICoreCommon.&quot;refuted&quot;\n          or Depression.verificationStatus ~ QICoreCommon.&quot;entered-in-error&quot;\n      )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>Denominator Identification Period</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Denominator Identification Period&quot;:\n  Interval[start of &quot;Measurement Period&quot; - 14 months, start of &quot;Measurement Period&quot; - 2 months )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>Depression Encounter</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Depression Encounter&quot;:\n  [Encounter: &quot;Contact or Office Visit&quot;] ValidEncounter\n    with &quot;Depression Diagnoses&quot; Depression\n      such that ValidEncounter.period overlaps Depression.prevalenceInterval ( )\n        and ValidEncounter.period ends during &quot;Denominator Identification Period&quot;\n        and ValidEncounter.status = 'finished'</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>Index Depression Assessment</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Index Depression Assessment&quot;:\n  First(&quot;Depression Assessments Greater than 9&quot; DepressionAssessment\n      with &quot;Depression Encounter&quot; DepressionEncounter\n        such that DepressionAssessment.effective.toInterval() during day of Interval[ToDate((start of DepressionEncounter.period) - 7 days), \n        end of DepressionEncounter.period]\n      sort by start of effective.toInterval()\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>Measure Assessment Period</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Measure Assessment Period&quot;:\n  &quot;Index Depression Assessment&quot; FirstIndexAssessment\n    let YearAfterIndexAssessment: date from start of FirstIndexAssessment.effective.toInterval ( ) + 12 months\n    return Interval[YearAfterIndexAssessment - 60 days, YearAfterIndexAssessment + 60 days]</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>Numerator</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Numerator&quot;:\n  Last([Observation: &quot;PHQ 9 and PHQ 9M Tools&quot;] DepressionAssessment\n      where ToDate(start of DepressionAssessment.effective.toInterval()) during &quot;Measure Assessment Period&quot;\n        and DepressionAssessment.status in { 'final', 'amended', 'corrected' }\n      sort by start of effective.toInterval()\n  ).value &lt; 5</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>Stratification 2</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Stratification 2&quot;:\n  &quot;Index Depression Assessment&quot; IndexAssessment\n    return AgeInYearsAt(date from start of IndexAssessment.effective.toInterval()) &gt;= 18</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>Stratification 1</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Stratification 1&quot;:\n  &quot;Index Depression Assessment&quot; IndexAssessment\n    return AgeInYearsAt(date from start of IndexAssessment.effective.toInterval()) in Interval[12, 17]</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>Initial Population</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  AgeInYearsAt(start of(&quot;Index Depression Assessment&quot;.effective.toInterval())) &gt;= 12</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>Denominator</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Denominator&quot;:\n  &quot;Initial Population&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElements</td>\n                            \n                            \n                                <td>SDE Payer</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Payer&quot;:\n  [Coverage: type in &quot;Payer Type&quot;] Payer\n    return {\n      code: Payer.type,\n      period: Payer.period\n    }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>SDE Payer</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Payer&quot;:\n  SDE.&quot;SDE Payer&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElements</td>\n                            \n                            \n                                <td>SDE Ethnicity</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Ethnicity&quot;:\n  Patient.ethnicity E\n    return Tuple {\n      codes: { E.ombCategory } union E.detailed,\n      display: E.text\n    }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>SDE Ethnicity</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Ethnicity&quot;:\n  SDE.&quot;SDE Ethnicity&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>Has Hospice Services in the Measure Assessment Period</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Has Hospice Services in the Measure Assessment Period&quot;:\n  exists ( [Encounter: &quot;Encounter Inpatient&quot;] InpatientEncounter\n      where ( InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to home for hospice care (procedure)&quot;\n          or InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to healthcare facility for hospice care (procedure)&quot;\n      )\n        and InpatientEncounter.period ends during day of Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]\n        and InpatientEncounter.status = 'finished'\n  )\n    or exists ( [Encounter: &quot;Hospice Encounter&quot;] HospiceEncounter\n        where HospiceEncounter.period overlaps day of Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]\n          and not ( HospiceEncounter.status in { 'cancelled', 'entered-in-error', 'unknown' } )\n    )\n    or exists ( [Observation: &quot;Hospice care [Minimum Data Set]&quot;] HospiceAssessment\n        where HospiceAssessment.value ~ &quot;Yes (qualifier value)&quot;\n          and HospiceAssessment.effective.toInterval ( ) overlaps day of Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]\n          and HospiceAssessment.status in { 'final', 'amended', 'corrected' }\n    )\n    or exists ( [ServiceRequest: code in &quot;Hospice Care Ambulatory&quot;] HospiceOrder\n        where HospiceOrder.authoredOn during day of Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]\n          and HospiceOrder.status in { 'active', 'completed' }\n          and HospiceOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n    )\n    or exists ( [Procedure: &quot;Hospice Care Ambulatory&quot;] HospicePerformed\n        where HospicePerformed.performed.toInterval ( ) overlaps day of Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]\n          and not ( HospicePerformed.status in { 'not-done', 'entered-in-error', 'unknown' } )\n    )\n    or exists ( [Condition: &quot;Hospice Diagnosis&quot;] HospiceCareDiagnosis\n        where HospiceCareDiagnosis.prevalenceInterval ( ) overlaps day of Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]\n          and HospiceCareDiagnosis.isActive ( )\n          and not ( HospiceCareDiagnosis.verificationStatus ~ QICoreCommon.&quot;unconfirmed&quot;\n              or HospiceCareDiagnosis.verificationStatus ~ QICoreCommon.&quot;refuted&quot;\n              or HospiceCareDiagnosis.verificationStatus ~ QICoreCommon.&quot;entered-in-error&quot;\n          )\n    )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>Has Palliative Care in the Measure Assessment Period</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Has Palliative Care in the Measure Assessment Period&quot;:\n  exists ( [Observation: &quot;Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)&quot;] PalliativeAssessment\n      where PalliativeAssessment.effective.toInterval ( ) overlaps Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]\n        and PalliativeAssessment.status in { 'final', 'amended', 'corrected' }\n  )\n    or exists ( [Condition: &quot;Palliative Care Diagnosis&quot;] PalliativeDiagnosis\n        where PalliativeDiagnosis.prevalenceInterval ( ) overlaps Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]\n          and PalliativeDiagnosis.isActive ( )\n          and not ( PalliativeDiagnosis.verificationStatus ~ QICoreCommon.&quot;unconfirmed&quot;\n              or PalliativeDiagnosis.verificationStatus ~ QICoreCommon.&quot;refuted&quot;\n              or PalliativeDiagnosis.verificationStatus ~ QICoreCommon.&quot;entered-in-error&quot;\n          )\n    )\n    or exists ( [Encounter: &quot;Palliative Care Encounter&quot;] PalliativeEncounter\n        where PalliativeEncounter.period overlaps Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]\n          and PalliativeEncounter.status = 'finished'\n    )\n    or exists ( [Procedure: &quot;Palliative Care Intervention&quot;] PalliativeIntervention\n        where PalliativeIntervention.performed.toInterval ( ) overlaps Interval[start of &quot;Denominator Identification Period&quot;, end of &quot;Measure Assessment Period&quot;]\n          and not ( PalliativeIntervention.status in { 'not-done', 'entered-in-error', 'unknown' } )\n    )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>Patient Expired</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Patient Expired&quot;:\n  Patient.deceased on or before end of &quot;Measure Assessment Period&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>Has Mental Health Disorder Diagnoses</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Has Mental Health Disorder Diagnoses&quot;:\n  exists ( ( [Condition: &quot;Bipolar Disorder&quot;]\n      union [Condition: &quot;Personality Disorder Emotionally Labile&quot;]\n      union [Condition: &quot;Schizophrenia or Psychotic Disorder&quot;]\n      union [Condition: &quot;Pervasive Developmental Disorder&quot;] ) MentalHealthDisorderDiagnoses\n      where ToDate(start of MentalHealthDisorderDiagnoses.prevalenceInterval()) on or before end of &quot;Measure Assessment Period&quot;\n        and MentalHealthDisorderDiagnoses.isActive ( )\n        and not ( MentalHealthDisorderDiagnoses.verificationStatus ~ QICoreCommon.&quot;unconfirmed&quot;\n            or MentalHealthDisorderDiagnoses.verificationStatus ~ QICoreCommon.&quot;refuted&quot;\n            or MentalHealthDisorderDiagnoses.verificationStatus ~ QICoreCommon.&quot;entered-in-error&quot;\n        )\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>Denominator Exclusions</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Denominator Exclusions&quot;:\n  &quot;Has Hospice Services in the Measure Assessment Period&quot;\n    or &quot;Has Palliative Care in the Measure Assessment Period&quot;\n    or &quot;Patient Expired&quot;\n    or &quot;Has Mental Health Disorder Diagnoses&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElements</td>\n                            \n                            \n                                <td>SDE Race</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Race&quot;:\n  Patient.race R\n    return Tuple {\n      codes: R.ombCategory union R.detailed,\n      display: R.text\n    }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DepressionRemissionatTwelveMonthsFHIR</td>\n                            \n                            \n                                <td>SDE Race</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Race&quot;:\n  SDE.&quot;SDE Race&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                    </table>\n                </td>\n            </tr>\n            \n        \n    \n\n    </table>\n</div>"
      },
      "contained" : [
        {
          "resourceType" : "Library",
          "id" : "effective-data-requirements",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
                "code" : "active"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
                "code" : "recurrence"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
                "code" : "relapse"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
                "code" : "unconfirmed"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
                "code" : "refuted"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
                "code" : "entered-in-error"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "428361000124107",
                "display" : "Discharge to home for hospice care (procedure)"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "428371000124100",
                "display" : "Discharge to healthcare facility for hospice care (procedure)"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "45755-6",
                "display" : "Hospice care [Minimum Data Set]"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "373066001",
                "display" : "Yes (qualifier value)"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "71007-9",
                "display" : "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"
              }
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "SupplementalDataElements"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Sex"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Sex\":\n  case\n      when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }\n      when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }\n      else null\n    end"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 0
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DepressionRemissionatTwelveMonthsFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Sex"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Sex\":\n  SDE.\"SDE Sex\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 1
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DepressionRemissionatTwelveMonthsFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Depression Assessments Greater than 9"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Depression Assessments Greater than 9\":\n  [Observation: \"PHQ 9 and PHQ 9M Tools\"] DepressionAssessment\n    where DepressionAssessment.value > 9\n      and DepressionAssessment.status in { 'final', 'amended', 'corrected' }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 2
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DepressionRemissionatTwelveMonthsFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Depression Diagnoses"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Depression Diagnoses\":\n  ( [Condition: \"Major Depression Including Remission\"]\n    union [Condition: \"Dysthymia\"] ) Depression\n    where Depression.isActive ( )\n      and not ( Depression.verificationStatus ~ QICoreCommon.\"unconfirmed\"\n          or Depression.verificationStatus ~ QICoreCommon.\"refuted\"\n          or Depression.verificationStatus ~ QICoreCommon.\"entered-in-error\"\n      )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 3
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DepressionRemissionatTwelveMonthsFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Denominator Identification Period"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Denominator Identification Period\":\n  Interval[start of \"Measurement Period\" - 14 months, start of \"Measurement Period\" - 2 months )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 4
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DepressionRemissionatTwelveMonthsFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Depression Encounter"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Depression Encounter\":\n  [Encounter: \"Contact or Office Visit\"] ValidEncounter\n    with \"Depression Diagnoses\" Depression\n      such that ValidEncounter.period overlaps Depression.prevalenceInterval ( )\n        and ValidEncounter.period ends during \"Denominator Identification Period\"\n        and ValidEncounter.status = 'finished'"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 5
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DepressionRemissionatTwelveMonthsFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Index Depression Assessment"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Index Depression Assessment\":\n  First(\"Depression Assessments Greater than 9\" DepressionAssessment\n      with \"Depression Encounter\" DepressionEncounter\n        such that DepressionAssessment.effective.toInterval() during day of Interval[ToDate((start of DepressionEncounter.period) - 7 days), \n        end of DepressionEncounter.period]\n      sort by start of effective.toInterval()\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 6
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DepressionRemissionatTwelveMonthsFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Measure Assessment Period"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Measure Assessment Period\":\n  \"Index Depression Assessment\" FirstIndexAssessment\n    let YearAfterIndexAssessment: date from start of FirstIndexAssessment.effective.toInterval ( ) + 12 months\n    return Interval[YearAfterIndexAssessment - 60 days, YearAfterIndexAssessment + 60 days]"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 7
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DepressionRemissionatTwelveMonthsFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Numerator"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Numerator\":\n  Last([Observation: \"PHQ 9 and PHQ 9M Tools\"] DepressionAssessment\n      where ToDate(start of DepressionAssessment.effective.toInterval()) during \"Measure Assessment Period\"\n        and DepressionAssessment.status in { 'final', 'amended', 'corrected' }\n      sort by start of effective.toInterval()\n  ).value < 5"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 8
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DepressionRemissionatTwelveMonthsFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Stratification 2"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Stratification 2\":\n  \"Index Depression Assessment\" IndexAssessment\n    return AgeInYearsAt(date from start of IndexAssessment.effective.toInterval()) >= 18"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 9
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DepressionRemissionatTwelveMonthsFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Stratification 1"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Stratification 1\":\n  \"Index Depression Assessment\" IndexAssessment\n    return AgeInYearsAt(date from start of IndexAssessment.effective.toInterval()) in Interval[12, 17]"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 10
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DepressionRemissionatTwelveMonthsFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Initial Population"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Initial Population\":\n  AgeInYearsAt(start of(\"Index Depression Assessment\".effective.toInterval())) >= 12"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 11
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DepressionRemissionatTwelveMonthsFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Denominator"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Denominator\":\n  \"Initial Population\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 12
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "SupplementalDataElements"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Payer"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Payer\":\n  [Coverage: type in \"Payer Type\"] Payer\n    return {\n      code: Payer.type,\n      period: Payer.period\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 13
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DepressionRemissionatTwelveMonthsFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Payer"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 14
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "SupplementalDataElements"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Ethnicity"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Ethnicity\":\n  Patient.ethnicity E\n    return Tuple {\n      codes: { E.ombCategory } union E.detailed,\n      display: E.text\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 15
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DepressionRemissionatTwelveMonthsFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Ethnicity"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 16
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DepressionRemissionatTwelveMonthsFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Has Hospice Services in the Measure Assessment Period"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Has Hospice Services in the Measure Assessment Period\":\n  exists ( [Encounter: \"Encounter Inpatient\"] InpatientEncounter\n      where ( InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n          or InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\"\n      )\n        and InpatientEncounter.period ends during day of Interval[start of \"Denominator Identification Period\", end of \"Measure Assessment Period\"]\n        and InpatientEncounter.status = 'finished'\n  )\n    or exists ( [Encounter: \"Hospice Encounter\"] HospiceEncounter\n        where HospiceEncounter.period overlaps day of Interval[start of \"Denominator Identification Period\", end of \"Measure Assessment Period\"]\n          and not ( HospiceEncounter.status in { 'cancelled', 'entered-in-error', 'unknown' } )\n    )\n    or exists ( [Observation: \"Hospice care [Minimum Data Set]\"] HospiceAssessment\n        where HospiceAssessment.value ~ \"Yes (qualifier value)\"\n          and HospiceAssessment.effective.toInterval ( ) overlaps day of Interval[start of \"Denominator Identification Period\", end of \"Measure Assessment Period\"]\n          and HospiceAssessment.status in { 'final', 'amended', 'corrected' }\n    )\n    or exists ( [ServiceRequest: code in \"Hospice Care Ambulatory\"] HospiceOrder\n        where HospiceOrder.authoredOn during day of Interval[start of \"Denominator Identification Period\", end of \"Measure Assessment Period\"]\n          and HospiceOrder.status in { 'active', 'completed' }\n          and HospiceOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n    )\n    or exists ( [Procedure: \"Hospice Care Ambulatory\"] HospicePerformed\n        where HospicePerformed.performed.toInterval ( ) overlaps day of Interval[start of \"Denominator Identification Period\", end of \"Measure Assessment Period\"]\n          and not ( HospicePerformed.status in { 'not-done', 'entered-in-error', 'unknown' } )\n    )\n    or exists ( [Condition: \"Hospice Diagnosis\"] HospiceCareDiagnosis\n        where HospiceCareDiagnosis.prevalenceInterval ( ) overlaps day of Interval[start of \"Denominator Identification Period\", end of \"Measure Assessment Period\"]\n          and HospiceCareDiagnosis.isActive ( )\n          and not ( HospiceCareDiagnosis.verificationStatus ~ QICoreCommon.\"unconfirmed\"\n              or HospiceCareDiagnosis.verificationStatus ~ QICoreCommon.\"refuted\"\n              or HospiceCareDiagnosis.verificationStatus ~ QICoreCommon.\"entered-in-error\"\n          )\n    )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 17
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DepressionRemissionatTwelveMonthsFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Has Palliative Care in the Measure Assessment Period"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Has Palliative Care in the Measure Assessment Period\":\n  exists ( [Observation: \"Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)\"] PalliativeAssessment\n      where PalliativeAssessment.effective.toInterval ( ) overlaps Interval[start of \"Denominator Identification Period\", end of \"Measure Assessment Period\"]\n        and PalliativeAssessment.status in { 'final', 'amended', 'corrected' }\n  )\n    or exists ( [Condition: \"Palliative Care Diagnosis\"] PalliativeDiagnosis\n        where PalliativeDiagnosis.prevalenceInterval ( ) overlaps Interval[start of \"Denominator Identification Period\", end of \"Measure Assessment Period\"]\n          and PalliativeDiagnosis.isActive ( )\n          and not ( PalliativeDiagnosis.verificationStatus ~ QICoreCommon.\"unconfirmed\"\n              or PalliativeDiagnosis.verificationStatus ~ QICoreCommon.\"refuted\"\n              or PalliativeDiagnosis.verificationStatus ~ QICoreCommon.\"entered-in-error\"\n          )\n    )\n    or exists ( [Encounter: \"Palliative Care Encounter\"] PalliativeEncounter\n        where PalliativeEncounter.period overlaps Interval[start of \"Denominator Identification Period\", end of \"Measure Assessment Period\"]\n          and PalliativeEncounter.status = 'finished'\n    )\n    or exists ( [Procedure: \"Palliative Care Intervention\"] PalliativeIntervention\n        where PalliativeIntervention.performed.toInterval ( ) overlaps Interval[start of \"Denominator Identification Period\", end of \"Measure Assessment Period\"]\n          and not ( PalliativeIntervention.status in { 'not-done', 'entered-in-error', 'unknown' } )\n    )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 18
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DepressionRemissionatTwelveMonthsFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Patient Expired"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Patient Expired\":\n  Patient.deceased on or before end of \"Measure Assessment Period\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 19
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DepressionRemissionatTwelveMonthsFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Has Mental Health Disorder Diagnoses"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Has Mental Health Disorder Diagnoses\":\n  exists ( ( [Condition: \"Bipolar Disorder\"]\n      union [Condition: \"Personality Disorder Emotionally Labile\"]\n      union [Condition: \"Schizophrenia or Psychotic Disorder\"]\n      union [Condition: \"Pervasive Developmental Disorder\"] ) MentalHealthDisorderDiagnoses\n      where ToDate(start of MentalHealthDisorderDiagnoses.prevalenceInterval()) on or before end of \"Measure Assessment Period\"\n        and MentalHealthDisorderDiagnoses.isActive ( )\n        and not ( MentalHealthDisorderDiagnoses.verificationStatus ~ QICoreCommon.\"unconfirmed\"\n            or MentalHealthDisorderDiagnoses.verificationStatus ~ QICoreCommon.\"refuted\"\n            or MentalHealthDisorderDiagnoses.verificationStatus ~ QICoreCommon.\"entered-in-error\"\n        )\n  )"
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      "version" : "0.0.001",
      "name" : "DepressionRemissionatTwelveMonthsFHIR",
      "title" : "Depression Remission at Twelve MonthsFHIR",
      "status" : "draft",
      "experimental" : false,
      "date" : "2023-08-28T17:12:47+00:00",
      "publisher" : "MN Community Measurement",
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      "description" : "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" : [
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      ],
      "purpose" : "UNKNOWN",
      "usage" : "When an index assessment is conducted with PHQ-9M, the follow-up assessment can use either a PHQ-9M or PHQ-9.\n\nThis eCQM is a patient-based measure.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS159v12. \n\nPlease 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" : "Copyright MN Community Measurement, 2023. All rights reserved.\n\nLimited 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.\n\nCPT(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" : "2023-08-28",
      "lastReviewDate" : "2023-08-28",
      "effectivePeriod" : {
        "start" : "2024-01-01",
        "end" : "2024-12-31"
      },
      "author" : [
        {
          "name" : "Telligen",
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              "value" : "https://www.telligen.com/"
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      ],
      "library" : [
        🔗 "http://ecqi.healthit.gov/ecqms/Library/DepressionRemissionatTwelveMonthsFHIR"
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      "disclaimer" : "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.\n\nTHE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.\n\nDue to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].",
      "rationale" : "Adults:\nDepression 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).\n\nDepression 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).\n\nAdolescents and Adults:\nThe 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).\n\nDepression 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).\n\nAdolescents:\nIn 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 < .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" : "Adults:\n\nRecommendations and algorithm notations supporting depression outcomes and duration of treatment according to Institute for Clinical Systems Improvement Health Care Guideline (Trangle et al., 2016):\n\nRecommendation: 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).\n\nProactive 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).\n\nThe 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).\n\nThe goals of treatment should be to achieve remission, reduce relapse and recurrence, and return to previous level of occupational and psychosocial function.\n\nIf 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).\n\nResponse 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.\n\nThis measure assesses achievement of remission, which is a desired outcome of effective depression treatment and monitoring.\n\nAdult Depression in Primary Care - Guideline Aims (Trangle et al., 2016): \n- 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.\n- Increase the percentage of patients with major depression or persistent depressive disorder who have follow-up to assess for outcomes from treatment.\n- Improve communication between the primary care physician and the mental health care clinician (if patient is co-managed).\n\nAdolescents:\n\nRecommendations supporting depression outcomes and duration of treatment according to American Academy of Child and Adolescent Psychiatry guideline (Birmaher et al., 2007): \n- 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).\n- Each phase of treatment should include psychoeducation, supportive management, and family and school involvement.\n- 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.\n- 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.\n\nRecommendations 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)): \n- Mild depression: consider a period of active support and monitoring before starting other evidence-based treatment\n- Moderate or severe major clinical depression or complicating factors:\n  -- consultation with mental health specialist with agreed upon roles\n  -- evidence based treatment (cognitive behavioral therapy or interpersonal psychotherapy and/or antidepressant selective serotonin reuptake inhibitors)  \n- Monitor for adverse effects during antidepressant therapy\n  -- clinical worsening, suicidality, unusual changes in behavior\n- Systematic and regular tracking of goals and outcomes\n  -- improvement in functioning status and resolution of depressive symptoms\nRegardless 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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