Knowledge Artifact Metadata Name (machine-readable) DepressionScreeningandFollowUp Title (human-readable) Preventive Care and Screening: Screening for Depression and Follow-Up Plan Status Draft Experimental false Description Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of or up to two days after the date of the qualifying encounter Purpose Unknown Effective Period 2024-01-01..2024-12-31 Measure Steward Clinical Quality Framework Steward Contact Details http://cqframework.org Copyright Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) is copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2022 World Health Organization. All Rights Reserved. Measure Metadata Version Number 0.1.0 Measure Scoring Proportion Measure Type process Rationale Depression affects more than two hundred sixty million people across the world and is a leading cause of disability, with a variety of depressive disorders that are independent risk factors for chronic diseases, such as cardiovascular disease and diabetes, lending screening for depression as paramount to identify depressive disorders that can affect the most vulnerable populations (Costantini et al., 2021). Results from a 2018 U.S. survey indicated that 14.4 percent of adolescents (3.5 million adolescents) had a major depressive episode (MDE) in the past year, with nine percent of adolescents (2.4 million adolescents) having one MDE with severe impairment (Substance Abuse and Mental Health Services Administration, 2019). The odds of a diagnosis of depression are believed to be 2.6 times greater for children and adolescents exposed to trauma as compared to those unexposed or less exposed (Vibhakar et al., 2019). Children and teens with major depressive disorder (MDD) have been found to have difficulty carrying out their daily activities, relating to others, growing up healthy, and are at an increased risk of suicide (Siu on behalf of the U.S. Preventive Services Task Force [USPSTF], 2016). The same 2018 study indicated that 7.2 percent of adults aged 18 or older (17.7 million adults) had at least one MDE with 4.7 percent of adults (11.5 million adults) having one MDE with severe impairment in the past year (Substance Abuse and Mental Health Services Administration, 2019). Moreover, it is estimated 22.9 percent of adult patients with chronic pain (2.2 million adults) were diagnosed with comorbid depression from 2011 to 2015, with an upward trend of prevalence among Black Americans, patients aged 65 to 84 years old, Medicare and Medicaid insured patients, and patients from zip code areas with low annual household incomes (Orhurhu et al., 2019). Depression and other mood disorders, such as bipolar disorder and anxiety disorders, especially during the perinatal period, can have devastating effects on women, infants, and families (American College of Obstetricians and Gynecologists, 2018). It's estimated that the global prevalence of antenatal (or perinatal) depression ranges from 15 to 65 percent, with current or previous exposure to abuse and violence, lack of social support, and family history of mental disorders being risk factors. Depressive symptoms measured during pregnancy have been shown to influence the quality of the postpartum mother-infant relationship (Hazell Raine et al., 2020). Additionally, the risk of low birth weight and preterm birth is higher among infants born from depressed mothers (Dadi, Miller, Bisetegn, & Mwanri, 2020). Negative outcomes associated with depression make it crucial to screen in order to identify and treat depression in its early stages. Multiple social costs of depression have been identified, such as reduced educational achievements, poor financial success and role performance, higher amount of days out of role, and increased risk of job loss (Costantini et al., 2021). Depression also imposes significant economic burden through direct and indirect costs, supporting the need for regular depression screening. "In the United States, an estimated $22.8 billion was spent on depression treatment in 2009, and lost productivity cost an additional estimated $23 billion in 2011" (Siu & USPSTF, 2016, p. 383-384). Numerous studies have found significant disparities in depression prevalence and treatment among racial/ethnic minorities. One study revealed that Indigenous adults are at a high risk for posttraumatic stress disorder, depression, suicide, substance use disorder, and concurrent behavioral health disorders secondary to these initial health problems (Ka’apu and Burnette, 2019). Additionally, though rates of depression are lower among Blacks and Hispanics than among whites, depression among Blacks and Hispanics is likely to be more recurrent. Furthermore, 48 percent of whites receive mental health services, compared to just 31 percent of Blacks and Hispanics, and 22 percent of Asians (American Psychiatric Association, 2017). Asian Americans and Black Americans are also significantly more likely to utilize emergency rooms for depression treatment, which contributes to inconsistent follow-up care (Lee et al., 2014). While primary care providers (PCPs) serve as the first line of defense in the detection of depression, studies show that PCPs fail to recognize up to 46 percent of depressed patients (Borner et al., 2010). "In nationally representative U.S. surveys, about eight percent of adolescents reported having major depression in the past year. Only 36 percent to 44 percent of children and adolescents with depression receive treatment, suggesting that the majority of depressed youth are undiagnosed and untreated" (Siu on behalf of USPSTF, 2016, p. 360 & p. 364). Furthermore, evidence supports that screening for depression in pregnant and postpartum women is of moderate net benefit, and treatment options for positive depression screening should be available for patients twelve and older including pregnant and postpartum women. This measure seeks to align with USPSTF clinical guideline recommendations as well as the Healthy People 2030 recommendation to increase the proportion of adolescents and adults who are screened and receive treatment for depression (U.S. Preventive Services Task Force, 2016) and makes an important contribution to the quality domain of community and population health. Clinical Recommendation Statement Adolescent Recommendation (12-18 years): "The USPSTF recommends screening for MDD in adolescents aged 12 to 18 years. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (B recommendation)" (Siu on behalf of USPSTF, 2016, p. 360). Adult Recommendation (18 years and older): "The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (B recommendation)" (Siu & USPSTF, 2016, p. 380). “The USPSTF recommends that clinicians provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions (B recommendation)” (U.S. Preventive Services Task Force, 2019). The American College of Obstetricians and Gynecologists (ACOG) provides the following recommendation: "All obstetrician–gynecologists and other obstetric care providers should complete a full assessment of mood and emotional well-being (including screening for postpartum depression and anxiety with a validated instrument) during the comprehensive postpartum visit for each patient" (American College of Obstetricians and Gynecologists, 2018). The Institute for Clinical Systems Improvement (ICSI) health care guideline, Adult Depression in Primary Care, provides the following recommendations: 1. "Clinicians should routinely screen all adults for depression using a standardized instrument." 2. "Clinicians should establish and maintain follow-up with patients." 3. "Clinicians should screen and monitor depression in pregnant and post-partum women" (Trangle et al., 2016, p. 8-10). Improvement Notation Higher score indicates better quality Guidance The intent of the measure is to screen for new cases of depression in patients who have never had a diagnosis of bipolar disorder. Patients who have ever been diagnosed with bipolar disorder prior to the qualifying encounter used to evaluate the numerator will be excluded from the measure regardless of whether the diagnosis is active or not. A depression screen is completed on the date of the encounter or up to 14 calendar days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan must be documented on the date of or up to two calendar days after the date of the encounter, such as referral to a provider for additional evaluation, pharmacological interventions, or other interventions for the treatment of depression. An example to illustrate the follow-up plan documentation timing: if the encounter is on a Monday from 3-4 pm (day 0) and the patient screens positive, the clinician has through anytime on Wednesday (day 2) to complete follow-up plan documentation. This measure does not require documentation of a specific score, just whether results of the normalized and validated depression screening tool used are considered positive or negative. Each standardized screening tool provides guidance on whether a particular score is considered positive for depression. This eCQM is a patient-based measure. Depression screening is required once per measurement period, not at all encounters. Screening Tools: An age-appropriate, standardized, and validated depression screening tool must be used for numerator compliance. The name of the age-appropriate standardized depression screening tool utilized must be documented in the medical record. The depression screening must be reviewed and addressed by the provider, filing the code, on the date of the encounter. Positive pre-screening results indicating a patient is at high risk for self-harm should receive more urgent intervention as determined by the provider practice. The screening should occur during a qualifying encounter or up to 14 calendar days prior to the date of the qualifying encounter. The measure assesses the most recent depression screening completed either during the qualifying encounter or within the 14 calendar days prior to that encounter. Therefore, a clinician would not be able to complete another screening at the time of the encounter to count towards a follow-up, because that would serve as the most recent screening. In order to satisfy the follow-up requirement for a patient screening positively, the eligible clinician would need to provide one of the aforementioned follow-up actions, which does not include use of a standardized depression screening tool. Follow-Up Plan: The follow-up plan MUST still be provided for and discussed with the patient during the qualifying encounter used to evaluate the numerator. However, documentation of the follow-up plan can occur up to two calendar days after the qualifying encounter, in accordance with the policies of an eligible clinician or provider’s practice or health system. All services should be documented during, or as soon as practicable, after the qualifying encounter in order to maintain an accurate medical record. The follow-up plan must be related to a positive depression screening, for example: "Patient referred for psychiatric evaluation due to positive depression screening." Examples of a follow-up plan include but are not limited to: Referral to a provider or program for further evaluation for depression, for example, referral to a psychiatrist, psychiatric nurse practitioner, psychologist, clinical social worker, mental health counselor, or other mental health service such as family or group therapy, support group, depression management program, or other service for treatment of depression Other interventions designed to treat depression such as behavioral health evaluation, psychotherapy, pharmacological interventions, or additional treatment options Should a patient screen positive for depression, a clinician should: Only order pharmacological intervention when appropriate and after sufficient diagnostic evaluation. However, for the purposes of this measure, additional screening and assessment during the qualifying encounter will not qualify as a follow-up plan. Opt to complete a suicide risk assessment when appropriate and based on individual patient characteristics. However, for the purposes of this measure, a suicide risk assessment or additional screening using a standardized tool will not qualify as a follow-up plan. This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM. Measure Population Criteria Initial Population ID: AD83208C-1313-401E-BB62-ABCCE0982B49 Description: All patients aged 12 years and older at the beginning of the measurement period with at least one qualifying encounter during the measurement period Logic Definition: Initial Population Denominator ID: 696066C7-C558-4849-A325-A3CDDB58CF8F Description: All patients aged 12 years and older at the beginning of the measurement period with at least one qualifying encounter during the measurement period Logic Definition: Denominator Numerator ID: E2557B71-1B97-413F-BE26-2B037E4D590B Description: Patients screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized tool AND if positive, a follow-up plan is documented on the date of or up to two days after the date of the qualifying encounter Logic Definition: Numerator Denominator Exclusions ID: E52F7FAE-96D9-417A-8538-6E3DB4A31D7A Description: Patients who have ever been diagnosed with bipolar disorder at any time prior to the qualifying encounter Logic Definition: Denominator Exclusions Denominator Exceptions ID: FBA7B9D9-8588-4CB2-AB72-642CBD980334 Description: Patient Reason(s) Patient refuses to participate in or complete the depression screening OR Medical Reason(s) Documentation of medical reason for not screening patient for depression Logic Definition: Denominator Exceptions Stratifier ID: stratifier-ethnicity Code: Ethnicity Description: Ethnicity (CDC Value Set) Stratifier ID: stratifier-payer Code: SDE Payer Description: Payer Stratifier ID: stratifier-race Code: SDE Race Description: Race (CDC Value Set) Stratifier ID: stratifier-sex Code: Sex [HL7.v3] Description: Administrative sex Stratifier ID: stratifier-age Code: Age Description: Age Stratifier ID: stratifier-food-insecurity-risk-status Code: Food insecurity risk [HVS] Description: Food insecurity risk status Supplemental Data Elements Supplemental Data Element ID: sde-ethnicity Usage Code: Supplemental Data Description: Ethnicity (CDC Value Set) Logic Definition: SDE Ethnicity Supplemental Data Element ID: sde-payer Usage Code: Supplemental Data Description: Payer Logic Definition: SDE Payer Supplemental Data Element ID: sde-race Usage Code: Supplemental Data Description: Race (CDC Value Set) Logic Definition: SDE Race Supplemental Data Element ID: sde-sex Usage Code: Supplemental Data Description: Administrative sex Logic Definition: SDE Sex Supplemental Data Element ID: sde-age Usage Code: Supplemental Data Description: Age Logic Definition: SDE Age Supplemental Data Element ID: sde-state-of-residence Usage Code: Supplemental Data Description: State of residence Logic Definition: SDE State of Residence Supplemental Data Element ID: sde-postal-code-of-residence Usage Code: Supplemental Data Description: Postal code of residence Logic Definition: SDE Postal Code of Residence Supplemental Data Element ID: sde-food-insecurity-risk-status Usage Code: Supplemental Data Description: Food insecurity risk status Logic Definition: SDE Food Insecurity Risk Status Measure Logic Primary Library DepressionScreeningandFollowUp Dependency Description: Library SurveillanceDataElements Resource: http://fhir.org/guides/cqf/aphl/chronic-ds/Library/SurveillanceDataElementsFHIR4|1.0.000 Canonical URL: http://fhir.org/guides/cqf/aphl/chronic-ds/Library/SurveillanceDataElementsFHIR4|1.0.000 Dependency Description: Library FHIRHelpers Resource: http://fhir.org/guides/cqf/aphl/chronic-ds/Library/FHIRHelpers|4.1.000 Canonical URL: http://fhir.org/guides/cqf/aphl/chronic-ds/Library/FHIRHelpers|4.1.000 Dependency Description: Library SDE Resource: http://fhir.org/guides/cqf/aphl/chronic-ds/Library/SupplementalDataElementsFHIR4|2.0.000 Canonical URL: http://fhir.org/guides/cqf/aphl/chronic-ds/Library/SupplementalDataElementsFHIR4|2.0.000 Dependency Description: Library AC Resource: AlphoraCommon Canonical URL: http://fhir.org/guides/cqf/aphl/chronic-ds/Library/AlphoraCommon Dependency Description: Library FC Resource: http://fhir.org/guides/cqf/aphl/chronic-ds/Library/FHIRCommon|1.1.000 Canonical URL: http://fhir.org/guides/cqf/aphl/chronic-ds/Library/FHIRCommon|1.1.000 Dependency Description: Library Common Resource: http://fhir.org/guides/cqf/aphl/chronic-ds/Library/MATGlobalCommonFunctionsFHIR4|6.0.000 Canonical URL: http://fhir.org/guides/cqf/aphl/chronic-ds/Library/MATGlobalCommonFunctionsFHIR4|6.0.000 Dependency Description: Code system SNOMEDCT Resource: SNOMED CT (all versions) Canonical URL: http://snomed.info/sct Dependency Description: Code system LOINC Resource: LOINC Canonical URL: http://loinc.org Dependency Description: Code system ConditionClinicalStatusCodes Resource: Condition Clinical Status Codes Canonical URL: http://terminology.hl7.org/CodeSystem/condition-clinical Dependency Description: Code system ConditionVerificationStatusCodes Resource: ConditionVerificationStatus Canonical URL: http://terminology.hl7.org/CodeSystem/condition-ver-status Dependency Description: Value set Adolescent Depression Screening Assessment Resource: http://fhir.org/guides/cqf/aphl/chronic-ds/ValueSet/adolescent-depression-screening-assessment Canonical URL: http://fhir.org/guides/cqf/aphl/chronic-ds/ValueSet/adolescent-depression-screening-assessment Dependency Description: Value set Encounter to Screen for Depression Resource: Encounter to Screen for Depression Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1916 Dependency Description: Value set Physical Therapy Evaluation Resource: Physical Therapy Evaluation Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1022 Dependency Description: Value set Telephone Visits Resource: Telephone Visits Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080 Dependency Description: Value set Adolescent Depression Medications Resource: Adolescent Depression Medications Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1567 Dependency Description: Value set Referral for Adolescent Depression Resource: Referral for Adolescent Depression Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1570 Dependency Description: Value set Follow Up for Adolescent Depression Resource: Follow Up for Adolescent Depression Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1569 Dependency Description: Value set Adult Depression Screening Assessment Resource: http://fhir.org/guides/cqf/aphl/chronic-ds/ValueSet/adult-depression-screening-assessment Canonical URL: http://fhir.org/guides/cqf/aphl/chronic-ds/ValueSet/adult-depression-screening-assessment Dependency Description: Value set Adult Depression Medications Resource: Adult Depression Medications Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1566 Dependency Description: Value set Referral for Adult Depression Resource: Referral for Adult Depression Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1571 Dependency Description: Value set Follow Up for Adult Depression Resource: Follow Up for Adult Depression Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1568 Dependency Description: Value set Payer Resource: Payer Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591 Dependency Description: Value set Bipolar Disorder Resource: Bipolar Disorder Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.67.1.101.1.128 Dependency Description: Value set Medical Reason Resource: Medical Reason Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1007 Direct Reference Code Display: Depression Screening Negative (finding) Code: 428171000124102 System: http://snomed.info/sct Direct Reference Code Display: Depression Screening Positive (finding) Code: 428181000124104 System: http://snomed.info/sct Direct Reference Code Display: Food insecurity risk [HVS] Code: 88124-3 System: http://loinc.org Direct Reference Code Code: active System: http://terminology.hl7.org/CodeSystem/condition-clinical Direct Reference Code Code: confirmed System: http://terminology.hl7.org/CodeSystem/condition-ver-status Direct Reference Code Code: recurrence System: http://terminology.hl7.org/CodeSystem/condition-clinical Direct Reference Code Code: relapse System: http://terminology.hl7.org/CodeSystem/condition-clinical Direct Reference Code Display: Depression Screening Declined (situation) Code: 720834000 System: http://snomed.info/sct Parameter Name: Measurement Period Use: In Min Cardinality: 0 Max Cardinality: 1 Type: Period Parameter Name: SDE Postal Code of Residence Use: Out Min Cardinality: 0 Max Cardinality: 1 Type: string Parameter Name: SDE State of Residence Use: Out Min Cardinality: 0 Max Cardinality: 1 Type: string Parameter Name: SDE Race Use: Out Min Cardinality: 0 Max Cardinality: * Type: Coding Parameter Name: SDE Sex Use: Out Min Cardinality: 0 Max Cardinality: 1 Type: Coding Parameter Name: Numerator Use: Out Min Cardinality: 0 Max Cardinality: 1 Type: boolean Parameter Name: Denominator Use: Out Min Cardinality: 0 Max Cardinality: 1 Type: boolean Parameter Name: SDE Payer Use: Out Min Cardinality: 0 Max Cardinality: * Type: Resource Parameter Name: SDE Food Insecurity Risk Status Use: Out Min Cardinality: 0 Max Cardinality: 1 Type: CodeableConcept Parameter Name: Initial Population Use: Out Min Cardinality: 0 Max Cardinality: 1 Type: boolean Parameter Name: SDE Ethnicity Use: Out Min Cardinality: 0 Max Cardinality: * Type: Coding Parameter Name: SDE Age Use: Out Min Cardinality: 0 Max Cardinality: 1 Type: integer Parameter Name: Denominator Exclusions Use: Out Min Cardinality: 0 Max Cardinality: 1 Type: boolean Parameter Name: Denominator Exceptions Use: Out Min Cardinality: 0 Max Cardinality: 1 Type: boolean Measure Logic Data Requirements Data Requirement Type: Patient Profile(s): Patient Must Support Elements: use, type, url, extension, value Data Requirement Type: Encounter Profile(s): Encounter Must Support Elements: type, status, period Code Filter(s): Path: type ValueSet: Encounter to Screen for Depression Data Requirement Type: Encounter Profile(s): Encounter Must Support Elements: type, status, period Code Filter(s): Path: type ValueSet: Physical Therapy Evaluation Data Requirement Type: Encounter Profile(s): Encounter Must Support Elements: type, status, period Code Filter(s): Path: type ValueSet: Telephone Visits Data Requirement Type: Observation Profile(s): Observation Must Support Elements: code, status, value, effective, issued, component Code Filter(s): Path: code ValueSet: http://fhir.org/guides/cqf/aphl/chronic-ds/ValueSet/adolescent-depression-screening-assessment Data Requirement Type: Observation Profile(s): Observation Must Support Elements: code, status, value, effective, issued, component Code Filter(s): Path: code ValueSet: http://fhir.org/guides/cqf/aphl/chronic-ds/ValueSet/adult-depression-screening-assessment Data Requirement Type: Observation Profile(s): Observation Must Support Elements: code, status, value, effective, issued, component Code Filter(s): Path: code Code: Data Requirement Type: MedicationRequest Profile(s): MedicationRequest Must Support Elements: medication, status, doNotPerform, intent Code Filter(s): Path: medication ValueSet: Adolescent Depression Medications Data Requirement Type: MedicationRequest Profile(s): MedicationRequest Must Support Elements: medication, status, doNotPerform, intent Code Filter(s): Path: medication ValueSet: Adult Depression Medications Data Requirement Type: MedicationRequest Profile(s): MedicationRequest Must Support Elements: medication.reference, status, doNotPerform, intent Data Requirement Type: Medication Profile(s): Medication Must Support Elements: id, code Data Requirement Type: ServiceRequest Profile(s): ServiceRequest Must Support Elements: code, status, intent, doNotPerform Code Filter(s): Path: code ValueSet: Referral for Adolescent Depression Data Requirement Type: ServiceRequest Profile(s): ServiceRequest Must Support Elements: code, status, intent, doNotPerform Code Filter(s): Path: code ValueSet: Referral for Adult Depression Data Requirement Type: Procedure Profile(s): Procedure Must Support Elements: code, status Code Filter(s): Path: code ValueSet: Follow Up for Adolescent Depression Data Requirement Type: Procedure Profile(s): Procedure Must Support Elements: code, status Code Filter(s): Path: code ValueSet: Follow Up for Adult Depression Data Requirement Type: Coverage Profile(s): Coverage Must Support Elements: type, period Code Filter(s): Path: type ValueSet: Payer Data Requirement Type: Condition Profile(s): Condition Must Support Elements: code, clinicalStatus, verificationStatus Code Filter(s): Path: code ValueSet: Bipolar Disorder Measure Logic Definitions Logic Definition Library Name: SurveillanceDataElementsFHIR4 // Jurisdiction of residence (jurisdiction of the patient) define "Most recent physical home address": First( Patient.address A where A.use = 'home' and A.type = 'physical' sort by end of period desc ) Logic Definition Library Name: SurveillanceDataElementsFHIR4 define "Postal Code of Residence": "Most recent physical home address".postalCode Logic Definition Library Name: DepressionScreeningandFollowUp define "SDE Postal Code of Residence": SurveillanceDataElements."Postal Code of Residence" Logic Definition Library Name: SurveillanceDataElementsFHIR4 define "State of Residence": "Most recent physical home address".state Logic Definition Library Name: DepressionScreeningandFollowUp define "SDE State of Residence": SurveillanceDataElements."State of Residence" Logic Definition Library Name: SupplementalDataElementsFHIR4 define "SDE Race": (flatten ( Patient.extension Extension where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race' return Extension.extension )) E where E.url = 'ombCategory' or E.url = 'detailed' return E.value as Coding Logic Definition Library Name: DepressionScreeningandFollowUp define "SDE Race": SDE."SDE Race" Logic Definition Library Name: SupplementalDataElementsFHIR4 define "SDE Sex": case when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' } when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' } else null end Logic Definition Library Name: DepressionScreeningandFollowUp define "SDE Sex": SDE."SDE Sex" Logic Definition Library Name: DepressionScreeningandFollowUp //Numerator define "Patient Age 12 to 16 Years at Start of Measurement Period": AgeInYearsAt(start of "Measurement Period") in Interval[12, 16] Logic Definition Library Name: DepressionScreeningandFollowUp define "Qualifying Encounters During Measurement Period": (AC.QualifiedEncounters([Encounter: "Encounter to Screen for Depression"]) union AC.QualifiedEncounters([Encounter: "Physical Therapy Evaluation"]) union AC.QualifiedEncounters([Encounter: "Telephone Visits"])) QualifyingEnc where FC.ToInterval(QualifyingEnc.period) during "Measurement Period" Logic Definition Library Name: DepressionScreeningandFollowUp define "Has Adolescent Depression Screening": ((AC.QualifiedObservations([Observation: "Adolescent Depression Screening Assessment"])) AdolescentScreening with "Qualifying Encounters During Measurement Period" QualifyingEnc such that "Screening Within 14 Days of Encounter"(AdolescentScreening, QualifyingEnc)) Logic Definition Library Name: DepressionScreeningandFollowUp //Adolescent Numerator define "Most Recent Adolescent Depression Screening": AC.MostRecent(("Has Adolescent Depression Screening")) Logic Definition Library Name: DepressionScreeningandFollowUp define "Most Recent Adolescent Screening Negative": ("Most Recent Adolescent Depression Screening" AdolescentScreening where AdolescentScreening.value ~ ToConcept("Depression Screening Negative")) is not null Logic Definition Library Name: DepressionScreeningandFollowUp define "Most Recent Adolescent Positive Depression Screening": "Most Recent Adolescent Depression Screening" RecentScreening where RecentScreening.value ~ ToConcept("Depression Screening Positive") Logic Definition Library Name: DepressionScreeningandFollowUp define "Follow Up Interventions For Positive Adolescent Depression Screening": (AC.QualifiedMedicationRequests([MedicationRequest: "Adolescent Depression Medications"]) union AC.QualifiedServiceRequests([ServiceRequest: "Referral for Adolescent Depression"]) union AC.QualifiedProcedures([Procedure: "Follow Up for Adolescent Depression"])) FollowUpInterventions let "Intervention Day": Coalesce(FC.ToInterval(FollowUpInterventions.authoredOn), FC.ToInterval(FollowUpInterventions.performed)) with "Qualifying Encounters During Measurement Period" QualifyingEnc such that "Intervention Day" same day as QualifyingEnc.period or "Intervention Day" 2 days or less after day of end of FC.ToInterval(QualifyingEnc.period) Logic Definition Library Name: DepressionScreeningandFollowUp define "Most Recent Adolescent Depression Screening Positive and Follow Up Provided": ("Most Recent Adolescent Positive Depression Screening" RecentScreening let "Screening Day": Coalesce(FC.ToInterval(RecentScreening.effective), FC.ToInterval(RecentScreening.issued)) with "Follow Up Interventions For Positive Adolescent Depression Screening" FollowUpInterventions such that "Screening Day" 14 days or less before start of Coalesce(FC.ToInterval(FollowUpInterventions.authoredOn), FC.ToInterval(FollowUpInterventions.performed)) ) is not null Logic Definition Library Name: DepressionScreeningandFollowUp define "Patient Age 17 Years at Start of Measurement Period": AgeInYearsAt(start of "Measurement Period") = 17 Logic Definition Library Name: DepressionScreeningandFollowUp define "Has Adult Depression Screening": ((AC.QualifiedObservations([Observation: "Adult Depression Screening Assessment"])) AdolescentScreening with "Qualifying Encounters During Measurement Period" QualifyingEnc such that "Screening Within 14 Days of Encounter"(AdolescentScreening, QualifyingEnc)) Logic Definition Library Name: DepressionScreeningandFollowUp //Adult Numerator define "Most Recent Adult Depression Screening": AC.MostRecent(("Has Adult Depression Screening")) Logic Definition Library Name: DepressionScreeningandFollowUp define "Most Recent Adult Screening Negative": ("Most Recent Adult Depression Screening" AdultScreening where AdultScreening.value ~ ToConcept("Depression Screening Negative")) is not null Logic Definition Library Name: DepressionScreeningandFollowUp define "Most Recent Adult Positive Depression Screening": "Most Recent Adult Depression Screening" RecentScreening where RecentScreening.value ~ ToConcept("Depression Screening Positive") Logic Definition Library Name: DepressionScreeningandFollowUp define "Follow Up Interventions For Positive Adult Depression Screening": ((AC.QualifiedMedicationRequests([MedicationRequest: "Adult Depression Medications"]) union AC.QualifiedServiceRequests([ServiceRequest: "Referral for Adult Depression"]) union AC.QualifiedProcedures([Procedure: "Follow Up for Adult Depression"]))) FollowUpInterventions let "Intervention Day": Coalesce(FC.ToInterval(FollowUpInterventions.authoredOn), FC.ToInterval(FollowUpInterventions.performed)) with "Qualifying Encounters During Measurement Period" QualifyingEnc such that "Intervention Day" same day as QualifyingEnc.period or "Intervention Day" 2 days or less after day of end of FC.ToInterval(QualifyingEnc.period) Logic Definition Library Name: DepressionScreeningandFollowUp define "Most Recent Adult Depression Screening Positive and Follow Up Provided": ("Most Recent Adult Positive Depression Screening" RecentScreening let "Screening Day": Coalesce(FC.ToInterval(RecentScreening.effective), FC.ToInterval(RecentScreening.issued)) with "Follow Up Interventions For Positive Adult Depression Screening" FollowUpInterventions such that "Screening Day" 14 days or less before start of Coalesce(FC.ToInterval(FollowUpInterventions.authoredOn), FC.ToInterval(FollowUpInterventions.performed)) ) is not null Logic Definition Library Name: DepressionScreeningandFollowUp define "Patient Age 18 Years or Older at Start of Measurement Period": AgeInYearsAt(start of "Measurement Period") >= 18 Logic Definition Library Name: DepressionScreeningandFollowUp define "Numerator": ( "Patient Age 12 to 16 Years at Start of Measurement Period" and ( "Most Recent Adolescent Screening Negative" or "Most Recent Adolescent Depression Screening Positive and Follow Up Provided" ) ) or ( "Patient Age 17 Years at Start of Measurement Period" and ( "Most Recent Adolescent Screening Negative" or "Most Recent Adolescent Depression Screening Positive and Follow Up Provided" or "Most Recent Adult Screening Negative" or "Most Recent Adult Depression Screening Positive and Follow Up Provided") ) or ( "Patient Age 18 Years or Older at Start of Measurement Period" and ( "Most Recent Adult Screening Negative" or "Most Recent Adult Depression Screening Positive and Follow Up Provided" ) ) Logic Definition Library Name: DepressionScreeningandFollowUp define "Initial Population": AgeInYearsAt(start of "Measurement Period") >= 12 and exists( "Qualifying Encounters During Measurement Period" E where FC.ToInterval(E.period) during "Measurement Period" ) Logic Definition Library Name: DepressionScreeningandFollowUp define "Denominator": "Initial Population" Logic Definition Library Name: SupplementalDataElementsFHIR4 define "SDE Payer": [Coverage: type in "Payer"] Payer return { code: Payer.type, period: Payer.period } Logic Definition Library Name: DepressionScreeningandFollowUp define "SDE Payer": SDE."SDE Payer" Logic Definition Library Name: SurveillanceDataElementsFHIR4 // Jurisdiction of care (jurisdiction of the most recent encounter) // TODO: //define "Most recent address of care": // NOTE: Included in eICR // Occupational Data for Health - Past or Present Job // http://hl7.org/fhir/us/odh/StructureDefinition-odh-PastOrPresentJob.html // Observation: LOINC#11341-5, valueCodeableConcept in https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7186 // Social Determinants of Health (SDOH) // http://build.fhir.org/ig/HL7/fhir-sdoh-clinicalcare/StructureDefinition-SDOHCC-ObservationScreeningResponse.html // Food insecurity risk: http://build.fhir.org/ig/HL7/fhir-sdoh-clinicalcare/Observation-SDOHCC-ObservationResponseHungerVitalSignQuestion3Example.html // Observation: LOINC#88124-3, valueCodeableConcept in https://loinc.org/LL2510-7/ (At risk, No risk) define "Food Insecurity Risk Status": First( [Observation: "Food insecurity risk [HVS]"] O sort by issued desc ).value as CodeableConcept Logic Definition Library Name: DepressionScreeningandFollowUp define "SDE Food Insecurity Risk Status": SurveillanceDataElements."Food Insecurity Risk Status" Logic Definition Library Name: SupplementalDataElementsFHIR4 define "SDE Ethnicity": (flatten ( Patient.extension Extension where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity' return Extension.extension )) E where E.url = 'ombCategory' or E.url = 'detailed' return E.value as Coding Logic Definition Library Name: DepressionScreeningandFollowUp define "SDE Ethnicity": SDE."SDE Ethnicity" Logic Definition Library Name: SurveillanceDataElementsFHIR4 // Age define "Age": AgeInYearsAt(end of "Measurement Period") Logic Definition Library Name: DepressionScreeningandFollowUp define "SDE Age": SurveillanceDataElements."Age" Logic Definition Library Name: DepressionScreeningandFollowUp //Denominator Exclusion define "History of Bipolar Diagnosis Before Qualifying Encounter": (AC.QualifiedConditions([Condition: "Bipolar Disorder"])) BipolarDiagnosis with "Qualifying Encounters During Measurement Period" QualifyingEnc such that FC.ToPrevalenceInterval(BipolarDiagnosis) starts before QualifyingEnc.period Logic Definition Library Name: DepressionScreeningandFollowUp define "Denominator Exclusions": exists("History of Bipolar Diagnosis Before Qualifying Encounter") Logic Definition Library Name: DepressionScreeningandFollowUp //Denominator Exception define "Medical or Patient Reason for Not Screening Adolescent for Depression": AC.AbsentData([Observation: "Adolescent Depression Screening Assessment"], "Qualifying Encounters During Measurement Period", "Depression Screening Declined", "Medical Reason") Logic Definition Library Name: DepressionScreeningandFollowUp define "Medical or Patient Reason for Not Screening Adult for Depression": AC.AbsentData([Observation: "Adult Depression Screening Assessment"], "Qualifying Encounters During Measurement Period", "Depression Screening Declined", "Medical Reason") Logic Definition Library Name: DepressionScreeningandFollowUp define "Denominator Exceptions": (exists("Medical or Patient Reason for Not Screening Adolescent for Depression") and not exists("Has Adolescent Depression Screening")) or (exists("Medical or Patient Reason for Not Screening Adult for Depression") and not exists("Has Adult Depression Screening")) Logic Definition Library Name: FHIRHelpers define function ToString(value AddressUse): value.value Logic Definition Library Name: FHIRHelpers define function ToString(value AddressType): value.value Logic Definition Library Name: FHIRHelpers define function ToInterval(period FHIR.Period): if period is null then null else if period."start" is null then Interval(period."start".value, period."end".value] else Interval[period."start".value, period."end".value] Logic Definition Library Name: FHIRHelpers define function ToString(value uri): value.value Logic Definition Library Name: FHIRHelpers define function ToString(value AdministrativeGender): value.value Logic Definition Library Name: AlphoraCommon define function MostRecent(observations List<Observation>): Last( observations O sort by start of FC.ToInterval(effective) ) Logic Definition Library Name: AlphoraCommon define function QualifiedObservations(value List<FHIR.Observation>): value Observation where ( //registered | preliminary | final | amended | corrected | cancelled | entered-in-error | unknown Observation.status ~ 'final' or Observation.status ~ 'amended' or Observation.status ~ 'corrected' ) Logic Definition Library Name: FHIRHelpers define function ToString(value ObservationStatus): value.value Logic Definition Library Name: AlphoraCommon /* Common Resource Qualifications and Negations */ define function QualifiedEncounters(value List<FHIR.Encounter>): value Encounter where ( //planned | arrived | triaged | in-progress | onleave | finished | cancelled | entered-in-error | unknown Encounter.status ~ 'arrived' or Encounter.status ~ 'in-progress' or Encounter.status ~ 'finished' or Encounter.status ~ 'onleave' or Encounter.status ~ 'triaged' ) Logic Definition Library Name: FHIRHelpers define function ToString(value EncounterStatus): value.value Logic Definition Library Name: FHIRCommon /* @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval @comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible representations for timing-valued elements in FHIR, allowing this function to be used across any resource. The input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range. The intent of this function is to provide a clear and concise mechanism to treat single elements that have multiple possible representations as intervals so that logic doesn't have to account for the variability. More complex calculations (such as medication request period or dispense period calculation) need specific guidance and consideration. That guidance may make use of this function, but the focus of this function is on single element calculations where the semantics are unambiguous. If the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime. If the input is a Period, the result is a DateTime Interval. If the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing. If the input is an instant, the result is a DateTime Interval beginning and ending on that instant. If the input is a string, an error is raised indicating a single interval cannot be computed from a string. If the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age, and ending immediately prior to when the patient was the given Age plus one year. If the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given by the low end of the Range, and ending immediately prior to when the patient was the Age given by the high end of the Range plus one year. NOTE: Due to the complexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used with a Timing or String. */ define function ToInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>): case when choice is FHIR.dateTime then Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)] when choice is FHIR.Period then FHIRHelpers.ToInterval(choice as FHIR.Period) when choice is FHIR.instant then Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)] when choice is FHIR.Age then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year) when choice is FHIR.Range then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year) when choice is FHIR.Timing then //Interval[FHIRHelpers.ToDateTime(choice as FHIR.timing), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)] Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute a single interval from a Timing type') when choice is FHIR.string then Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute an interval from a String value') else null as Interval<DateTime> end Logic Definition Library Name: FHIRHelpers define function ToDateTime(value dateTime): value.value Logic Definition Library Name: FHIRHelpers define function ToDateTime(value instant): value.value Logic Definition Library Name: FHIRHelpers define function ToDate(value date): value.value Logic Definition Library Name: FHIRHelpers define function ToQuantity(quantity FHIR.Quantity): case when quantity is null then null when quantity.value is null then null when quantity.comparator is not null then Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.') when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org' or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) } else Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')') end Logic Definition Library Name: FHIRHelpers define function ToCalendarUnit(unit System.String): case unit when 'ms' then 'millisecond' when 's' then 'second' when 'min' then 'minute' when 'h' then 'hour' when 'd' then 'day' when 'wk' then 'week' when 'mo' then 'month' when 'a' then 'year' else unit end Logic Definition Library Name: DepressionScreeningandFollowUp define function "Screening Within 14 Days of Encounter"(observation FHIR.Observation, encounter FHIR.Encounter) returns System.Boolean: Coalesce(end of FC.ToInterval(observation.effective), observation.issued) 14 days or less before day of start of encounter.period and observation.value is not null Logic Definition Library Name: FHIRHelpers define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value } Logic Definition Library Name: FHIRHelpers define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value } Logic Definition Library Name: AlphoraCommon define function QualifiedMedicationRequests(value List<FHIR.MedicationRequest>): value MedicationRequest where ( //active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown (MedicationRequest.status ~ 'active' or MedicationRequest.status ~ 'completed' ) and ( MedicationRequest.doNotPerform is null or MedicationRequest.doNotPerform = false ) and MedicationRequest.intent ~ 'order' ) Logic Definition Library Name: FHIRHelpers define function ToString(value MedicationRequestStatus): value.value Logic Definition Library Name: FHIRHelpers define function ToBoolean(value boolean): value.value Logic Definition Library Name: FHIRHelpers define function ToString(value MedicationRequestIntent): value.value Logic Definition Library Name: FHIRHelpers define function ToString(value string): value.value Logic Definition Library Name: AlphoraCommon define function QualifiedServiceRequests(value List<FHIR.ServiceRequest>): value ServiceRequest where ( //draft | active | on-hold | revoked | completed | entered-in-error | unknown ServiceRequest.status ~ 'active' or ServiceRequest.status ~ 'completed' and ServiceRequest.intent ~ 'order' ) and ( ServiceRequest.doNotPerform is null or ServiceRequest.doNotPerform = false ) Logic Definition Library Name: FHIRHelpers define function ToString(value ServiceRequestStatus): value.value Logic Definition Library Name: FHIRHelpers define function ToString(value ServiceRequestIntent): value.value Logic Definition Library Name: AlphoraCommon define function QualifiedProcedures(value List<FHIR.Procedure>): value Procedure where ( //preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Procedure.status ~ 'completed' ) Logic Definition Library Name: FHIRHelpers define function ToString(value ProcedureStatus): value.value Logic Definition Library Name: AlphoraCommon define function QualifiedConditions(value List<FHIR.Condition>): value Condition where ( FHIRHelpers.ToConcept(Condition.clinicalStatus) ~ FC."active" ) and ( FHIRHelpers.ToConcept(Condition.verificationStatus) ~ FC."confirmed" ) Logic Definition Library Name: FHIRCommon /* @description: Returns an interval representing the normalized prevalence period of a given Condition resource. @comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from onset to abatement as specified in the given Condition. */ define function ToPrevalenceInterval(condition Condition): if condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse" then Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition)] else Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition)) Logic Definition Library Name: FHIRCommon /* @description: Returns an interval representing the normalized Abatement of a given Condition resource. @comment: NOTE: Due to the complexity of determining an interval from a String, this function will throw a run-time exception if used with a Condition instance that has a String as the abatement value. */ define function ToAbatementInterval(condition Condition): if condition.abatement is FHIR.dateTime then Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)] else if condition.abatement is FHIR.Period then FHIRHelpers.ToInterval(condition.abatement as FHIR.Period) else if condition.abatement is FHIR.string then Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute an interval from a String value') else if condition.abatement is FHIR.Age then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year) else if condition.abatement is FHIR.Range then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year) else if condition.abatement is FHIR.boolean then Interval[end of ToInterval(condition.onset), condition.recordedDate) else null Logic Definition Library Name: AlphoraCommon define function AbsentData(observation List<FHIR.Observation>, enc List<FHIR.Encounter>, code1 System.Code, valueset1 System.ValueSet) returns List<FHIR.Observation>: (QualifiedObservations(observation)) Obs with enc QualifyingEnc such that Coalesce(end of FC.ToInterval(Obs.effective), end of FC.ToInterval(Obs.issued)) same day as end of QualifyingEnc.period where exists( Obs.component c where( c.code as CodeableConcept ~ code1 or c.code as CodeableConcept in valueset1 )) and not exists(Obs.component c where(c.value is not null)) or (ResourceNotDone(Obs).value as FHIR.boolean = true and (ResourceNotDoneReason(Obs).value as CodeableConcept ~ code1 or ResourceNotDoneReason(Obs).value as CodeableConcept in valueset1)) Logic Definition Library Name: AlphoraCommon define function ResourceNotDone(notDone DomainResource): QICoreModifierExtension(notDone, 'qicore-notDone') Logic Definition Library Name: AlphoraCommon define function QICoreModifierExtension(domainResource DomainResource, url String): singleton from QICoreModifierExtensions(domainResource, url) Logic Definition Library Name: AlphoraCommon /* QI-CORE Extensions */ /* NOTE: Extensions are not the preferred approach, but are used as a way to access content that is defined by extensions but not yet surfaced in the CQL model info. */ define function QICoreModifierExtensions(domainResource DomainResource, url String): domainResource.modifierExtension E where E.url = ('http://hl7.org/fhir/us/qicore/StructureDefinition/' + url) return E Logic Definition Library Name: AlphoraCommon define function ResourceNotDoneReason(notDoneReason DomainResource): QICoreExtension(notDoneReason, 'qicore-notDoneReason') Logic Definition Library Name: AlphoraCommon define function QICoreExtension(domainResource DomainResource, url String): singleton from QICoreExtensions(domainResource, url) Logic Definition Library Name: AlphoraCommon define function QICoreExtensions(domainResource DomainResource, url String): domainResource.extension E where E.url = ('http://hl7.org/fhir/us/qicore/StructureDefinition/' + url) return E Generated using version 0.4.6 of the sample-content-ig Liquid templates
Depression Screening Declined (situation)
// Jurisdiction of residence (jurisdiction of the patient) define "Most recent physical home address": First( Patient.address A where A.use = 'home' and A.type = 'physical' sort by end of period desc )
define "Postal Code of Residence": "Most recent physical home address".postalCode
define "SDE Postal Code of Residence": SurveillanceDataElements."Postal Code of Residence"
define "State of Residence": "Most recent physical home address".state
define "SDE State of Residence": SurveillanceDataElements."State of Residence"
define "SDE Race": (flatten ( Patient.extension Extension where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race' return Extension.extension )) E where E.url = 'ombCategory' or E.url = 'detailed' return E.value as Coding
define "SDE Sex": case when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' } when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' } else null end
Patient Age 12 to 16 Years at Start of Measurement Period
//Numerator define "Patient Age 12 to 16 Years at Start of Measurement Period": AgeInYearsAt(start of "Measurement Period") in Interval[12, 16]
Qualifying Encounters During Measurement Period
define "Qualifying Encounters During Measurement Period": (AC.QualifiedEncounters([Encounter: "Encounter to Screen for Depression"]) union AC.QualifiedEncounters([Encounter: "Physical Therapy Evaluation"]) union AC.QualifiedEncounters([Encounter: "Telephone Visits"])) QualifyingEnc where FC.ToInterval(QualifyingEnc.period) during "Measurement Period"
define "Has Adolescent Depression Screening": ((AC.QualifiedObservations([Observation: "Adolescent Depression Screening Assessment"])) AdolescentScreening with "Qualifying Encounters During Measurement Period" QualifyingEnc such that "Screening Within 14 Days of Encounter"(AdolescentScreening, QualifyingEnc))
Most Recent Adolescent Depression Screening
//Adolescent Numerator define "Most Recent Adolescent Depression Screening": AC.MostRecent(("Has Adolescent Depression Screening"))
Most Recent Adolescent Screening Negative
define "Most Recent Adolescent Screening Negative": ("Most Recent Adolescent Depression Screening" AdolescentScreening where AdolescentScreening.value ~ ToConcept("Depression Screening Negative")) is not null
Most Recent Adolescent Positive Depression Screening
define "Most Recent Adolescent Positive Depression Screening": "Most Recent Adolescent Depression Screening" RecentScreening where RecentScreening.value ~ ToConcept("Depression Screening Positive")
Follow Up Interventions For Positive Adolescent Depression Screening
define "Follow Up Interventions For Positive Adolescent Depression Screening": (AC.QualifiedMedicationRequests([MedicationRequest: "Adolescent Depression Medications"]) union AC.QualifiedServiceRequests([ServiceRequest: "Referral for Adolescent Depression"]) union AC.QualifiedProcedures([Procedure: "Follow Up for Adolescent Depression"])) FollowUpInterventions let "Intervention Day": Coalesce(FC.ToInterval(FollowUpInterventions.authoredOn), FC.ToInterval(FollowUpInterventions.performed)) with "Qualifying Encounters During Measurement Period" QualifyingEnc such that "Intervention Day" same day as QualifyingEnc.period or "Intervention Day" 2 days or less after day of end of FC.ToInterval(QualifyingEnc.period)
Most Recent Adolescent Depression Screening Positive and Follow Up Provided
define "Most Recent Adolescent Depression Screening Positive and Follow Up Provided": ("Most Recent Adolescent Positive Depression Screening" RecentScreening let "Screening Day": Coalesce(FC.ToInterval(RecentScreening.effective), FC.ToInterval(RecentScreening.issued)) with "Follow Up Interventions For Positive Adolescent Depression Screening" FollowUpInterventions such that "Screening Day" 14 days or less before start of Coalesce(FC.ToInterval(FollowUpInterventions.authoredOn), FC.ToInterval(FollowUpInterventions.performed)) ) is not null
Patient Age 17 Years at Start of Measurement Period
define "Patient Age 17 Years at Start of Measurement Period": AgeInYearsAt(start of "Measurement Period") = 17
define "Has Adult Depression Screening": ((AC.QualifiedObservations([Observation: "Adult Depression Screening Assessment"])) AdolescentScreening with "Qualifying Encounters During Measurement Period" QualifyingEnc such that "Screening Within 14 Days of Encounter"(AdolescentScreening, QualifyingEnc))
//Adult Numerator define "Most Recent Adult Depression Screening": AC.MostRecent(("Has Adult Depression Screening"))
define "Most Recent Adult Screening Negative": ("Most Recent Adult Depression Screening" AdultScreening where AdultScreening.value ~ ToConcept("Depression Screening Negative")) is not null
Most Recent Adult Positive Depression Screening
define "Most Recent Adult Positive Depression Screening": "Most Recent Adult Depression Screening" RecentScreening where RecentScreening.value ~ ToConcept("Depression Screening Positive")
Follow Up Interventions For Positive Adult Depression Screening
define "Follow Up Interventions For Positive Adult Depression Screening": ((AC.QualifiedMedicationRequests([MedicationRequest: "Adult Depression Medications"]) union AC.QualifiedServiceRequests([ServiceRequest: "Referral for Adult Depression"]) union AC.QualifiedProcedures([Procedure: "Follow Up for Adult Depression"]))) FollowUpInterventions let "Intervention Day": Coalesce(FC.ToInterval(FollowUpInterventions.authoredOn), FC.ToInterval(FollowUpInterventions.performed)) with "Qualifying Encounters During Measurement Period" QualifyingEnc such that "Intervention Day" same day as QualifyingEnc.period or "Intervention Day" 2 days or less after day of end of FC.ToInterval(QualifyingEnc.period)
Most Recent Adult Depression Screening Positive and Follow Up Provided
define "Most Recent Adult Depression Screening Positive and Follow Up Provided": ("Most Recent Adult Positive Depression Screening" RecentScreening let "Screening Day": Coalesce(FC.ToInterval(RecentScreening.effective), FC.ToInterval(RecentScreening.issued)) with "Follow Up Interventions For Positive Adult Depression Screening" FollowUpInterventions such that "Screening Day" 14 days or less before start of Coalesce(FC.ToInterval(FollowUpInterventions.authoredOn), FC.ToInterval(FollowUpInterventions.performed)) ) is not null
Patient Age 18 Years or Older at Start of Measurement Period
define "Patient Age 18 Years or Older at Start of Measurement Period": AgeInYearsAt(start of "Measurement Period") >= 18
define "Numerator": ( "Patient Age 12 to 16 Years at Start of Measurement Period" and ( "Most Recent Adolescent Screening Negative" or "Most Recent Adolescent Depression Screening Positive and Follow Up Provided" ) ) or ( "Patient Age 17 Years at Start of Measurement Period" and ( "Most Recent Adolescent Screening Negative" or "Most Recent Adolescent Depression Screening Positive and Follow Up Provided" or "Most Recent Adult Screening Negative" or "Most Recent Adult Depression Screening Positive and Follow Up Provided") ) or ( "Patient Age 18 Years or Older at Start of Measurement Period" and ( "Most Recent Adult Screening Negative" or "Most Recent Adult Depression Screening Positive and Follow Up Provided" ) )
define "Initial Population": AgeInYearsAt(start of "Measurement Period") >= 12 and exists( "Qualifying Encounters During Measurement Period" E where FC.ToInterval(E.period) during "Measurement Period" )
define "Denominator": "Initial Population"
define "SDE Payer": [Coverage: type in "Payer"] Payer return { code: Payer.type, period: Payer.period }
// Jurisdiction of care (jurisdiction of the most recent encounter) // TODO: //define "Most recent address of care": // NOTE: Included in eICR // Occupational Data for Health - Past or Present Job // http://hl7.org/fhir/us/odh/StructureDefinition-odh-PastOrPresentJob.html // Observation: LOINC#11341-5, valueCodeableConcept in https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7186 // Social Determinants of Health (SDOH) // http://build.fhir.org/ig/HL7/fhir-sdoh-clinicalcare/StructureDefinition-SDOHCC-ObservationScreeningResponse.html // Food insecurity risk: http://build.fhir.org/ig/HL7/fhir-sdoh-clinicalcare/Observation-SDOHCC-ObservationResponseHungerVitalSignQuestion3Example.html // Observation: LOINC#88124-3, valueCodeableConcept in https://loinc.org/LL2510-7/ (At risk, No risk) define "Food Insecurity Risk Status": First( [Observation: "Food insecurity risk [HVS]"] O sort by issued desc ).value as CodeableConcept
define "SDE Food Insecurity Risk Status": SurveillanceDataElements."Food Insecurity Risk Status"
define "SDE Ethnicity": (flatten ( Patient.extension Extension where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity' return Extension.extension )) E where E.url = 'ombCategory' or E.url = 'detailed' return E.value as Coding
define "SDE Ethnicity": SDE."SDE Ethnicity"
// Age define "Age": AgeInYearsAt(end of "Measurement Period")
define "SDE Age": SurveillanceDataElements."Age"
History of Bipolar Diagnosis Before Qualifying Encounter
//Denominator Exclusion define "History of Bipolar Diagnosis Before Qualifying Encounter": (AC.QualifiedConditions([Condition: "Bipolar Disorder"])) BipolarDiagnosis with "Qualifying Encounters During Measurement Period" QualifyingEnc such that FC.ToPrevalenceInterval(BipolarDiagnosis) starts before QualifyingEnc.period
define "Denominator Exclusions": exists("History of Bipolar Diagnosis Before Qualifying Encounter")
Medical or Patient Reason for Not Screening Adolescent for Depression
//Denominator Exception define "Medical or Patient Reason for Not Screening Adolescent for Depression": AC.AbsentData([Observation: "Adolescent Depression Screening Assessment"], "Qualifying Encounters During Measurement Period", "Depression Screening Declined", "Medical Reason")
Medical or Patient Reason for Not Screening Adult for Depression
define "Medical or Patient Reason for Not Screening Adult for Depression": AC.AbsentData([Observation: "Adult Depression Screening Assessment"], "Qualifying Encounters During Measurement Period", "Depression Screening Declined", "Medical Reason")
define "Denominator Exceptions": (exists("Medical or Patient Reason for Not Screening Adolescent for Depression") and not exists("Has Adolescent Depression Screening")) or (exists("Medical or Patient Reason for Not Screening Adult for Depression") and not exists("Has Adult Depression Screening"))
define function ToString(value AddressUse): value.value
define function ToString(value AddressType): value.value
define function ToInterval(period FHIR.Period): if period is null then null else if period."start" is null then Interval(period."start".value, period."end".value] else Interval[period."start".value, period."end".value]
define function ToString(value uri): value.value
define function ToString(value AdministrativeGender): value.value
define function MostRecent(observations List<Observation>): Last( observations O sort by start of FC.ToInterval(effective) )
define function QualifiedObservations(value List<FHIR.Observation>): value Observation where ( //registered | preliminary | final | amended | corrected | cancelled | entered-in-error | unknown Observation.status ~ 'final' or Observation.status ~ 'amended' or Observation.status ~ 'corrected' )
define function ToString(value ObservationStatus): value.value
/* Common Resource Qualifications and Negations */ define function QualifiedEncounters(value List<FHIR.Encounter>): value Encounter where ( //planned | arrived | triaged | in-progress | onleave | finished | cancelled | entered-in-error | unknown Encounter.status ~ 'arrived' or Encounter.status ~ 'in-progress' or Encounter.status ~ 'finished' or Encounter.status ~ 'onleave' or Encounter.status ~ 'triaged' )
define function ToString(value EncounterStatus): value.value
/* @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval @comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible representations for timing-valued elements in FHIR, allowing this function to be used across any resource. The input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range. The intent of this function is to provide a clear and concise mechanism to treat single elements that have multiple possible representations as intervals so that logic doesn't have to account for the variability. More complex calculations (such as medication request period or dispense period calculation) need specific guidance and consideration. That guidance may make use of this function, but the focus of this function is on single element calculations where the semantics are unambiguous. If the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime. If the input is a Period, the result is a DateTime Interval. If the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing. If the input is an instant, the result is a DateTime Interval beginning and ending on that instant. If the input is a string, an error is raised indicating a single interval cannot be computed from a string. If the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age, and ending immediately prior to when the patient was the given Age plus one year. If the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given by the low end of the Range, and ending immediately prior to when the patient was the Age given by the high end of the Range plus one year. NOTE: Due to the complexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used with a Timing or String. */ define function ToInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>): case when choice is FHIR.dateTime then Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)] when choice is FHIR.Period then FHIRHelpers.ToInterval(choice as FHIR.Period) when choice is FHIR.instant then Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)] when choice is FHIR.Age then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year) when choice is FHIR.Range then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year) when choice is FHIR.Timing then //Interval[FHIRHelpers.ToDateTime(choice as FHIR.timing), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)] Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute a single interval from a Timing type') when choice is FHIR.string then Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute an interval from a String value') else null as Interval<DateTime> end
define function ToDateTime(value dateTime): value.value
define function ToDateTime(value instant): value.value
define function ToDate(value date): value.value
define function ToQuantity(quantity FHIR.Quantity): case when quantity is null then null when quantity.value is null then null when quantity.comparator is not null then Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.') when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org' or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) } else Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')') end
define function ToCalendarUnit(unit System.String): case unit when 'ms' then 'millisecond' when 's' then 'second' when 'min' then 'minute' when 'h' then 'hour' when 'd' then 'day' when 'wk' then 'week' when 'mo' then 'month' when 'a' then 'year' else unit end
define function "Screening Within 14 Days of Encounter"(observation FHIR.Observation, encounter FHIR.Encounter) returns System.Boolean: Coalesce(end of FC.ToInterval(observation.effective), observation.issued) 14 days or less before day of start of encounter.period and observation.value is not null
define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value }
define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value }
define function QualifiedMedicationRequests(value List<FHIR.MedicationRequest>): value MedicationRequest where ( //active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown (MedicationRequest.status ~ 'active' or MedicationRequest.status ~ 'completed' ) and ( MedicationRequest.doNotPerform is null or MedicationRequest.doNotPerform = false ) and MedicationRequest.intent ~ 'order' )
define function ToString(value MedicationRequestStatus): value.value
define function ToBoolean(value boolean): value.value
define function ToString(value MedicationRequestIntent): value.value
define function ToString(value string): value.value
define function QualifiedServiceRequests(value List<FHIR.ServiceRequest>): value ServiceRequest where ( //draft | active | on-hold | revoked | completed | entered-in-error | unknown ServiceRequest.status ~ 'active' or ServiceRequest.status ~ 'completed' and ServiceRequest.intent ~ 'order' ) and ( ServiceRequest.doNotPerform is null or ServiceRequest.doNotPerform = false )
define function ToString(value ServiceRequestStatus): value.value
define function ToString(value ServiceRequestIntent): value.value
define function QualifiedProcedures(value List<FHIR.Procedure>): value Procedure where ( //preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Procedure.status ~ 'completed' )
define function ToString(value ProcedureStatus): value.value
define function QualifiedConditions(value List<FHIR.Condition>): value Condition where ( FHIRHelpers.ToConcept(Condition.clinicalStatus) ~ FC."active" ) and ( FHIRHelpers.ToConcept(Condition.verificationStatus) ~ FC."confirmed" )
/* @description: Returns an interval representing the normalized prevalence period of a given Condition resource. @comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from onset to abatement as specified in the given Condition. */ define function ToPrevalenceInterval(condition Condition): if condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse" then Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition)] else Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition))
/* @description: Returns an interval representing the normalized Abatement of a given Condition resource. @comment: NOTE: Due to the complexity of determining an interval from a String, this function will throw a run-time exception if used with a Condition instance that has a String as the abatement value. */ define function ToAbatementInterval(condition Condition): if condition.abatement is FHIR.dateTime then Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)] else if condition.abatement is FHIR.Period then FHIRHelpers.ToInterval(condition.abatement as FHIR.Period) else if condition.abatement is FHIR.string then Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute an interval from a String value') else if condition.abatement is FHIR.Age then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year) else if condition.abatement is FHIR.Range then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year) else if condition.abatement is FHIR.boolean then Interval[end of ToInterval(condition.onset), condition.recordedDate) else null
define function AbsentData(observation List<FHIR.Observation>, enc List<FHIR.Encounter>, code1 System.Code, valueset1 System.ValueSet) returns List<FHIR.Observation>: (QualifiedObservations(observation)) Obs with enc QualifyingEnc such that Coalesce(end of FC.ToInterval(Obs.effective), end of FC.ToInterval(Obs.issued)) same day as end of QualifyingEnc.period where exists( Obs.component c where( c.code as CodeableConcept ~ code1 or c.code as CodeableConcept in valueset1 )) and not exists(Obs.component c where(c.value is not null)) or (ResourceNotDone(Obs).value as FHIR.boolean = true and (ResourceNotDoneReason(Obs).value as CodeableConcept ~ code1 or ResourceNotDoneReason(Obs).value as CodeableConcept in valueset1))
define function ResourceNotDone(notDone DomainResource): QICoreModifierExtension(notDone, 'qicore-notDone')
define function QICoreModifierExtension(domainResource DomainResource, url String): singleton from QICoreModifierExtensions(domainResource, url)
/* QI-CORE Extensions */ /* NOTE: Extensions are not the preferred approach, but are used as a way to access content that is defined by extensions but not yet surfaced in the CQL model info. */ define function QICoreModifierExtensions(domainResource DomainResource, url String): domainResource.modifierExtension E where E.url = ('http://hl7.org/fhir/us/qicore/StructureDefinition/' + url) return E
define function ResourceNotDoneReason(notDoneReason DomainResource): QICoreExtension(notDoneReason, 'qicore-notDoneReason')
define function QICoreExtension(domainResource DomainResource, url String): singleton from QICoreExtensions(domainResource, url)
define function QICoreExtensions(domainResource DomainResource, url String): domainResource.extension E where E.url = ('http://hl7.org/fhir/us/qicore/StructureDefinition/' + url) return E
Code system ConditionClinicalStatusCodes
Code system ConditionVerificationStatusCodes
Value set Adolescent Depression Screening Assessment
Value set Encounter to Screen for Depression
Value set Adolescent Depression Medications
Value set Referral for Adolescent Depression
Value set Follow Up for Adolescent Depression
Value set Adult Depression Screening Assessment
Value set Follow Up for Adult Depression
Preventive Care and Screening: Screening for Depression and Follow-Up Plan
Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of or up to two days after the date of the qualifying encounter
Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) is copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2022 World Health Organization. All Rights Reserved.
These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Depression affects more than two hundred sixty million people across the world and is a leading cause of disability, with a variety of depressive disorders that are independent risk factors for chronic diseases, such as cardiovascular disease and diabetes, lending screening for depression as paramount to identify depressive disorders that can affect the most vulnerable populations (Costantini et al., 2021). Results from a 2018 U.S. survey indicated that 14.4 percent of adolescents (3.5 million adolescents) had a major depressive episode (MDE) in the past year, with nine percent of adolescents (2.4 million adolescents) having one MDE with severe impairment (Substance Abuse and Mental Health Services Administration, 2019). The odds of a diagnosis of depression are believed to be 2.6 times greater for children and adolescents exposed to trauma as compared to those unexposed or less exposed (Vibhakar et al., 2019). Children and teens with major depressive disorder (MDD) have been found to have difficulty carrying out their daily activities, relating to others, growing up healthy, and are at an increased risk of suicide (Siu on behalf of the U.S. Preventive Services Task Force [USPSTF], 2016). The same 2018 study indicated that 7.2 percent of adults aged 18 or older (17.7 million adults) had at least one MDE with 4.7 percent of adults (11.5 million adults) having one MDE with severe impairment in the past year (Substance Abuse and Mental Health Services Administration, 2019). Moreover, it is estimated 22.9 percent of adult patients with chronic pain (2.2 million adults) were diagnosed with comorbid depression from 2011 to 2015, with an upward trend of prevalence among Black Americans, patients aged 65 to 84 years old, Medicare and Medicaid insured patients, and patients from zip code areas with low annual household incomes (Orhurhu et al., 2019). Depression and other mood disorders, such as bipolar disorder and anxiety disorders, especially during the perinatal period, can have devastating effects on women, infants, and families (American College of Obstetricians and Gynecologists, 2018). It's estimated that the global prevalence of antenatal (or perinatal) depression ranges from 15 to 65 percent, with current or previous exposure to abuse and violence, lack of social support, and family history of mental disorders being risk factors. Depressive symptoms measured during pregnancy have been shown to influence the quality of the postpartum mother-infant relationship (Hazell Raine et al., 2020). Additionally, the risk of low birth weight and preterm birth is higher among infants born from depressed mothers (Dadi, Miller, Bisetegn, & Mwanri, 2020). Negative outcomes associated with depression make it crucial to screen in order to identify and treat depression in its early stages. Multiple social costs of depression have been identified, such as reduced educational achievements, poor financial success and role performance, higher amount of days out of role, and increased risk of job loss (Costantini et al., 2021). Depression also imposes significant economic burden through direct and indirect costs, supporting the need for regular depression screening. "In the United States, an estimated $22.8 billion was spent on depression treatment in 2009, and lost productivity cost an additional estimated $23 billion in 2011" (Siu & USPSTF, 2016, p. 383-384). Numerous studies have found significant disparities in depression prevalence and treatment among racial/ethnic minorities. One study revealed that Indigenous adults are at a high risk for posttraumatic stress disorder, depression, suicide, substance use disorder, and concurrent behavioral health disorders secondary to these initial health problems (Ka’apu and Burnette, 2019). Additionally, though rates of depression are lower among Blacks and Hispanics than among whites, depression among Blacks and Hispanics is likely to be more recurrent. Furthermore, 48 percent of whites receive mental health services, compared to just 31 percent of Blacks and Hispanics, and 22 percent of Asians (American Psychiatric Association, 2017). Asian Americans and Black Americans are also significantly more likely to utilize emergency rooms for depression treatment, which contributes to inconsistent follow-up care (Lee et al., 2014). While primary care providers (PCPs) serve as the first line of defense in the detection of depression, studies show that PCPs fail to recognize up to 46 percent of depressed patients (Borner et al., 2010). "In nationally representative U.S. surveys, about eight percent of adolescents reported having major depression in the past year. Only 36 percent to 44 percent of children and adolescents with depression receive treatment, suggesting that the majority of depressed youth are undiagnosed and untreated" (Siu on behalf of USPSTF, 2016, p. 360 & p. 364). Furthermore, evidence supports that screening for depression in pregnant and postpartum women is of moderate net benefit, and treatment options for positive depression screening should be available for patients twelve and older including pregnant and postpartum women. This measure seeks to align with USPSTF clinical guideline recommendations as well as the Healthy People 2030 recommendation to increase the proportion of adolescents and adults who are screened and receive treatment for depression (U.S. Preventive Services Task Force, 2016) and makes an important contribution to the quality domain of community and population health.
Adolescent Recommendation (12-18 years): "The USPSTF recommends screening for MDD in adolescents aged 12 to 18 years. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (B recommendation)" (Siu on behalf of USPSTF, 2016, p. 360). Adult Recommendation (18 years and older): "The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (B recommendation)" (Siu & USPSTF, 2016, p. 380). “The USPSTF recommends that clinicians provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions (B recommendation)” (U.S. Preventive Services Task Force, 2019). The American College of Obstetricians and Gynecologists (ACOG) provides the following recommendation: "All obstetrician–gynecologists and other obstetric care providers should complete a full assessment of mood and emotional well-being (including screening for postpartum depression and anxiety with a validated instrument) during the comprehensive postpartum visit for each patient" (American College of Obstetricians and Gynecologists, 2018). The Institute for Clinical Systems Improvement (ICSI) health care guideline, Adult Depression in Primary Care, provides the following recommendations: 1. "Clinicians should routinely screen all adults for depression using a standardized instrument." 2. "Clinicians should establish and maintain follow-up with patients." 3. "Clinicians should screen and monitor depression in pregnant and post-partum women" (Trangle et al., 2016, p. 8-10).
The intent of the measure is to screen for new cases of depression in patients who have never had a diagnosis of bipolar disorder. Patients who have ever been diagnosed with bipolar disorder prior to the qualifying encounter used to evaluate the numerator will be excluded from the measure regardless of whether the diagnosis is active or not. A depression screen is completed on the date of the encounter or up to 14 calendar days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan must be documented on the date of or up to two calendar days after the date of the encounter, such as referral to a provider for additional evaluation, pharmacological interventions, or other interventions for the treatment of depression. An example to illustrate the follow-up plan documentation timing: if the encounter is on a Monday from 3-4 pm (day 0) and the patient screens positive, the clinician has through anytime on Wednesday (day 2) to complete follow-up plan documentation. This measure does not require documentation of a specific score, just whether results of the normalized and validated depression screening tool used are considered positive or negative. Each standardized screening tool provides guidance on whether a particular score is considered positive for depression. This eCQM is a patient-based measure. Depression screening is required once per measurement period, not at all encounters. Screening Tools: - An age-appropriate, standardized, and validated depression screening tool must be used for numerator compliance. - The name of the age-appropriate standardized depression screening tool utilized must be documented in the medical record. - The depression screening must be reviewed and addressed by the provider, filing the code, on the date of the encounter. Positive pre-screening results indicating a patient is at high risk for self-harm should receive more urgent intervention as determined by the provider practice. - The screening should occur during a qualifying encounter or up to 14 calendar days prior to the date of the qualifying encounter. - The measure assesses the most recent depression screening completed either during the qualifying encounter or within the 14 calendar days prior to that encounter. Therefore, a clinician would not be able to complete another screening at the time of the encounter to count towards a follow-up, because that would serve as the most recent screening. In order to satisfy the follow-up requirement for a patient screening positively, the eligible clinician would need to provide one of the aforementioned follow-up actions, which does not include use of a standardized depression screening tool. Follow-Up Plan: The follow-up plan MUST still be provided for and discussed with the patient during the qualifying encounter used to evaluate the numerator. However, documentation of the follow-up plan can occur up to two calendar days after the qualifying encounter, in accordance with the policies of an eligible clinician or provider’s practice or health system. All services should be documented during, or as soon as practicable, after the qualifying encounter in order to maintain an accurate medical record. The follow-up plan must be related to a positive depression screening, for example: \"Patient referred for psychiatric evaluation due to positive depression screening.\" Examples of a follow-up plan include but are not limited to: - Referral to a provider or program for further evaluation for depression, for example, referral to a psychiatrist, psychiatric nurse practitioner, psychologist, clinical social worker, mental health counselor, or other mental health service such as family or group therapy, support group, depression management program, or other service for treatment of depression - Other interventions designed to treat depression such as behavioral health evaluation, psychotherapy, pharmacological interventions, or additional treatment options Should a patient screen positive for depression, a clinician should: - Only order pharmacological intervention when appropriate and after sufficient diagnostic evaluation. However, for the purposes of this measure, additional screening and assessment during the qualifying encounter will not qualify as a follow-up plan. - Opt to complete a suicide risk assessment when appropriate and based on individual patient characteristics. However, for the purposes of this measure, a suicide risk assessment or additional screening using a standardized tool will not qualify as a follow-up plan. This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.
All patients aged 12 years and older at the beginning of the measurement period with at least one qualifying encounter during the measurement period
Patients screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized tool AND if positive, a follow-up plan is documented on the date of or up to two days after the date of the qualifying encounter
Patients who have ever been diagnosed with bipolar disorder at any time prior to the qualifying encounter
Patient Reason(s) Patient refuses to participate in or complete the depression screening OR Medical Reason(s) Documentation of medical reason for not screening patient for depression
State, district or territory federal abbreviation