Metadata Title Preventive Care and Screening: Screening for Depression and Follow-Up PlanFHIR Version 0.2.000 Short Name CMS2FHIR GUID (Version Independent) urn:uuid:deb30835-dbec-4f11-aab0-3a282040e37c GUID (Version Specific) urn:uuid:7cb8ac66-85c4-489b-aa4a-af861d69c9a5 CMS Identifier 2FHIR Effective Period 2025-01-01 through 2025-12-31 Status Draft Steward (Publisher) Centers for Medicare &amp; Medicaid Services (CMS) Developer Mathematica 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. 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 2004-2023 American Medical Association. LOINC(R) is copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organization. ICD-10 is copyright 2023 World Health Organization. All Rights Reserved. Disclaimer These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]. Measure Scoring Proportion 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, and 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 and 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 a majority of depressed youth are undiagnosed and untreated" (Siu on behalf of USPSTF, 2016). 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 for depression and if positive, receive appropriate treatment (U.S. Preventive Services Task Force, 2016). For patients depression, rescreening has been shown to be an effective tool for measuring response to therapy, therefore influencing appropriate care adjustments in the treatment of depression (Anderson et al., 2002). Chen et al. noted that when patients were re-administered a screening tool after at least eight weeks after starting treatment, their "score gave primary care physicians a clear idea about the nature of patients' depressive symptoms and gave both the patient and the physician an indication of treatment progress" (Chen et al., 2006). 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). 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 and USPSTF, 2016). “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). Guidance (Usage) The intent of the measure is to screen all patients for depression except those with a diagnosis of bipolar disorder. Patients who have ever been diagnosed with bipolar disorder prior to the qualifying encounter 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 an additional screening using a standardized tool will not qualify as a follow-up plan. This FHIR-based measure has been derived from the QDM-based measure: CMS2v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html). Measure Group (Rate) (ID: 64ef8dd856d636294b157c6f) Summary 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. Basis boolean Scoring Proportion Improvement Notation increase Type Process Rate Aggregation None Initial Population ID: 34AE0037-E4E3-443E-B7A7-ACE09BF46826 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 Criteria: Initial Population Denominator ID: 13152749-0C35-476A-89F2-5C579BD9BE4A Description: Equals Initial Population Criteria: Denominator Denominator Exclusion ID: 5001B9F9-5ECE-4E40-9B3C-46161FA366F9 Description: Patients who have ever been diagnosed with bipolar disorder at any time prior to the qualifying encounter Criteria: Denominator Exclusions Denominator Exception ID: 0411DA66-4881-4FC9-B4CE-73973320F1DC 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 (e.g., cognitive, functional, or motivational limitations that may impact accuracy of results; patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient's health status) Criteria: Denominator Exceptions Numerator ID: BFE91CA3-DC28-49B0-AD42-97D6808E7689 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 Criteria: Numerator Supplemental Data Elements Supplemental Data Element ID: sde-ethnicity Usage Code: Supplemental Data Description: SDE Ethnicity Logic Definition: SDE Ethnicity Supplemental Data Element ID: sde-payer Usage Code: Supplemental Data Description: SDE Payer Logic Definition: SDE Payer Supplemental Data Element ID: sde-race Usage Code: Supplemental Data Description: SDE Race Logic Definition: SDE Race Supplemental Data Element ID: sde-sex Usage Code: Supplemental Data Description: SDE Sex Logic Definition: SDE Sex Measure Logic Primary Library PCSDepressionScreenAndFollowUpFHIR Contents Population Criteria Logic Definitions Terminology Dependencies Data Requirements Parameters Population Criteria Measure Group (Rate) (ID: 64ef8dd856d636294b157c6f) Initial Population define "Initial Population": "Patient Age 12 Years or Older at Start of Measurement Period" and exists ( "Qualifying Encounter During Measurement Period" ) Definition Denominator define "Denominator": "Initial Population" Definition Denominator Exclusion define "Denominator Exclusions": exists "History of Bipolar Diagnosis Before Qualifying Encounter" Definition Denominator Exception define "Denominator Exceptions": ( exists "Medical or Patient Reason for Not Screening Adolescent for Depression" and not "Has Adolescent Depression Screening" ) or ( exists "Medical or Patient Reason for Not Screening Adult for Depression" and not "Has Adult Depression Screening" ) Definition Numerator define "Numerator": ( "Patient Age 12 to 16 Years at Start of Measurement Period" and ( "Has Most Recent Adolescent Screening Negative" or exists "Most Recent Adolescent Depression Screening Positive and Follow Up Provided" ) ) or ( "Patient Age 17 Years at Start of Measurement Period" and ( "Has Most Recent Adolescent Screening Negative" or exists "Most Recent Adolescent Depression Screening Positive and Follow Up Provided" or "Has Most Recent Adult Screening Negative" or exists "Most Recent Adult Depression Screening Positive and Follow Up Provided" ) ) or ( "Patient Age 18 Years or Older at Start of Measurement Period" and ( "Has Most Recent Adult Screening Negative" or exists "Most Recent Adult Depression Screening Positive and Follow Up Provided" ) ) Definition Logic Definitions Logic Definition Library Name: SupplementalDataElements define "SDE Sex": case when Patient.gender = 'male' then "M" when Patient.gender = 'female' then "F" else null end Logic Definition Library Name: SupplementalDataElements define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period } Logic Definition Library Name: SupplementalDataElements define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text } Logic Definition Library Name: SupplementalDataElements define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text } Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "SDE Sex": SDE."SDE Sex" Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Patient Age 12 to 16 Years at Start of Measurement Period": AgeInYearsAt(date from start of "Measurement Period") in Interval[12, 16] Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Qualifying Encounter During Measurement Period": ( [Encounter: "Encounter to Screen for Depression"] union [Encounter: "Physical Therapy Evaluation"] union [Encounter: "Telephone Visits"] ) QualifyingEncounter where QualifyingEncounter.period during day of "Measurement Period" and QualifyingEncounter.status = 'finished' Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Most Recent Adolescent Depression Screening": Last([Observation: "Adolescent depression screening assessment"] AdolescentDepressionScreening with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that AdolescentDepressionScreening.effective.toInterval() 14 days or less on or before day of start of QualifyingEncounter.period and AdolescentDepressionScreening.value is not null and AdolescentDepressionScreening.status = 'final' sort by start of effective.toInterval() ) Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Has Most Recent Adolescent Screening Negative": ( "Most Recent Adolescent Depression Screening" AdolescentScreen where AdolescentScreen.value ~ "Depression screening negative (finding)" ) is not null Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Follow Up Intervention for Positive Adolescent Depression Screening": ( ( [MedicationRequest: "Adolescent Depression Medications"] AdolescentMed where AdolescentMed.status in { 'active', 'completed' } and AdolescentMed.intent = 'order' ) union ( [ServiceRequest: "Referral for Adolescent Depression"] AdolescentReferral where AdolescentReferral.status in { 'active', 'completed' } ) union ( [Procedure: "Follow Up for Adolescent Depression"] AdolescentFollowUp where AdolescentFollowUp.status = 'completed' ) ) Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Most Recent Adolescent Depression Screening Positive and Follow Up Provided": from "Most Recent Adolescent Depression Screening" LastAdolescentScreen, "Follow Up Intervention for Positive Adolescent Depression Screening" FollowUpPositiveAdolescentScreen, "Qualifying Encounter During Measurement Period" QualifyingEncounter where LastAdolescentScreen.effective.toInterval ( ) starts 14 days or less on or before day of start of QualifyingEncounter.period and LastAdolescentScreen.value ~ "Depression screening positive (finding)" and ( start of FollowUpPositiveAdolescentScreen.performed.toInterval ( ) during QualifyingEncounter.period or FollowUpPositiveAdolescentScreen.authoredOn 2 days or less on or after day of end of QualifyingEncounter.period ) and ( Coalesce(start of FollowUpPositiveAdolescentScreen.performed.toInterval(), FollowUpPositiveAdolescentScreen.authoredOn) during day of "Measurement Period" ) Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Patient Age 17 Years at Start of Measurement Period": AgeInYearsAt(date from start of "Measurement Period") = 17 Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Most Recent Adult Depression Screening": Last([Observation: "Adult depression screening assessment"] AdultDepressionScreening with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that AdultDepressionScreening.effective.toInterval() 14 days or less on or before day of start of QualifyingEncounter.period and AdultDepressionScreening.value is not null and AdultDepressionScreening.status = 'final' sort by start of effective.toInterval() ) Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Has Most Recent Adult Screening Negative": ( "Most Recent Adult Depression Screening" AdultScreen where AdultScreen.value ~ "Depression screening negative (finding)" ) is not null Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Follow Up Intervention for Positive Adult Depression Screening": ( ( [MedicationRequest: "Adult Depression Medications"] AdultMed where AdultMed.status in { 'active', 'completed' } and AdultMed.intent = 'order' ) union ( [ServiceRequest: "Referral for Adult Depression"] AdultReferral where AdultReferral.status in { 'active', 'completed' } ) union ( [Procedure: "Follow Up for Adult Depression"] AdultFollowUp where AdultFollowUp.status = 'completed' ) ) Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Most Recent Adult Depression Screening Positive and Follow Up Provided": from "Most Recent Adult Depression Screening" LastAdultScreen, "Follow Up Intervention for Positive Adult Depression Screening" FollowUpPositiveAdultScreen, "Qualifying Encounter During Measurement Period" QualifyingEncounter where LastAdultScreen.effective.toInterval ( ) starts 14 days or less on or before day of start of QualifyingEncounter.period and LastAdultScreen.value ~ "Depression screening positive (finding)" and ( start of FollowUpPositiveAdultScreen.performed.toInterval ( ) during QualifyingEncounter.period or FollowUpPositiveAdultScreen.authoredOn 2 days or less on or after day of end of QualifyingEncounter.period ) and ( Coalesce(start of FollowUpPositiveAdultScreen.performed.toInterval(), FollowUpPositiveAdultScreen.authoredOn) during day of "Measurement Period" ) Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Patient Age 18 Years or Older at Start of Measurement Period": AgeInYearsAt(date from start of "Measurement Period") >= 18 Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Numerator": ( "Patient Age 12 to 16 Years at Start of Measurement Period" and ( "Has Most Recent Adolescent Screening Negative" or exists "Most Recent Adolescent Depression Screening Positive and Follow Up Provided" ) ) or ( "Patient Age 17 Years at Start of Measurement Period" and ( "Has Most Recent Adolescent Screening Negative" or exists "Most Recent Adolescent Depression Screening Positive and Follow Up Provided" or "Has Most Recent Adult Screening Negative" or exists "Most Recent Adult Depression Screening Positive and Follow Up Provided" ) ) or ( "Patient Age 18 Years or Older at Start of Measurement Period" and ( "Has Most Recent Adult Screening Negative" or exists "Most Recent Adult Depression Screening Positive and Follow Up Provided" ) ) Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Patient Age 12 Years or Older at Start of Measurement Period": AgeInYearsAt(date from start of "Measurement Period") >= 12 Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Initial Population": "Patient Age 12 Years or Older at Start of Measurement Period" and exists ( "Qualifying Encounter During Measurement Period" ) Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Denominator": "Initial Population" Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "SDE Payer": SDE."SDE Payer" Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "SDE Ethnicity": SDE."SDE Ethnicity" Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "History of Bipolar Diagnosis Before Qualifying Encounter": [Condition: "Bipolar Disorder"] BipolarDiagnosis with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that ( BipolarDiagnosis.isProblemListItem ( ) or BipolarDiagnosis.isHealthConcern ( ) ) and BipolarDiagnosis.prevalenceInterval ( ) starts before QualifyingEncounter.period Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Denominator Exclusions": exists "History of Bipolar Diagnosis Before Qualifying Encounter" Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "SDE Race": SDE."SDE Race" Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Medical or Patient Reason for Not Screening Adolescent for Depression": [ObservationNotDone: code ~ "Adolescent depression screening assessment"] NoAdolescentScreen with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that NoAdolescentScreen.issued during QualifyingEncounter.period where ( NoAdolescentScreen.notDoneReason ~ "Depression screening declined (situation)" or NoAdolescentScreen.notDoneReason in "Medical Reason" ) and NoAdolescentScreen.status = 'cancelled' Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Has Adolescent Depression Screening": exists ( [Observation: "Adolescent depression screening assessment"] AdolescentScreening with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that AdolescentScreening.effective.toInterval ( ) 14 days or less on or before day of start of QualifyingEncounter.period and AdolescentScreening.value is not null and AdolescentScreening.status = 'final' ) Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Medical or Patient Reason for Not Screening Adult for Depression": [ObservationNotDone: code ~ "Adult depression screening assessment"] NoAdultScreen with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that NoAdultScreen.issued during QualifyingEncounter.period where ( NoAdultScreen.notDoneReason ~ "Depression screening declined (situation)" or NoAdultScreen.notDoneReason in "Medical Reason" ) and NoAdultScreen.status = 'cancelled' Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Has Adult Depression Screening": exists ( [Observation: "Adult depression screening assessment"] AdultScreening with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that AdultScreening.effective.toInterval ( ) 14 days or less on or before day of start of QualifyingEncounter.period and AdultScreening.value is not null and AdultScreening.status = 'final' ) Logic Definition Library Name: PCSDepressionScreenAndFollowUpFHIR define "Denominator Exceptions": ( exists "Medical or Patient Reason for Not Screening Adolescent for Depression" and not "Has Adolescent Depression Screening" ) or ( exists "Medical or Patient Reason for Not Screening Adult for Depression" and not "Has Adult Depression Screening" ) Logic Definition Library Name: FHIRHelpers /* @description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period) value to a CQL DateTime Interval @comment: If the start value of the given period is unspecified, the starting boundary of the resulting interval will be open (meaning the start of the interval is unknown, as opposed to interpreted as the beginning of time). */ 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 /* @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code. */ 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: FHIRHelpers /* @description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept. */ define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value } Logic Definition Library Name: QICoreCommon /* @description: Returns true if the given condition is a problem list item. */ define fluent function isProblemListItem(condition Condition): exists (condition.category C where C ~ "problem-list-item" ) Logic Definition Library Name: QICoreCommon /* @description: Returns true if the given condition is a health concern */ define fluent function isHealthConcern(condition Condition): exists (condition.category C where C ~ "health-concern" ) Logic Definition Library Name: QICoreCommon /* @description: Returns an interval representing the normalized prevalence period of a given Condition. @comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary. */ define fluent function prevalenceInterval(condition Condition): if condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse" then Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()] else (end of condition.abatementInterval()) abatementDate return if abatementDate is null then Interval[start of condition.onset.toInterval(), abatementDate) else Interval[start of condition.onset.toInterval(), abatementDate] Logic Definition Library Name: QICoreCommon /* @description: Returns an interval representing the normalized abatement of a given Condition. @comment: If the abatement element of the Condition is represented as a DateTime, the result is an interval beginning and ending on that DateTime. If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The result is an interval from the date the patient turned that age to immediately before one year later. If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately before one year later than the date the patient turned the ending age of the quantity interval. */ define fluent function abatementInterval(condition Condition): if condition.abatement is DateTime then Interval[condition.abatement as DateTime, condition.abatement as DateTime] else if condition.abatement is Quantity then Interval[Patient.birthDate + (condition.abatement as Quantity), Patient.birthDate + (condition.abatement as Quantity) + 1 year) else if condition.abatement is Interval<Quantity> then Interval[Patient.birthDate + (condition.abatement.low as Quantity), Patient.birthDate + (condition.abatement.high as Quantity) + 1 year) else if condition.abatement is Interval<DateTime> then Interval[condition.abatement.low, condition.abatement.high) else null as Interval<DateTime> Terminology Code System Description: Code system AdministrativeGender Resource: AdministrativeGender Canonical URL: http://hl7.org/fhir/administrative-gender Code System Description: Code system LOINC Resource: Logical Observation Identifiers, Names and Codes (LOINC) Canonical URL: http://loinc.org Code System Description: Code system SNOMEDCT Resource: SNOMED CT (all versions) Canonical URL: http://snomed.info/sct Code System Description: Code system ConditionCategory Resource: Condition Category Codes Canonical URL: http://terminology.hl7.org/CodeSystem/condition-category Code System Description: Code system USCoreConditionCategoryExtensionCodes Resource: US Core Condition Category Extension Codes Canonical URL: http://hl7.org/fhir/us/core/CodeSystem/condition-category Code System Description: Code system ConditionClinicalStatusCodes Resource: Condition Clinical Status Codes Canonical URL: http://terminology.hl7.org/CodeSystem/condition-clinical Value Set 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 Value Set 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 Value Set 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 Value Set 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 Value Set 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 Value Set 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 Value Set 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 Value Set 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 Value Set 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 Value Set Description: Value set Payer Type Resource: Payer Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591 Value Set 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 Value Set 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: Male Code: M System: http://hl7.org/fhir/administrative-gender Direct Reference Code Display: Female Code: F System: http://hl7.org/fhir/administrative-gender Direct Reference Code Display: Adolescent depression screening assessment Code: 73831-0 System: http://loinc.org 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: Adult depression screening assessment Code: 73832-8 System: http://loinc.org Direct Reference Code Display: Problem List Item Code: problem-list-item System: http://terminology.hl7.org/CodeSystem/condition-category Direct Reference Code Display: Health Concern Code: health-concern System: http://hl7.org/fhir/us/core/CodeSystem/condition-category Direct Reference Code Display: Active Code: active System: http://terminology.hl7.org/CodeSystem/condition-clinical Direct Reference Code Display: Recurrence Code: recurrence System: http://terminology.hl7.org/CodeSystem/condition-clinical Direct Reference Code Display: Relapse 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 Dependencies Dependency Description: QICore model information Resource: http://hl7.org/fhir/us/qicore/Library/QICore-ModelInfo|4.1.1 Canonical URL: http://hl7.org/fhir/us/qicore/Library/QICore-ModelInfo|4.1.1 Dependency Description: Library SDE Resource: SupplementalDataElementsversion: null3.5.000) Canonical URL: https://madie.cms.gov/Library/SupplementalDataElements|3.5.000 Dependency Description: Library FHIRHelpers Resource: FHIRHelpersversion: null4.4.000) Canonical URL: https://madie.cms.gov/Library/FHIRHelpers|4.4.000 Dependency Description: Library QICoreCommon Resource: QICoreCommonversion: null2.1.000) Canonical URL: https://madie.cms.gov/Library/QICoreCommon|2.1.000 Data Requirements Data Requirement Type: Patient Profile(s): QICorePatient Must Support Elements: ethnicity, race Data Requirement Type: Encounter Profile(s): QICoreEncounter Must Support Elements: type, period, status, status.value Code Filter(s): Path: type ValueSet: Encounter to Screen for Depression Data Requirement Type: Encounter Profile(s): QICoreEncounter Must Support Elements: type, period, status, status.value Code Filter(s): Path: type ValueSet: Physical Therapy Evaluation Data Requirement Type: Encounter Profile(s): QICoreEncounter Must Support Elements: type, period, status, status.value Code Filter(s): Path: type ValueSet: Telephone Visits Data Requirement Type: Observation Profile(s): QICoreObservation Must Support Elements: code, effective, value, status, status.value Code Filter(s): Path: code Code(s): LOINC: 73831-0 (Adolescent depression screening assessment) Path: status.value Code(s): [not stated]: final (final) Data Requirement Type: Observation Profile(s): QICoreObservation Must Support Elements: code, effective, value, status, status.value Code Filter(s): Path: code Code(s): LOINC: 73832-8 (Adult depression screening assessment) Path: status.value Code(s): [not stated]: final (final) Data Requirement Type: Medication Profile(s): QICoreMedication Must Support Elements: id.value, code Code Filter(s): Path: code ValueSet: Adolescent Depression Medications Data Requirement Type: Medication Profile(s): QICoreMedication Must Support Elements: id.value, code Code Filter(s): Path: code ValueSet: Adult Depression Medications Data Requirement Type: MedicationRequest Profile(s): QICoreMedicationRequest Must Support Elements: medication, status, status.value, intent, intent.value Code Filter(s): Path: medication ValueSet: Adolescent Depression Medications Data Requirement Type: MedicationRequest Profile(s): QICoreMedicationRequest Must Support Elements: medication.reference.value, status, status.value, intent, intent.value Data Requirement Type: MedicationRequest Profile(s): QICoreMedicationRequest Must Support Elements: medication, status, status.value, intent, intent.value Code Filter(s): Path: medication ValueSet: Adult Depression Medications Data Requirement Type: ServiceRequest Profile(s): QICoreServiceRequest Must Support Elements: code, status, status.value Code Filter(s): Path: code ValueSet: Referral for Adolescent Depression Data Requirement Type: ServiceRequest Profile(s): QICoreServiceRequest Must Support Elements: code, status, status.value Code Filter(s): Path: code ValueSet: Referral for Adult Depression Data Requirement Type: Procedure Profile(s): QICoreProcedure Must Support Elements: code, status, status.value Code Filter(s): Path: code ValueSet: Follow Up for Adolescent Depression Path: status.value Code(s): [not stated]: completed (completed) Data Requirement Type: Procedure Profile(s): QICoreProcedure Must Support Elements: code, status, status.value Code Filter(s): Path: code ValueSet: Follow Up for Adult Depression Path: status.value Code(s): [not stated]: completed (completed) Data Requirement Type: Coverage Profile(s): QICoreCoverage Must Support Elements: type, period Code Filter(s): Path: type ValueSet: Payer Data Requirement Type: Condition Profile(s): QICoreCondition Must Support Elements: code Code Filter(s): Path: code ValueSet: Bipolar Disorder Data Requirement Type: Observation Profile(s): QICoreObservationNotDone Must Support Elements: code, issued, issued.value, extension, status, status.value Code Filter(s): Path: code Code(s): LOINC: 73831-0 (Adolescent depression screening assessment) Data Requirement Type: Observation Profile(s): QICoreObservationNotDone Must Support Elements: code, issued, issued.value, extension, status, status.value Code Filter(s): Path: code Code(s): LOINC: 73832-8 (Adult depression screening assessment) Parameters Name Use Card. Type Documentation Measurement Period In 0..1 Period SDE Sex Out 0..1 Coding Numerator Out 0..1 boolean Denominator Out 0..1 boolean SDE Payer Out 0..* Resource Initial Population Out 0..1 boolean SDE Ethnicity Out 0..1 Resource Denominator Exclusions Out 0..1 boolean SDE Race Out 0..1 Resource Denominator Exceptions Out 0..1 boolean Generated using version 0.5.4-cibuild of the sample-content-ig Liquid templates
Adolescent depression screening assessment
Depression screening declined (situation)
define "SDE Sex": case when Patient.gender = 'male' then "M" when Patient.gender = 'female' then "F" else null end
Patient Age 12 to 16 Years at Start of Measurement Period
define "Patient Age 12 to 16 Years at Start of Measurement Period": AgeInYearsAt(date from start of "Measurement Period") in Interval[12, 16]
Qualifying Encounter During Measurement Period
define "Qualifying Encounter During Measurement Period": ( [Encounter: "Encounter to Screen for Depression"] union [Encounter: "Physical Therapy Evaluation"] union [Encounter: "Telephone Visits"] ) QualifyingEncounter where QualifyingEncounter.period during day of "Measurement Period" and QualifyingEncounter.status = 'finished'
Most Recent Adolescent Depression Screening
define "Most Recent Adolescent Depression Screening": Last([Observation: "Adolescent depression screening assessment"] AdolescentDepressionScreening with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that AdolescentDepressionScreening.effective.toInterval() 14 days or less on or before day of start of QualifyingEncounter.period and AdolescentDepressionScreening.value is not null and AdolescentDepressionScreening.status = 'final' sort by start of effective.toInterval() )
Has Most Recent Adolescent Screening Negative
define "Has Most Recent Adolescent Screening Negative": ( "Most Recent Adolescent Depression Screening" AdolescentScreen where AdolescentScreen.value ~ "Depression screening negative (finding)" ) is not null
Follow Up Intervention for Positive Adolescent Depression Screening
define "Follow Up Intervention for Positive Adolescent Depression Screening": ( ( [MedicationRequest: "Adolescent Depression Medications"] AdolescentMed where AdolescentMed.status in { 'active', 'completed' } and AdolescentMed.intent = 'order' ) union ( [ServiceRequest: "Referral for Adolescent Depression"] AdolescentReferral where AdolescentReferral.status in { 'active', 'completed' } ) union ( [Procedure: "Follow Up for Adolescent Depression"] AdolescentFollowUp where AdolescentFollowUp.status = 'completed' ) )
Most Recent Adolescent Depression Screening Positive and Follow Up Provided
define "Most Recent Adolescent Depression Screening Positive and Follow Up Provided": from "Most Recent Adolescent Depression Screening" LastAdolescentScreen, "Follow Up Intervention for Positive Adolescent Depression Screening" FollowUpPositiveAdolescentScreen, "Qualifying Encounter During Measurement Period" QualifyingEncounter where LastAdolescentScreen.effective.toInterval ( ) starts 14 days or less on or before day of start of QualifyingEncounter.period and LastAdolescentScreen.value ~ "Depression screening positive (finding)" and ( start of FollowUpPositiveAdolescentScreen.performed.toInterval ( ) during QualifyingEncounter.period or FollowUpPositiveAdolescentScreen.authoredOn 2 days or less on or after day of end of QualifyingEncounter.period ) and ( Coalesce(start of FollowUpPositiveAdolescentScreen.performed.toInterval(), FollowUpPositiveAdolescentScreen.authoredOn) during day of "Measurement Period" )
Patient Age 17 Years at Start of Measurement Period
define "Patient Age 17 Years at Start of Measurement Period": AgeInYearsAt(date from start of "Measurement Period") = 17
define "Most Recent Adult Depression Screening": Last([Observation: "Adult depression screening assessment"] AdultDepressionScreening with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that AdultDepressionScreening.effective.toInterval() 14 days or less on or before day of start of QualifyingEncounter.period and AdultDepressionScreening.value is not null and AdultDepressionScreening.status = 'final' sort by start of effective.toInterval() )
Has Most Recent Adult Screening Negative
define "Has Most Recent Adult Screening Negative": ( "Most Recent Adult Depression Screening" AdultScreen where AdultScreen.value ~ "Depression screening negative (finding)" ) is not null
Follow Up Intervention for Positive Adult Depression Screening
define "Follow Up Intervention for Positive Adult Depression Screening": ( ( [MedicationRequest: "Adult Depression Medications"] AdultMed where AdultMed.status in { 'active', 'completed' } and AdultMed.intent = 'order' ) union ( [ServiceRequest: "Referral for Adult Depression"] AdultReferral where AdultReferral.status in { 'active', 'completed' } ) union ( [Procedure: "Follow Up for Adult Depression"] AdultFollowUp where AdultFollowUp.status = 'completed' ) )
Most Recent Adult Depression Screening Positive and Follow Up Provided
define "Most Recent Adult Depression Screening Positive and Follow Up Provided": from "Most Recent Adult Depression Screening" LastAdultScreen, "Follow Up Intervention for Positive Adult Depression Screening" FollowUpPositiveAdultScreen, "Qualifying Encounter During Measurement Period" QualifyingEncounter where LastAdultScreen.effective.toInterval ( ) starts 14 days or less on or before day of start of QualifyingEncounter.period and LastAdultScreen.value ~ "Depression screening positive (finding)" and ( start of FollowUpPositiveAdultScreen.performed.toInterval ( ) during QualifyingEncounter.period or FollowUpPositiveAdultScreen.authoredOn 2 days or less on or after day of end of QualifyingEncounter.period ) and ( Coalesce(start of FollowUpPositiveAdultScreen.performed.toInterval(), FollowUpPositiveAdultScreen.authoredOn) during day of "Measurement Period" )
Patient Age 18 Years or Older at Start of Measurement Period
define "Patient Age 18 Years or Older at Start of Measurement Period": AgeInYearsAt(date from start of "Measurement Period") >= 18
define "Numerator": ( "Patient Age 12 to 16 Years at Start of Measurement Period" and ( "Has Most Recent Adolescent Screening Negative" or exists "Most Recent Adolescent Depression Screening Positive and Follow Up Provided" ) ) or ( "Patient Age 17 Years at Start of Measurement Period" and ( "Has Most Recent Adolescent Screening Negative" or exists "Most Recent Adolescent Depression Screening Positive and Follow Up Provided" or "Has Most Recent Adult Screening Negative" or exists "Most Recent Adult Depression Screening Positive and Follow Up Provided" ) ) or ( "Patient Age 18 Years or Older at Start of Measurement Period" and ( "Has Most Recent Adult Screening Negative" or exists "Most Recent Adult Depression Screening Positive and Follow Up Provided" ) )
Patient Age 12 Years or Older at Start of Measurement Period
define "Patient Age 12 Years or Older at Start of Measurement Period": AgeInYearsAt(date from start of "Measurement Period") >= 12
define "Initial Population": "Patient Age 12 Years or Older at Start of Measurement Period" and exists ( "Qualifying Encounter During Measurement Period" )
define "Denominator": "Initial Population"
define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period }
define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text }
define "SDE Ethnicity": SDE."SDE Ethnicity"
History of Bipolar Diagnosis Before Qualifying Encounter
define "History of Bipolar Diagnosis Before Qualifying Encounter": [Condition: "Bipolar Disorder"] BipolarDiagnosis with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that ( BipolarDiagnosis.isProblemListItem ( ) or BipolarDiagnosis.isHealthConcern ( ) ) and BipolarDiagnosis.prevalenceInterval ( ) starts before QualifyingEncounter.period
define "Denominator Exclusions": exists "History of Bipolar Diagnosis Before Qualifying Encounter"
define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text }
Medical or Patient Reason for Not Screening Adolescent for Depression
define "Medical or Patient Reason for Not Screening Adolescent for Depression": [ObservationNotDone: code ~ "Adolescent depression screening assessment"] NoAdolescentScreen with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that NoAdolescentScreen.issued during QualifyingEncounter.period where ( NoAdolescentScreen.notDoneReason ~ "Depression screening declined (situation)" or NoAdolescentScreen.notDoneReason in "Medical Reason" ) and NoAdolescentScreen.status = 'cancelled'
define "Has Adolescent Depression Screening": exists ( [Observation: "Adolescent depression screening assessment"] AdolescentScreening with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that AdolescentScreening.effective.toInterval ( ) 14 days or less on or before day of start of QualifyingEncounter.period and AdolescentScreening.value is not null and AdolescentScreening.status = 'final' )
Medical or Patient Reason for Not Screening Adult for Depression
define "Medical or Patient Reason for Not Screening Adult for Depression": [ObservationNotDone: code ~ "Adult depression screening assessment"] NoAdultScreen with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that NoAdultScreen.issued during QualifyingEncounter.period where ( NoAdultScreen.notDoneReason ~ "Depression screening declined (situation)" or NoAdultScreen.notDoneReason in "Medical Reason" ) and NoAdultScreen.status = 'cancelled'
define "Has Adult Depression Screening": exists ( [Observation: "Adult depression screening assessment"] AdultScreening with "Qualifying Encounter During Measurement Period" QualifyingEncounter such that AdultScreening.effective.toInterval ( ) 14 days or less on or before day of start of QualifyingEncounter.period and AdultScreening.value is not null and AdultScreening.status = 'final' )
define "Denominator Exceptions": ( exists "Medical or Patient Reason for Not Screening Adolescent for Depression" and not "Has Adolescent Depression Screening" ) or ( exists "Medical or Patient Reason for Not Screening Adult for Depression" and not "Has Adult Depression Screening" )
/* @description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period) value to a CQL DateTime Interval @comment: If the start value of the given period is unspecified, the starting boundary of the resulting interval will be open (meaning the start of the interval is unknown, as opposed to interpreted as the beginning of time). */ 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
/* @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code. */ 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 }
/* @description: Returns true if the given condition is a problem list item. */ define fluent function isProblemListItem(condition Condition): exists (condition.category C where C ~ "problem-list-item" )
/* @description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept. */ define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value }
/* @description: Returns true if the given condition is a health concern */ define fluent function isHealthConcern(condition Condition): exists (condition.category C where C ~ "health-concern" )
/* @description: Returns an interval representing the normalized prevalence period of a given Condition. @comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary. */ define fluent function prevalenceInterval(condition Condition): if condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse" then Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()] else (end of condition.abatementInterval()) abatementDate return if abatementDate is null then Interval[start of condition.onset.toInterval(), abatementDate) else Interval[start of condition.onset.toInterval(), abatementDate]
/* @description: Returns an interval representing the normalized abatement of a given Condition. @comment: If the abatement element of the Condition is represented as a DateTime, the result is an interval beginning and ending on that DateTime. If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The result is an interval from the date the patient turned that age to immediately before one year later. If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately before one year later than the date the patient turned the ending age of the quantity interval. */ define fluent function abatementInterval(condition Condition): if condition.abatement is DateTime then Interval[condition.abatement as DateTime, condition.abatement as DateTime] else if condition.abatement is Quantity then Interval[Patient.birthDate + (condition.abatement as Quantity), Patient.birthDate + (condition.abatement as Quantity) + 1 year) else if condition.abatement is Interval<Quantity> then Interval[Patient.birthDate + (condition.abatement.low as Quantity), Patient.birthDate + (condition.abatement.high as Quantity) + 1 year) else if condition.abatement is Interval<DateTime> then Interval[condition.abatement.low, condition.abatement.high) else null as Interval<DateTime>
Code system USCoreConditionCategoryExtensionCodes
Code system ConditionClinicalStatusCodes
Value set Encounter to Screen for Depression
Value set Adolescent Depression Medications
Value set Referral for Adolescent Depression
Value set Follow Up for Adolescent Depression
Value set Follow Up for Adult Depression
Preventive Care and Screening: Screening for Depression and Follow-Up PlanFHIR
Centers for Medicare & Medicaid Services (CMS)
Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive a follow-up plan is documented on the date of or up to two days after the date of the qualifying encounter.
The intent of the measure is to screen all patients for depression except those with a diagnosis of bipolar disorder. Patients who have ever been diagnosed with bipolar disorder prior to the qualifying encounter 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 an additional screening using a standardized tool will not qualify as a follow-up plan. This FHIR-based measure has been derived from the QDM-based measure: CMS2v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).
Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. LOINC(R) is copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organization. ICD-10 is copyright 2023 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, and 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 and 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 a majority of depressed youth are undiagnosed and untreated" (Siu on behalf of USPSTF, 2016). 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 for depression and if positive, receive appropriate treatment (U.S. Preventive Services Task Force, 2016). For patients depression, rescreening has been shown to be an effective tool for measuring response to therapy, therefore influencing appropriate care adjustments in the treatment of depression (Anderson et al., 2002). Chen et al. noted that when patients were re-administered a screening tool after at least eight weeks after starting treatment, their "score gave primary care physicians a clear idea about the nature of patients' depressive symptoms and gave both the patient and the physician an indication of treatment progress" (Chen et al., 2006).
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). 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 and USPSTF, 2016). “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).
All patients aged 12 years and older at the beginning of the measurement period with at least one qualifying encounter during the measurement period
Patients who have ever been diagnosed with bipolar disorder at any time prior to the qualifying encounter
Patients screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized tool AND if positive, a follow-up plan is documented on the date of or up to two days after the date of the qualifying encounter
Patient Reason(s) Patient refuses to participate in or complete the depression screening OR Medical Reason(s) Documentation of medical reason for not screening patient for depression (e.g., cognitive, functional, or motivational limitations that may impact accuracy of results; patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient's health status)