Outcome

Increased score indicates improvement

define "Initial Population":
  AgeInYearsAt(start of("Index Depression Assessment".effective.toInterval())) >= 12

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  "Has Hospice Services in the Measure Assessment Period"
    or "Has Palliative Care in the Measure Assessment Period"
    or "Patient Expired"
    or "Has Mental Health Disorder Diagnoses"

define "Numerator":
  Last([Observation: "PHQ 9 and PHQ 9M Tools"] DepressionAssessment
      where ToDate(start of DepressionAssessment.effective.toInterval()) during "Measure Assessment Period"
        and DepressionAssessment.status in { 'final', 'amended', 'corrected' }
      sort by start of effective.toInterval()
  ).value < 5

define "SDE Sex":
  case
    when Patient.gender = 'male' then "M"
    when Patient.gender = 'female' then "F"
    else null
  end

define "SDE Sex":
  SDE."SDE Sex"

define "Depression Assessments Greater than 9":
  [Observation: "PHQ 9 and PHQ 9M Tools"] DepressionAssessment
    where DepressionAssessment.value > 9
      and DepressionAssessment.status in { 'final', 'amended', 'corrected' }

define "Depression Diagnoses":
  ( [Condition: "Major Depression Including Remission"]
    union [Condition: "Dysthymia"] ) Depression
    where Depression.isConfirmedActiveDiagnosis ( )

define "Denominator Identification Period":
  Interval[start of "Measurement Period" - 14 months, start of "Measurement Period" - 2 months )

define "Depression Encounter":
  [Encounter: "Contact or Office Visit"] ValidEncounter
    with "Depression Diagnoses" Depression
      such that ValidEncounter.period overlaps Depression.prevalenceInterval ( )
        and ValidEncounter.period ends during "Denominator Identification Period"
        and ValidEncounter.status = 'finished'

define "Index Depression Assessment":
  First("Depression Assessments Greater than 9" DepressionAssessment
      with "Depression Encounter" DepressionEncounter
        such that DepressionAssessment.effective.toInterval() during day of Interval[ToDate((start of DepressionEncounter.period) - 7 days), 
        end of DepressionEncounter.period]
      sort by start of effective.toInterval()
  )

define "Measure Assessment Period":
  "Index Depression Assessment" FirstIndexAssessment
    let YearAfterIndexAssessment: date from start of FirstIndexAssessment.effective.toInterval ( ) + 12 months
    return Interval[YearAfterIndexAssessment - 60 days, YearAfterIndexAssessment + 60 days]

define "Numerator":
  Last([Observation: "PHQ 9 and PHQ 9M Tools"] DepressionAssessment
      where ToDate(start of DepressionAssessment.effective.toInterval()) during "Measure Assessment Period"
        and DepressionAssessment.status in { 'final', 'amended', 'corrected' }
      sort by start of effective.toInterval()
  ).value < 5

define "Initial Population":
  AgeInYearsAt(start of("Index Depression Assessment".effective.toInterval())) >= 12

define "Denominator":
  "Initial Population"

define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }

define "SDE Payer":
  SDE."SDE Payer"

define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }

define "SDE Ethnicity":
  SDE."SDE Ethnicity"

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

define "Has Palliative Care in the Measure Assessment Period":
  exists ( [Observation: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"] PalliativeAssessment
      where PalliativeAssessment.effective.toInterval ( ) overlaps Interval[start of "Denominator Identification Period", end of "Measure Assessment Period"]
        and PalliativeAssessment.status in { 'final', 'amended', 'corrected' }
  )
    or exists ( [Condition: "Palliative Care Diagnosis"] PalliativeDiagnosis
        where PalliativeDiagnosis.prevalenceInterval ( ) overlaps Interval[start of "Denominator Identification Period", end of "Measure Assessment Period"]
          and PalliativeDiagnosis.isConfirmedActiveDiagnosis ( )
    )
    or exists ( [Encounter: "Palliative Care Encounter"] PalliativeEncounter
        where PalliativeEncounter.period overlaps Interval[start of "Denominator Identification Period", end of "Measure Assessment Period"]
          and PalliativeEncounter.status = 'finished'
    )
    or exists ( [Procedure: "Palliative Care Intervention"] PalliativeIntervention
        where PalliativeIntervention.performed.toInterval ( ) overlaps Interval[start of "Denominator Identification Period", end of "Measure Assessment Period"]
          and not ( PalliativeIntervention.status in { 'not-done', 'entered-in-error', 'unknown' } )
    )

define "Patient Expired":
  Patient.deceased occurs on or before end of "Measure Assessment Period"

define "Has Mental Health Disorder Diagnoses":
  exists ( ( [Condition: "Bipolar Disorder"]
      union [Condition: "Personality Disorder Emotionally Labile"]
      union [Condition: "Schizophrenia or Psychotic Disorder"]
      union [Condition: "Pervasive Developmental Disorder"] ) MentalHealthDisorderDiagnoses
      where ToDate(start of MentalHealthDisorderDiagnoses.prevalenceInterval()) on or before end of "Measure Assessment Period"
        and MentalHealthDisorderDiagnoses.isConfirmedActiveDiagnosis ( )
  )

define "Denominator Exclusions":
  "Has Hospice Services in the Measure Assessment Period"
    or "Has Palliative Care in the Measure Assessment Period"
    or "Patient Expired"
    or "Has Mental Health Disorder Diagnoses"

define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }

define "SDE Race":
  SDE."SDE Race"

define fluent function isConfirmedActiveDiagnosis(condition Condition):
  condition.isActive ( )
    and condition.verificationStatus ~ QICoreCommon."confirmed"

/* Candidates for FHIRCommon */

/*
@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse
*/
define fluent function isActive(condition Condition):
  condition.clinicalStatus ~ "active"
    or condition.clinicalStatus ~ "recurrence"
    or condition.clinicalStatus ~ "relapse"

/*
@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]

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
        }