Bipolar Disorder: Monitoring change in level-of-functioning (NQF 0112)

eMeasure Name Bipolar Disorder: Monitoring change in level-of-functioning eMeasure Id B034521C-D0D5-4383-96B0-70FD28671F76
Version number 1 eMeasure Set Id E8431721-4FF3-4CA1-A641-CE26F0E66B44
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Center for Quality Assessment and Improvement in Mental Health
Endorsed by National Quality Forum
Description Percentage of patients aged 18 years and older with an initial diagnosis or new episode/presentation of bipolar disorder.
Copyright
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
Recovery in Bipolar Disorder
- Recovery includes remission of symptomatology, minimizing relapse or recurrence and maximizing functioning and improving quality of life (Harvey, P. 2006)
- Achieving treatment-related symptomatic improvement does not necessarily mean that the functional recovery is achieved (Harvey, P. 2006) 
- Functional recovery involves the ability to sustain and maintain social, occupational, educational, and independent living activities and relationships (Harvey, P. 2006) 
Bipolar Disorder and Response to Treatment
- The 2002 APA Practice Guideline for the Treatment of Patients with Bipolar Disorder defines remission during the acute phase of treatment as a complete return to baseline level of functioning and a virtual lack of symptoms (Keck, PE. 2004) 
- The ability to function involves more than the presence or absence of symptoms as some patients with bipolar disorder function well despite having severe symptoms while others have few symptoms but can be dysfunctional (Keck, PE. 2004) 
- Monitoring response to treatment in bipolar disorder should extend beyond symptom reduction to include a focus on a person's improvement in level-of-functioning (Keck, PE. 2004) 
Measuring Level-of-functioning
- Level-of-functioning instruments measure a person's ability to interact with others, form relationships and handle day-to-day tasks (O'Malia, L. et. al. 2002) 
- Self-report of level of functioning has been found to have an important role in treatment as it encourages patient participation and collaborative dialogue (O'Malia, L. et. al. 2002)
Clinical Recommendation Statement
A functional assessment provides the clinician with a means to quantify the patient's impairment.
- Level-of-functioning instruments measure a person's ability to interact with others, form relationships and handle day-to-day tasks. (O'Malia, L. et. al. 2002) 
- Self-report of level-of-functioning has been found to have an important role in treatment as it encourages patient participation and collaborative dialogue.(O'Malia, L. et. al. 2002)
- Monitoring response to treatment in bipolar disorder should extend beyond symptom reduction to include a focus on a person's improvement in functioning.(Keck, PE. 2004)
Improvement notation
Higher scores indicate better quality
Measurement duration
12 month(s)
Reference
Harvey P, Defining and Achieving Recovery From Bipolar Disorder, J Clin Psychiatry 2006; 67 (suppl 9) 14-18
Reference
Keck PE, Defining and Improving Response to Treatment in Patients With Bipolar Disorder; J Clin Psychiatry 2004; (suppl 15) 25-29
Reference
O'Malia L, McFarland B, et.al, A Level-of-Functioning Self-Report Measure for Consumers With Severe Mental Illness, Psychiatric Services, March 2002, Vol 53, No. 3 26-331
Definition
Initial Patient Population(s): All patients aged 18 years or older who currently have a diagnosis of Bipolar Disorder
Definition
Denominator(s): None
Definition
Denominator Exception(s): N/A
Definition
Numerator(s): All patients who have had a Level of functioning assessment completed less than 1 day after the patient was diagnosed with Bipolar Disorder and again within 12 days.
Definition
Denominator Exclusion(s): All patients who refused to have Level of functioning assessment completed.
Guidance
This measure requires appropriate classification of disease activity to indicate the difference between active and inactive to indicate new episodes.

Level of functioning assessment includes the following:
- occupational participation/attendance
- academic participation/attendance
- social functioning including involvement with family or significant others, and
- independence in activities associated with daily living such as maintaining personal care needs, caring for family, taking care of place of residence, etc.

The following instruments are recommended by the STABLE National Coordinating Council for use in monitoring level-of-functioning:
- Sheehan Disability Scale: A brief self-report tool
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012