Depression Remission at Twelve Months (NQF OT3-011-10)

eMeasure Name Depression Remission at Twelve Months eMeasure Id 1DF09949-49C0-473E-930D-49B332790357
Version number 1 eMeasure Set Id B9261F43-8229-4CC2-9213-038B97D2DA64
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Minnesota Community Measurement
Endorsed by National Quality Forum
Description Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at twelve months defined as PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment.
Copyright
Measure scoring Proportion
Measure type Outcome
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
The Centers for Disease Control and Prevention states that nationally 15.7% of people report being told by a health care professional that they had depression at some point in their lifetime. Persons with a current diagnosis of depression and a lifetime diagnosis of depression or anxiety were significantly more likely than persons without these conditions to have cardiovascular disease, diabetes, asthma and obesity and to be a current smoker, to be physically inactive and to drink heavily. According to National Institute of Mental Health (NIMH), 6.7 percent of the U.S. population ages 18 and older (14.8 million people) in any given year have a diagnosis of a major depressive disorder. Major depression is the leading cause of disability in the U.S. for ages 15 - 44. Additionally, dysthymia accounts for an additional 3.3 million Americans.
Clinical Recommendation Statement
Improvement in the symptoms of depression and an ongoing assessment of the current treatment plan is crucial to the reduction of symptoms and psychosocial well being of patients with major depression. Most people treated for initial depression need to be on medication at least six to twelve months after adequate response to symptoms, patients with recurrent depression need to be treated for three years or more and response with psychotherapy can take eight to twelve weeks of regular and frequent therapy to show improvement. Remission is defined as a PHQ-9 score of less than five at twelve months. The Patient Health Questionnaire (PHQ-9) tool is a widely accepted, standardized tool [Copyright © 2005 Pfizer, Inc. All rights reserved] that is completed by the patient, ideally at each visit, and utilized by the provider to monitor treatment progress. This tool was selected for measuring outcomes for this population because it is 1) validated with a sensitivity of .080 and a specificity of 0.92 with substantial heterogeneity I2 = 82%, 2) widely accepted and utilized in our state, 3) available for clinical use, 4) translated into many languages and 5) easy for the patient to complete and the provider to score. This nine question tool contains the following questions which are scored on a scale of 0 to 27 based on the scale of Not at All (0), Several Days (1), More Than Half the Days (2), or Nearly Every Day (3) for responses to the questions over the last 2 weeks. 

• Little interest or pleasure in doing things 
• Feeling down, depressed, or hopeless
• Feeling tired or having little energy 
• Poor appetite or overeating 
• Feeling bad about yourself - or that you are a failure or have let yourself or your family down 
• Trouble concentrating on things, such as reading the newspaper or watching television 
• Moving or speaking so slowly that other people could have noticed? Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual 
• Thoughts that you would be better off dead or of hurting yourself in some way
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
Institute for Clinical Systems Improvement (ICSI) Major Depression in Adults in Primary Care 12th edition May 2009   www.icsi.org
Reference
Centers for Disease Control and Prevention: Anxiety and Depression Effective Treatments Exist: People with depression and anxiety should seek help as early as possible to reduce health effects and improve quality of life. March 2009. Based on 2006 Behavior Risk Factor Surveillance System www.cdc.gov/Features/dsBRFSSDepressionAnxiety/
Reference
Suicide Prevention Resource Center: Minnesota Suicide Fact Sheet; Suicides 1999 - 2005 www.sprc.org/
Reference
www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america
Reference
National Institute of Mental Health: The Numbers Count: Mental Disorders in America August 2009
Reference
Screening for Depression in Medical Settings with the Patient Health Questionnaire (PHQ) A Diagnostic Meta Analysis. Gilbody, Simon et al Journal of General Internal Medicine Sept 2007
Reference
The PHQ-9: Validity of a Brief Depression Severity Measure Kurt Kroenke, MD, Robert Spitzer, MD J Gen Intern Med 2001 16:606-613
Definition
Remission is defined as a PHQ-9 score of less than five

Twelve Months is defined as the point in time from the date in the measurement period that a patient meets the inclusion criteria (diagnosis and elevated PHQ-9 > 9) extending out twelve months and then allowing a grace period of thirty days prior to and thirty days after this date.  Any PHQ-9 less than five obtained during this period is deemed as remission at twelve months, values obtained prior to or after this period are not counted as numerator compliant (remission)
Definition
Initial Patient Population(s): All patients age 18 and older.
Definition
Denominator(s): All patients age 18 and older with a diagnosis of major depression or dysthymia and a PHQ-9 score greater than nine at an outpatient encounter.
Definition
Denominator Exclusion(s): 1: Patients who died
2: Patients who received hospice services
3: Patients who were permanent nursing home residents (> 1 year)
4: Patients with a diagnosis of  bipolar disorder
5: Patients with a diagnosis of personality disorder
Definition
Numerator(s): The number of patients whose depression symptoms were in remission at twelve months.  Remission is the absence of depression symptoms defined as a PHQ-9 score of less than 5.
Definition
Denominator Exception(s): N/A
Guidance
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