Major Depressive Disorder (MDD): Diagnostic Evaluation (NQF 0103)

eMeasure Name Major Depressive Disorder (MDD): Diagnostic Evaluation eMeasure Id 00BB652D-8168-4762-84F7-A1EF9C1EDA01
Version number 1 eMeasure Set Id 7472660A-B5DF-4946-AC29-B8B1DEAB8FBC
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward American Medical Association - Physician Consortium for Performance Improvement
Endorsed by National Quality Forum
Description Percentage of patients with a diagnosis of major depressive disorder who met the DSM-IV™ criteria during the visit in which the new diagnosis or recurrent episode was identified.
Copyright
© 2010 American Medical Association. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
Thorough assessment of depressive symptoms sets the basis for accurate diagnosis and treatment of major depressive disorder.
Clinical Recommendation Statement
Successful treatment of patients with major depressive disorder is promoted by a thorough assessment of the patient (Category I). Patients with major depressive disorder symptoms should receive a thorough diagnostic evaluation both to determine whether a diagnosis of depression is warranted and to reveal the presence of other psychiatric or general medical conditions. (APA)

Criteria for Major Depressive Episode
A.At least five of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either 1) depressed mood or 2) loss of interest or pleasure (do not include symptoms that are clearly due to general medical condition or mood-incongruent delusions or hallucinations).
1.Depressed mood most of the day, nearly every day as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful)
2.Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
3.Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% body weight in a month), or decrease in appetite nearly every day
4.Insomnia or hypersomnia nearly every day
5.Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
6.Fatigue or loss of energy nearly every day
7.Feelings of worthlessness or excessive inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
8.Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or observed by others)
9.Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide
B.The symptoms do not meet criteria for a mixed episode
C.The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
D.The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism)
E.The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation. (DSM-IV)

Diagnostic criteria for 296.2x Major Depressive Disorder, Single Episode
A.Presence of a single Major Depressive Episode.
B.The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
C.There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exception does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition. (DSM-IV)

Diagnostic criteria for 296.3x Major Depressive Disorder, Recurrent
A.Presence of two or more Major Depressive Episodes. Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode.
B.The Major Depressive Episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
C.There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exception does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition. (DSM-IV)
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
American Psychiatric Association (APA). Practice guidelines for the treatment of patients with major depressive disorder (revision). Am J Psychiatry. 2000;157(suppl 4): 1-45.
Reference
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). American Psychiatric Association. 1994.
Definition
DSM-IV Criteria: Includes presence of depressed mood, marked diminished interest/pleasure, significant weight loss or weight gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness, diminished ability to concentrate and recurrent suicidal ideation
Definition
Initial Patient Population(s): Patient Age:  Patients aged 18 years and older at the beginning of the measurement period.

Diagnosis Active:  Patient has a documented diagnosis of Major Depressive Disorder (MDD), new or recurrent episode 

Encounter:  At least two visits with the physician, physician's assistant, or nurse practitioner during the measurement period.
Definition
Denominator(s): All patients aged 18 years and older with a new diagnosis or recurrent episode of MDD.
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): Patients with documented evidence that they met the Diagnosis and Statistical Manual (DSM)-IV criteria [At least 5 elements from the DSM-IV criteria: includes presence of depressed mood, marked diminished interest/pleasure, significant weight loss or weight gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness, diminished ability to concentrate and recurrent suicidal ideation with symptom duration of 2 weeks or longer (must include: 1. depressed mood or 2. loss of interest or pleasure)] during the visit in which the new diagnosis or recurrent episode was identified.
Definition
Denominator Exception(s): N/A
Guidance
DSM IV Criteria should be documented during the encounter at which the diagnosis of major depressive disorder was made.
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