CMS2v4 screening tool for adolescents

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Done
    • Priority: Minor
    • Component/s: Measure
    • None
    • Elissa Chandler
    • 267-725-5354
    • NextGen Healthcare
    • can we use PHQ-9 for adolescents as recommended?
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      We are not prescriptive as to what depression screening tool is used. The intent of the measure is to use a “Standardized Depression Screening tool” defined as “A normalized and validated depression screening tool developed for the patient population in which it is being utilized” And if the screen for depression is positive a follow-up plan should be documented.
      We list in the specification, “Examples of depression screening tools include but are not limited to:”
      This is not meant to be an all-inclusive list. If a provider or eligible professional has deemed the PHQ-9 an appropriate “standardized depression screening tool” for all patients 12 and older and they are documenting this in the EHR or medical record then that would meet the intent of the measure.
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      We are not prescriptive as to what depression screening tool is used. The intent of the measure is to use a “Standardized Depression Screening tool” defined as “A normalized and validated depression screening tool developed for the patient population in which it is being utilized” And if the screen for depression is positive a follow-up plan should be documented. We list in the specification, “Examples of depression screening tools include but are not limited to:” This is not meant to be an all-inclusive list. If a provider or eligible professional has deemed the PHQ-9 an appropriate “standardized depression screening tool” for all patients 12 and older and they are documenting this in the EHR or medical record then that would meet the intent of the measure.
    • CMS2v4/NQF0418
    • Critically impacts software development.

      QUESTION CMS2v4 and PQRS 134: Can we use the PHQ-9 as a depression screening tool for the adolescent population? Our measures team posed this question to CMS Qualitynet for PQRS 134 Registry measure for Qualified Registry reporting and were directed to post this question on JIRA for CMS2v4.

      We were informed that the PHQ-9 is replacing the PHQ-A as an adolescent screening tool. This is the information we received:

      A common question is what version of the PHQ to use in adolescents when assessing depression. It appears the standard PHQ-9 is emerging as the best choice. There is a PHQ-A (PHQ for adolescents) (validation study in Johnson JG, et al. J Adolescent Health. 2002;30:196-204). However, the PHQ-9 is likely to replace the PHQ-A as the PHQ measure most commonly used to screen for adolescent depression, for the following reasons:

      1. There have been two published studies by Richardson et al in 2009 and 2010 in the top pediatric journal (Pediatrics), validating the PHQ-9 and PHQ-2, respectively, in adolescents. It appears a cutpoint of 11 (as opposed to 10) in adults may be optimal
      2. Although the USPSTF (Pediatrics 2009) recommended either the PHQ-A or Beck, the above studies had not been done (also, the Beck is proprietary so there is a cost to using)
      3. Additionally, the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) included the PHQ-9 as one of the few screening measures in its toolkit. Although the GLAD-PC article (Zuckerbrot et al, Pediatrics 2007) does not mention the PHQ-9 in the article itself, the article refers you to its tool kit on the website www.gladpc.org where it includes a modified version of the PHQ-9 which adds several questions for dysthymia and suicide which are not included in the PHQ-9 scoring.
      4. Certainly, the PHQ-A can be used instead of the PHQ-9, but it is not “scoreable” like the PHQ-9 and it is a more complex measure. Furthermore, there is nearly as much validation data on the PHQ-9 in adolescents (with Richardson studies) as on original PHQ-A.
      5. In DSM-V, it is quite possible the PHQ-9 might be included as a recommended measure (with PHQ-A as another option) for adolescent depression.

      Thus, the PHQ-9 (or modified versions) is likely to ultimately replace PHQ-A for reasons above.

      Please let me know if you need more information.

      Thank you.
      Elissa Chandler

            Assignee:
            Mathematica EC eCQM Team (Inactive)
            Reporter:
            Elissa Chandler (Inactive)
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