Initial population for depression measures recommended to change based on EHR available data

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Done
    • Priority: Moderate
    • Component/s: Measure
    • NQF 0710 and 0712 should remove the criteria of "primary diagnosis" or "primary position" from initial population on index psych visit
    • John DAmore
    • 917.733.3735
    • Diameter Health, Inc.
    • Measure logic change
    • Hide
      Thank you for bringing your concern to our attention. We had a similar inquiry recently, see CQM-2578.

      The rationale for using the Principal Diagnosis for the Psychiatric visit (encounter) has been because patients seen in psychiatry setting may have more serious (not comparable) primary psychiatric conditions with underlying or secondary depression. It was determined by the measure development workgroup that in this setting only, major depression or dysthymia needed to be the primary diagnosis for the patient. Recent QDM updates have allowed us to directly tie the diagnosis to the encounter using the diagnosis attribute for the encounter. This requires that the listed diagnosis is what the patient was being seen for at this encounter. Prior logic only required the encounter happen while the diagnosis was active, but it did not require that that was the actual reason for the visit. Work is under way to introduce additional exclusions that will negate the need to use the " Principal Diagnosis" attribute. However, we will likely need to use the "Diagnosis" attribute for the Pyschiatric visit (encounter) for the reasons stated above.
      Show
      Thank you for bringing your concern to our attention. We had a similar inquiry recently, see CQM-2578 . The rationale for using the Principal Diagnosis for the Psychiatric visit (encounter) has been because patients seen in psychiatry setting may have more serious (not comparable) primary psychiatric conditions with underlying or secondary depression. It was determined by the measure development workgroup that in this setting only, major depression or dysthymia needed to be the primary diagnosis for the patient. Recent QDM updates have allowed us to directly tie the diagnosis to the encounter using the diagnosis attribute for the encounter. This requires that the listed diagnosis is what the patient was being seen for at this encounter. Prior logic only required the encounter happen while the diagnosis was active, but it did not require that that was the actual reason for the visit. Work is under way to introduce additional exclusions that will negate the need to use the " Principal Diagnosis" attribute. However, we will likely need to use the "Diagnosis" attribute for the Pyschiatric visit (encounter) for the reasons stated above.
    • CMS159v5/NQF0710, CMS160v5/NQF0712
    • Hide
      Insufficient data from EHRs is available and/or documented for initial population inclusion in a population affected by several measures (CMS 159v5/NQF 0710 and CMS 160v5/NQF 0712)

      The most direct solution to allow for consistent eCQM calculation would be to remove the "primary diagnosis" or "primary position" criteria from an index pysch visit diagnosis. Using problem and diagnosis data associated from ambulatory encounters do not routinely generate identifiable primary diagnoses.
      Show
      Insufficient data from EHRs is available and/or documented for initial population inclusion in a population affected by several measures (CMS 159v5/NQF 0710 and CMS 160v5/NQF 0712) The most direct solution to allow for consistent eCQM calculation would be to remove the "primary diagnosis" or "primary position" criteria from an index pysch visit diagnosis. Using problem and diagnosis data associated from ambulatory encounters do not routinely generate identifiable primary diagnoses.

      Issue Description:
      The Depression Care Measures (http://mncm.org/wp-content/uploads/2016/12/Depression-Care-Measures-2017-Data-Collection-Guide-FINAL-v2.pdf), specifically CMS159/NQF710 and CMS160/NQF712, have an initial population inclusion criteria where a depression diagnosis must be in the "principaldiagnosis" or "primary position" when included during an index psych visit.

      The concept of "principle diagnosis" or "primary diagnosis" is not regularly recorded in ambulatory electronic health records (EHRs). Therefore, patients are being inadvertently excluded from the measure population. For example, when a problem list contains an eligible diagnosis, the order of diagnoses in the EHR and the order which data are exported to quality measurement systems do not routinely retain "primary" or "principle" concepts (i.e. since problem lists are often longitudinal and not encounter-based). While billing data may have places to record this information in regards to the encounter, revenue cycle systems may not transmit this information back to an EHR. It is clear that diagnoses should include information from problem lists since SNOMED is used in the value set (and not just ICD-9/ICD-10 codes). It is clear that ambulatory encounters are the focus of this measure given the CPT codes listed in the psych value set (2.16.840.113883.3.67.1.101.3.2445)

      A similar measure regarding low back pain and imaging utilization (CMS165) made a change during the transition to electronic clinical quality measurement from billing/claim measurement to address this issue. In that instance the requirement for a primary/principle diagnosis was not included in the electronic clinical quality measure (see https://ecqi.healthit.gov/ep/ecqms-2017-performance-period/controlling-high-blood-pressure for reference).

      All Potentially Affected measures:
      NQF 0710 - Depression Remission at Twelve Months
      NQF 0711 - Depression Remission at Six Months
      NQF 0712 - Depression Utilization of the PHQ-9 Tool
      NQF 1884 - Depression Response at Six Months- Progress Towards Remission
      NQF 1885 - Depression Response at Twelve Months- Progress Towards Remission

      Links to Measure
      https://ecqi.healthit.gov/ep/ecqms-2017-performance-period/depression-remission-twelve-months

            Assignee:
            Mathematica EC eCQM Team (Inactive)
            Reporter:
            John DAmore (Inactive)
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