Brief Description of Measure:
​CMS128: Anti-depressant Medication Management:
Percentage of patients 18 years of age and older who were treated with antidepressant medication, had a diagnosis of major depression, and who remained on an antidepressant medication treatment. Two rates are reported.
a. Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks).
b. Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months).

Description of Issue:
The current specification requires  antidepressant medications dispensed "within 245 days (8 months) prior to the  measurement period through the first 120 days (4 months) of the measurement period”. This timeframe can be defined as the "Intake Period" and is used repeatedly across the measure specification to improve readability.
 
The measure developer proposes changing the description to “the 12-month window starting on May 1 of the year prior to the measurement period and ending on April 30 of the measurement period” as opposed to using counts of days. This language provides better clarity on what the timeframe requirement is for implementers.

Proposed Solution:
Before

//Header: Definition
Index Prescription Start Date (IPSD): The date of the earliest prescription dispensing event for an antidepressant medication during the period of 245 days prior to the start of the measurement period through 120 days after the start of the measurement period.

After

//Header: Definition
Intake Period: The 12-month window starting on May 1 of the year prior to the measurement period and ending on April 30 of the measurement period.

Index Prescription Start Date (IPSD): The date of the earliest prescription dispensing event for an antidepressant medication during the Intake Period.

Before

//Header: Initial Population
Patients 18 years of age and older who were dispensed antidepressant medications within 245 days (8 months) prior to the measurement period through the first 120 days (4 months) of the measurement period, and were diagnosed with major depression 60 days prior to, or 60 days after the dispensing event and had a visit 60 days prior to, or 60 days after the dispensing event

After

//Header: Initial Population
Patients 18 years of age and older as of April 30 of the measurement period who were dispensed antidepressant medications during the Intake Period, and were diagnosed with major depression 60 days prior to, or 60 days after the dispensing event and had a visit 60 days prior to, or 60 days after the dispensing event

Before

//Logic

define "Earliest Antidepressant Dispensed 245 Days Before or 120 Days After Start of Measurement Period":
First(["Medication, Dispensed": "Antidepressant Medication"] Antidepressant
    where Antidepressant.relevantDatetime in Interval[start of "Measurement Period" - 245 days, start of "Measurement Period" + 120 days]
    sort by relevantDatetime
)

define "Denominator Exclusions":
Hospice."Has Hospice"
  or exists ( ["Medication, Active": "Antidepressant Medication"] ActiveAntidepressant
      let ActiveMedPeriod: ActiveAntidepressant Meds
        return Meds.relevantPeriod
          intersect Interval[start of "Measurement Period" - 245 days,
          end of "Measurement Period"],
      AntidepressantDispensed: "Earliest Antidepressant Dispensed 245 Days Before or 120 Days After Start of Measurement Period"
      where AntidepressantDispensed.relevantDatetime is not null
        and ActiveMedPeriod overlaps Interval[AntidepressantDispensed.relevantDatetime - 105 days, AntidepressantDispensed.relevantDatetime )
  )

After

//Logic

define "Earliest Antidepressant Dispensed During Intake Period":
  First(["Medication, Dispensed": "Antidepressant Medication"] Antidepressant
      where Antidepressant.relevantDatetime in "Intake Period"
      sort by relevantDatetime
  )

define "Denominator Exclusions":
  Hospice."Has Hospice"
    or exists ( ["Medication, Active": "Antidepressant Medication"] ActiveAntidepressant
        let ActiveMedPeriod: ActiveAntidepressant Meds
          return Meds.relevantPeriod
            intersect Interval[start of "Intake Period",
            end of "Measurement Period"] ...

define "Intake Period":
  Interval["May 1 of the Year Prior to the Measurement Period", "April 30 of the Measurement Period"]

define "May 1 of the Year Prior to the Measurement Period":
  DateTime((year from start of "Measurement Period" -1), 5, 1, 0, 0, 0, 0, 0)

define "April 30 of the Measurement Period":
  DateTime((year from start of "Measurement Period"), 4, 30, 23, 59, 59, 0, 0)

Below are definitions that referenced "Earliest Antidepressant Dispensed 245 Days Before or 120 Days After Start of Measurement Period" and will now reference the updated definition name "Earliest Antidepressant Dispensed During Intake Period":
"Qualifying Encounters"
"Has Initial Major Depression Diagnosis"
"Denominator Exclusions"
"Antidepressant Medication Period In 114 Days After Initial Dispense"
"Antidepressant Medication Period In 231 Days After Initial Dispense"

Rationale for Change:
​The goal of this change is to improve measure specification readability by defining and using the term "Intake Period".