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  1. eCQM Issue Tracker
  2. CQM-5610

CRP: Remove denominator exclusion for current of history of diagnosis for depression

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    • Other
    • Resolution: Unresolved
    • Moderate
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      Brief description of measure
      ​CMS2: Preventive Care and Screening: Screening for Depression and Follow-Up Plan
      Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of or up to two days after the date of the qualifying encounter

      Description of issue
      ​​The current intent of the measure is to promote screening for new cases of depression in patients across various clinical settings. Thus, patients who have ever been diagnosed with depression or bipolar disorder at any time prior to the qualifying encounter are excluded from the measure—that is, they are removed from the measure denominator. However, concerns have been raised about the appropriateness of excluding patients with a history of depression or bipolar disorder because the risk of depression recurrence is high for these patients.

      The measure steward explored potentially adding a time limitation to the exclusion of patients with a history of depression or bipolar disorder, OR whether it is appropriate to continue to exclude patients with a history of depression or bipolar disorder and if the measure denominator should be expanded to include them. 

      ​After performing a focused literature review in response to these requests, and evaluating potential changes to the exclusions of this measure with various interested parties, the final recommendation was made by the expert work group to continue excluding patients who have ever had a bipolar disorder diagnosis but recommended including all patients with a history of depression, regardless of status (active or inactive/resolved), explaining it is clinically appropriate to continue screening these patients.

      Goal of review
      Obtain clinical and technical feedback
      Show
      Brief description of measure ​CMS2: Preventive Care and Screening: Screening for Depression and Follow-Up Plan Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of or up to two days after the date of the qualifying encounter Description of issue ​​The current intent of the measure is to promote screening for new cases of depression in patients across various clinical settings. Thus, patients who have ever been diagnosed with depression or bipolar disorder at any time prior to the qualifying encounter are excluded from the measure—that is, they are removed from the measure denominator. However, concerns have been raised about the appropriateness of excluding patients with a history of depression or bipolar disorder because the risk of depression recurrence is high for these patients. The measure steward explored potentially adding a time limitation to the exclusion of patients with a history of depression or bipolar disorder, OR whether it is appropriate to continue to exclude patients with a history of depression or bipolar disorder and if the measure denominator should be expanded to include them.  ​After performing a focused literature review in response to these requests, and evaluating potential changes to the exclusions of this measure with various interested parties, the final recommendation was made by the expert work group to continue excluding patients who have ever had a bipolar disorder diagnosis but recommended including all patients with a history of depression, regardless of status (active or inactive/resolved), explaining it is clinically appropriate to continue screening these patients. Goal of review Obtain clinical and technical feedback
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      Proposed solution
      Current Header Denominator Exclusion:
      Patients who have ever been diagnosed with depression or with bipolar disorder at any time prior to the qualifying encounter

      Proposed ​Header: Denominator Exclusion:
      Patients who have ever been diagnosed with bipolar disorder at any time prior to the qualifying encounter

      Current Logic: 

      define "Denominator Exclusions"
      exists "History of Bipolar or Depression Diagnosis Before Qualifying Encounter"

      define "History of Bipolar or Depression Diagnosis Before Qualifying Encounter"
      ( ["Diagnosis": "Bipolar Diagnosis"]
         union ["Diagnosis": "Depression Diagnosis"] ) DiagnosisBipolarorDepression
        with "Qualifying Encounter During Measurement Period" QualifyingEncounter
           such that DiagnosisBipolarorDepression.prevalencePeriod starts before QualifyingEncounter.relevantPeriod

      Proposed Logic: 

      define "Denominator Exclusions"
      exists "History of Bipolar Diagnosis Before Qualifying Encounter"

      define "History of Bipolar Diagnosis Before Qualifying Encounter
      ( ["Diagnosis": "Bipolar Diagnosis"] BipolarDiagnosis
         with "Qualifying Encounter During Measurement Period" QualifyingEncounter
           such that BipolarDiagnosis.prevalencePeriod starts before QualifyingEncounter.relevantPeriod

      Rationale for change
      Including patients with any history of depression is more clinically appropriate, as this population is at risk for a recurrence of depression, and ensures that the proper patients are included in the denominator.
      Show
      Proposed solution Current Header Denominator Exclusion: Patients who have ever been diagnosed with depression or with bipolar disorder at any time prior to the qualifying encounter Proposed ​Header: Denominator Exclusion: Patients who have ever been diagnosed with bipolar disorder at any time prior to the qualifying encounter Current Logic:  define "Denominator Exclusions" exists "History of Bipolar or Depression Diagnosis Before Qualifying Encounter" define "History of Bipolar or Depression Diagnosis Before Qualifying Encounter" ( ["Diagnosis": "Bipolar Diagnosis"]    union ["Diagnosis": "Depression Diagnosis"] ) DiagnosisBipolarorDepression   with "Qualifying Encounter During Measurement Period" QualifyingEncounter      such that DiagnosisBipolarorDepression.prevalencePeriod starts before QualifyingEncounter.relevantPeriod Proposed Logic:  define "Denominator Exclusions" exists "History of Bipolar Diagnosis Before Qualifying Encounter" define "History of Bipolar Diagnosis Before Qualifying Encounter ( ["Diagnosis": "Bipolar Diagnosis"] BipolarDiagnosis    with "Qualifying Encounter During Measurement Period" QualifyingEncounter      such that BipolarDiagnosis.prevalencePeriod starts before QualifyingEncounter.relevantPeriod Rationale for change Including patients with any history of depression is more clinically appropriate, as this population is at risk for a recurrence of depression, and ensures that the proper patients are included in the denominator.

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          edave Mathematica EC eCQM Team
          edave Mathematica EC eCQM Team
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