eMeasure Title Depression Utilization of the PHQ-9 Tool
eMeasure Identifier
(Measure Authoring Tool)
160 eMeasure Version number 1
NQF Number 0712 GUID a4b9763c-847e-4e02-bb7e-acc596e90e2c
Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Minnesota Community Measurement
Measure Developer Minnesota Community Measurement
Endorsed By National Quality Forum
Description
Adult patients age 18 and older with the diagnosis of major depression or dysthymia who have a PHQ-9 tool administered at least once during a 4 month period in which there was a qualifying visit.
Copyright
Copyright MN Community Measurement, 2012. All rights reserved
Disclaimer
This measure is “re-tooled” from the existing NQF # 712 measure. eMeasure development was a collaboration between MN Community Measurement and the Iowa Foundation for Medical Care (IFMC) with technical assistance provided by IFMC.
Measure Scoring Proportion
Measure Type Process
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
The Centers for Disease Control and Prevention states that nationally 15.7% of people report being told by a health care professional that they had depression at some point in their lifetime. Persons with a current diagnosis of depression and a lifetime diagnosis of depression or anxiety were significantly more likely than persons without these conditions to have cardiovascular disease, diabetes, asthma and obesity and to be a current smoker, to be physically inactive and to drink heavily. According to National Institute of Mental Health (NIMH), 6.7 percent of the U.S. population ages 18 and older (14.8 million people) in any given year have a diagnosis of a major depressive disorder. Major depression is the leading cause of disability in the U.S. for ages 15 - 44. Additionally, dysthymia accounts for an additional 3.3 million Americans.
Clinical Recommendation Statement
This process measure for using the PHQ-9 tool is directly related to the desired outcomes of demonstrating improvement in symptoms of depression (remission). Improvement in the symptoms of depression and an ongoing assessment of the current treatment plan is crucial to the reduction of symptoms and psychosocial well being of patients with major depression. Most people treated for initial depression need to be on medication at least six to twelve months after adequate response to symptoms, patients with recurrent depression need to be treated for three years or more and response with psychotherapy can take eight to twelve weeks of regular and frequent therapy to show improvement. Remission is defined as a PHQ-9 score of less than five at twelve months. The Patient Health Questionnaire (PHQ-9) tool is a widely accepted, standardized tool [Copyright (C) 2005 Pfizer, Inc. All rights reserved] that is completed by the patient, ideally at each visit, and utilized by the provider to monitor treatment progress. This tool was selected for measuring outcomes for this population because it is 1) validated with a sensitivity of .080 and a specificity of 0.92 with substantial heterogeneity I2 = 82%, 2) widely accepted and utilized in Minnesota, 3) available for clinical use, 4) translated into many languages and 5) easy for the patient to complete and the provider to score. This nine question tool contains the following questions which are scored on a scale of 0 to 27 based on the scale of Not at All (0), Several Days (1), More Than Half the Days (2), or Nearly Every Day (3) for responses to the questions over the last 2 weeks. 
• Little interest or pleasure in doing things 
• Feeling down, depressed, or hopeless
• Feeling tired or having little energy 
• Poor appetite or overeating 
• Feeling bad about yourself - or that you are a failure or have let yourself or your family down 
• Trouble concentrating on things, such as reading the newspaper or watching television 
• Moving or speaking so slowly that other people could have noticed? Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual 
• Thoughts that you would be better off dead or of hurting yourself in some way
Improvement Notation
Higher scores indicate better quality
Reference
Centers for Disease Control and Prevention: Anxiety and Depression Effective Treatments Exist: People with depression and anxiety should seek help as early as possible to reduce health effects and improve quality of life. March 2009. Based on 2006 Behavior Risk Factor Surveillance System www.cdc.gov/Features/dsBRFSSDepressionAnxiety/
Reference
Suicide Prevention Resource Center: Minnesota Suicide Fact Sheet; Suicides 1999 - 2005 www.sprc.org/
Reference
www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america
Reference
National Institute of Mental Health: The Numbers Count: Mental Disorders in America August 2009
Reference
Screening for Depression in Medical Settings with the Patient Health Questionnaire (PHQ) A Diagnostic Meta Analysis. Gilbody, Simon et al Journal of General Internal Medicine Sept 2007
Reference
The PHQ-9: Validity of a Brief Depression Severity Measure Kurt Kroenke, MD, Robert Spitzer, MD J Gen Intern Med 2001 16:606-613
Reference
Collaborative Care for Depression: a Cumulative Meta-analysis and Review of Longer-term Outcomes. Gilbody, Simon et al Archives Internal Medicine Dec 2006
Definition
None
Guidance
None
Transmission Format
TBD
Initial Patient Population
Adult patients age 18 and older with an office visit and the diagnosis of major depression or dysthymia during each four month period
Denominator
Equals the Initial Patient Population
Denominator Exclusions
1: Patients who died
2: Patients who received hospice services
3: Patients who were permanent nursing home residents (> 1 year)
4: Patients with a diagnosis of bipolar disorder
5: Patients with a diagnosis of personality disorder
Numerator
Adult patients who have a PHQ-9 tool administered at least once during the four-month period.
Numerator Exclusions
Not applicable
Denominator Exceptions
None
Measure Population
Not applicable
Measure Observations
Not applicable
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Table of Contents


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Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements




Measure Set
None