FHIR Server FHIR Server Version n/a

Resource Measure/FHIR Server from package gov.healthit.ecqi.ecqms#current (141 ms)

Package

gov.healthit.ecqi.ecqms

Type

Measure

FHIR Version

Source

http://ecqi.healthit.gov/ecqms/https://build.fhir.org/ig/cqframework/ecqm-content-qicore-2024/Measure-ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR.html

Url

https://madie.cms.gov/Measure/ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR

Version

0.1.000

Status

draft

Date

2024-12-16T18:17:09+00:00

Name

ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR

Title

Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk AssessmentFHIR

Experimental

False

Description

Percentage of patient visits for those patients aged 6 through 16 at the start of the measurement period with a diagnosis of major depressive disorder (MDD) with an assessment for suicide risk

Purpose

UNKNOWN

Copyright 2024 Mathematica Inc. All Rights Reserved. The PCPI and American Medical Association's (AMA) significant past efforts and contributions to the development and updating of the Measure is acknowledged.

Resources that use this resource

No resources found

Resources that this resource uses

No resources found

Narrative

Note: links and images are rebased to the (stated) source

Title: Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk AssessmentFHIR

Id: ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR

Version: 0.1.000

Url: Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk AssessmentFHIR

short-name identifier:

CMS177FHIR

version-independent identifier:

urn:uuid:50d1dfcf-e2bf-41e8-bc1c-c607e5a09e79

version-specific identifier:

urn:uuid:9920a350-4525-4cc1-98f3-b80dc323a8c2

endorser (CMS Consensus Based Entity) identifier:

1365e

publisher (CMS) identifier:

177FHIR

Effective Period: 2025-01-01..2025-12-31

Status: draft

Publisher: Mathematica

Author: American Medical Association (AMA), American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), Mathematica

Description:

Percentage of patient visits for those patients aged 6 through 16 at the start of the measurement period with a diagnosis of major depressive disorder (MDD) with an assessment for suicide risk

Purpose:

UNKNOWN

Copyright:

Disclaimer:

The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.

The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain.

Commercial uses of the Measure require a license agreement between the user and Mathematica. Neither Mathematica, the PCPI, nor the American Medical Association (AMA), nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor their members shall be responsible for any use of the Measure.

Mathematica encourages use of the Measure by other health care professionals, where appropriate.

THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

Limited proprietary coding may be contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party’s use of Current Procedural Terminology (CPT[R]) or other proprietary code set contained in the Measure. Any other use of CPT or other coding by a third party is strictly prohibited. Mathematica, the AMA, and former members of the PCPI disclaim all liability for use or accuracy of any CPT(R) or other coding contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. LOINC(R) is copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2023 World Health Organization. All Rights Reserved.

Due to technical limitations, registered trademarks are indicated by (R) or [R].

Scoring:

Proportion

Rationale:

Research has shown that youth with major depressive disorder (MDD) are at a high risk for suicide attempts and completion - among the most significant and devastating sequelae of the disease (Fontanella et al., 2020). Suicide risk is a critical consideration in children and adolescents with MDD, and an important aspect of care that should be assessed at each visit and subsequently managed to minimize that risk. Additionally, the importance of the assessments is underscored by research (Fontanella et al., 2020; Luoma, Martin, & Pearson, 2002) that indicates that many individuals who die by suicide do make contact with primary care providers and mental health services beforehand. More specifically, approximately 15% of suicide victims aged 35 years or younger had seen a mental health professional within 1 month of suicide while approximately 23% had seen a primary care provider within 1 month of suicide (Luoma, Martin, & Pearson, 2002). A recent analysis of depression severity and suicidal ideation symptom trajectories (Witt et al., 2021) found that suicidal ideation among children and young adults (15-25 years) might not improve with depression symptom severity. This evidence suggests the potential utility of continued suicide risk screening even after improvements in depression symptoms. Better assessment and identification of suicide risk in the health care setting should lead to improved connection to treatment and reduction in suicide attempts and deaths by suicide.

Clinical recommendation statement:

The evaluation must include assessment for the presence of harm to self or others (Birmaher et al., 2007).

Suicidal behavior exists along a continuum from passive thoughts of death to a clearly developed plan and intent to carry out that plan. Because depression is closely associated with suicidal thoughts and behavior, it is imperative to evaluate these symptoms at the initial and subsequent assessments. For this purpose, low burden tools to track suicidal ideation and behavior such as the Columbia-Suicidal Severity Rating Scale can be used. Also, it is crucial to evaluate the risk (e.g., age, sex, stressors, comorbid conditions, hopelessness, impulsivity) and protective factors (e.g., religious belief, concern not to hurt family) that might influence the desire to attempt suicide. The risk for suicidal behavior increases if there is a history of suicide attempts, comorbid psychiatric disorders (e.g., disruptive disorders, substance abuse), impulsivity and aggression, availability of lethal agents (e.g., firearms), exposure to negative events (e.g., physical or sexual abuse, violence), and a family history of suicidal behavior (Birmaher et al., 2007).

A careful and ongoing evaluation of suicide risk is necessary for all patients with major depressive disorder (Category I). Such an assessment includes specific inquiry about suicidal thoughts, intent, plans, means, and behaviors; identification of specific psychiatric symptoms (e.g., psychosis, severe anxiety, substance use) or general medical conditions that may increase the likelihood of acting on suicidal ideas; assessment of past and, particularly, recent suicidal behavior; delineation of current stressors and potential protective factors (e.g., positive reasons for living, strong social support); and identification of any family history of suicide or mental illness (Category I) (Gelenberg et al., 2010).

Guidance (Usage): This eCQM is an episode-based measure. An episode is defined as each eligible encounter for major depressive disorder (MDD) during the measurement period. A suicide risk assessment should be performed at every visit for MDD during the measurement period. In recognition of the growing use of integrated and team-based care, the diagnosis of depression and the assessment for suicide risk need not be performed by the same provider or clinician. Suicide risk assessments completed via telehealth services can also meet numerator performance. Use of a standardized tool(s) or instrument(s) to assess suicide risk will meet numerator performance, so long as the minimum criteria noted above is evaluated. Standardized tools can be mapped to the concept "Intervention, Performed": "Suicide risk assessment (procedure)" included in the numerator logic below, as no individual suicide risk assessment tool or instrument would satisfy the requirements alone. To ensure all patients with major depressive disorder (MDD) are assessed for suicide risk, there are two clinical quality measures addressing suicide risk assessment; CMS177 covers children and adolescents aged 6 through 16 at the start of the measurement period, and CMS161 - Adult Major Depressive Disorder (MDD): Suicide Risk Assessment covers the adult population aged 17 years and older at the start of the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS177v13. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).

Population Criteria:

64f0dd3c56d636294b157f18

Initial Population:

All patient visits for those patients aged 6 through 16 at the start of the measurement period with a diagnosis of major depressive disorder

Denominator:

Equals Initial Population

Numerator:

Patient visits with an assessment for suicide risk

Supplemental Data Elements:

SDE Ethnicity

SDE Race

SDE Sex

SDE Payer

Supplemental Data Guidance : For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Libraries:

ChildandAdolescentMajorDepressiveDisorderMDDSuicideRiskAssessmentFHIR

Terminology and Other Dependencies: Library/SupplementalDataElements|3.5.000

Library/FHIRHelpers|4.4.000

Library/CQMCommon|2.2.000

Library/QICoreCommon|2.1.000

AdministrativeGender

SNOMED CT (all versions)

Office Visit

Outpatient Consultation

Psych Visit - Diagnostic Evaluation

Psych Visit - Family Psychotherapy

Psych Visit - Psychotherapy

Psychoanalysis

Group Psychotherapy

Telephone Visits

Major Depressive Disorder-Active

Payer

Parameters:

name

use

min

max

type

Measurement Period

Period

SDE Sex

Out

Coding

Numerator

Out

Resource

Denominator

Out

Resource

SDE Payer

Out

Resource

Initial Population

Out

Resource

SDE Ethnicity

Out

Resource

SDE Race

Out

Resource

DataRequirements:

Resource Type

Resource Elements

Valueset Name

Valueset

Patient(QICorePatient)

ethnicity race

Condition(QICoreCondition)

id id.value code

Encounter(QICoreEncounter)