Tracking PHQ9 scores
Any recommendations on tracking PHQ9s for response and remission from a data standpoint?
Specifically, what do you use as a starting point from which to compare future scores for response and remission? First PHQ9 score of 10 or greater? First diagnosis of MDD? What about patients with chronic, recurrent depression who have scores that go up and down over time (which is common)?
The HEDIS metric on this doesn’t seem to give much guidance from what I can tell, except that it looks at scores 4-8 months from said starting point.
Thanks in advance.
We are working locally to develop a training on measurements and metrics for integrated care. We are going to start with depression/PhQ9. I have an intern who has done a lot of our research on this.
I like to look at these similar to the measurement guidelines for FQHCs – similarly to measuring an A1c.
Here is some information we have found. We are going to have to pull several different measurement studies for this to create something robust.
“A depression screen is completed on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, either additional evaluation for depression, suicide risk assessment, referral to a practitioner who is qualified to diagnose and treat depression, pharmacological interventions, or other interventions or follow-up for the diagnosis or treatment of depression is documented on the date of the positive screen. Depression screening is required once per measurement period, not at all encounters; this is patient based and not an encounter based measure.” - https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS2v8.html
Also – according to a presentation on new HEDIS measures (see the attached PDF):
CMS Medicare ACO and PCMH measures Depression remission PHQ-9 less than five @ 12 months
Depression response PH-Q9 decrease by greater than 50% @ 12 months
Preventive Care and Screening: Screening for Depression and Follow-Up Plan (Line 21), CMS2v7 http://bphcdata.net/docs/table_6b.pdf (page#9)
Measure Description Percentage of patients age 12 years and older screened for depression on the date of the visit using an age-appropriate standardized depression screening tool and if positive, a follow-up plan is documented on the date of the positive screen.
Universe (Column a)
■ Patients age 12 years and older* with at least one medical visit during the measurement period.
*Patients born on or before December 31, 2005 Denominator (Column b) Number of records reviewed.
Numerator (Column c) Patients who:
■ Were screened for depression on the date of the visit using an age-appropriate standardized tool; and
■ If screened positive for depression, had a follow-up plan documented on the date of the positive screen.
■ Column c INCLUDES patients with a negative depression screening. Those with a negative screening do not require a documented follow-up plan to be included in the numerator.
Exclusions/Exceptions Exclude from the denominator, patients:
■ With an active diagnosis of depression or a diagnosis of bipolar disorder
■ Who refuse to participate
■ Who are in urgent or emergent situations where time is of the essence and to delay treatment would jeopardize the patient’s health status
■ Whose functional capacity or motivation to improve may impact the accuracy of results *Please refer to the UDS Manual for detailed Specification Guidance and UDS Reporting Considerations.
Not sure if that helps. But I hope so!
Hi Chad – I will be giving a talk on this at the CFHA meeting this Friday in Denver if you are going to be there. Specifically setting up a measurement program, registry, tracking and using data on a personal basis and in aggregate form.
You can start by looking at just the past year – a combo of PHQ9>9 and a diagnosis of depression or dysthymia. This will generate a good sized list in most clinics and then you can dig into the particulars. The standard of care is a PHQ9 administered at least monthly until “stable”, tracking these scores over time to clinically significant response at 6 and 12 months (NQF 1884 and 1885) or remission at 6 and 12 months (NQF 710 and 711). And yes many patients do not get as well as we would hope – there are multiple chronic morbidities (like pain, SUD and personality do for example) that prevent a nice textbook response. Hence set your benchmarks close to what the literature has shown is typical in primary care – about 40-50% will reach clinically significant response (50% reduction in PHQ9) and 15-20 % of those may hit remission which is even more difficult.