In October, MNCM’s Measurement and Reporting Committee (MARC) approved recommendations for redesign of the depression measures. The consideration for redesign is in response to use of the measures in federal programs, a desire to include adolescents and a recent adaptation of the measures for use in the National Committee for Quality Assurance’s (NCQA) Healthcare Efectivness Data and Information Set (HEDIS) program.
The depression measure development workgroup, led by Michael Trangle from HealthPartners, included provider representation from primary care, pediatrics, adult and adolescent psychiatry. The scope of redesign consideration focused on the inclusion of adolescents, expansion of the window for follow-up, consideration of additional patient reported outcome (PRO) tools, and a review of appropriate exclusions.
Incorporate adolescents into the depression measures and expand the follow-up assessment window
After a through discussion on the relevance of measuring depression outcomes for adolescents, the workgroup reached consensus that it was important to include adolescents in the measurement of depression outcomes. Further, the recommendation would modify the age range to include adolescents age 12 and older and report measures as two separate stratifications by age (not combined) into ages 12 to 17 and ages 18 and older.
The workgroup also reviewed the concept of expanding the window for follow-up among adolescents, in part, due to the challenges in following up with adolescent patients. In the end, the workgroup acknowledged that follow-up is challenging for adults as well and determined it is reasonable to expand the follow-up assessment window for all patients. The follow-up assessment window will be expanded to +/- 60 days for all patients and all outcome measures.
Additional Patient Reported Outcome tools reviewed
MNCM is frequently asked “Why just the PHQ-9 tool?” In response, the workgroup considered 21 Patient Reported Outcome (PRO) tools. Information on each was collected using standardized criteria and compiled for review. Many tools did not have the required cut-points for remission or scoring levels that address severity of depression symptoms. Many of the tools listed were acceptable for screening for potential depression but did not support the diagnosis of depression or measuring progress of symptoms (outcomes) over time. Ultimately, the workgroup reached consensus on adding only the PHQ-9M tool.
The workgroup decided to allow the use of both tools (PHQ-9 and PHQ-9M) and not restrict tool use by age. They believed it was best to leave the decision up to the medical groups in terms of which tool best fits their practice (e.g., a pediatric practice could use the PHQ-9M for all their patients including “older” patients and a family practice clinic could use the PHQ-9 for all their patients ages 12 and older).
MARC also approved modifications to exclusions.
In order to minimize disruption, allow time for medical groups to make changes and to permit future comparability of performance over time, MARC approved the workgroup’s recommendations in their entirety for 2018 dates of index reported in 2020 (i.e., for 2020 Report Year dates of index event January 1, 2018 to December 31, 2018).
Feedback about these changes will be accepted at firstname.lastname@example.org until Friday, December 9, 2016.