Depression Utilization of the PHQ-9 Tool

Patients age 18 and older with the diagnosis of major depression or dysthymia who have a Patient Health Questionnaire (PHQ-9) tool administered at least once during a 4-month period in which there was a qualifying visit

Copyright MN Community Measurement, 2016. All rights reserved

This measure is "re-tooled" from the existing NQF # 712 measure. eMeasure development was a collaboration between MN Community Measurement and Telligen with technical assistance provided by Telligen.

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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 the National Institute of Mental Health (NIMH), 6.7% 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.

This process measure for using the Patient Health Questionnaire (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 PHQ-9 tool is a widely accepted, standardized tool [Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute.] 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. Available at www.phqscreeners.com. 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
* Trouble falling or staying asleep, or sleeping too much 
* 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

Higher scores indicate better quality

Institute for Clinical Systems Improvement (ICSI) Major  Depression in Adults in Primary Care 16th edition September 2013 www.icsi.org.

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.

The PHQ-9: Validity of a Brief Depression Severity Measure Kurt Kroenke, MD, Robert Spitzer, MD J Gen Intern Med 2001 16:606-613.

Collaborative Care for Depression: a Cumulative Meta-analysis and Review of Longer-term Outcomes. Gilbody, Simon et al Archives Internal Medicine Dec 2006.

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TBD

Patients age 18 and older with an office visit and the diagnosis of major depression or dysthymia during the four month period

Equals Initial Population

1: Patients who died
2: Patients who received hospice or palliative care services
3: Patients who were permanent nursing home residents 
4: Patients with a diagnosis of bipolar disorder
5: Patients with a diagnosis of personality disorder

Patients who have a PHQ-9 tool administered at least once during the four-month period

Not applicable

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For every patient evaluated by this measure also identify payer, race, ethnicity and sex

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