HEDIS Depression Measures Specified for Electronic Clinical Data

Why Focus on Depression?

Depression significantly impacts both mental and physical health and is the second leading cause of disability worldwide. The need to develop outcome measures that assess the quality of depression care planted the seed for the HEDIS Electronic Clinical Data System (ECDS) approach. Patient reported outcome measures are needed to understand depression outcomes, and these data are challenging to collect through typical HEDIS reporting methods. NCQA sees these measures as an opportunity to revolutionize the way data are collected and reported. 

Opportunities for Collaboration

NCQA is currently leading two initiatives focused on depression care work. We are currently seeking health plans and providers to participate in this important work beginning in July 2018. Interested plans and providers can participate in one or both projects. Please contact Cindy Manaoat (manaoat@ncqa.org) if your organization is interested to learn more about either project. 

Perinatal Depression Quality Measures Field Test

Funded by the California Health Care Foundation and the Colorado-based Zoma Foundation

NCQA will use its multi-stakeholder process to specify and test existing HEDIS depression care quality measures for prenatal/postpartum women. Additional information can be found here.

National Collaborative for Innovation in Quality Measurement

Funded by AHRQ/CMS under the Pediatric Quality Measures Program

NCINQ will be leading a learning collaborative with plans focused on improving performance on depression care measures for adolescents. Additional information can be found here.

What are the Depression Care Measures? 

NCQA adapted existing provider and practice level depression care quality measures for inclusion in HEDIS using data from electronic clinical data systems. NCQA has an FAQ for answers to frequently asked questions about reporting using data from electronic clinical data systems. Below is a high-level description of each of the measures.  

Depression Screening and Follow-up for Adolescents and Adults (DSF)
This measure is adapted from a provider-level measure developed by Quality Insights of Pennsylvania (QIP) (NQF #0418, CMS2). Learn more here. First implemented in HEDIS 2018.

The percentage of members 12 years of age and older who were screened for clinical depression using a standardized tool and, if screened positive, who received follow-up care. 

Denominator: All members age ≥12. 

Numerator: Screened for depression using a standardized tool and, if screened positive, received follow-up care within 30 days.  

Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS)
This measure is adapted from a depression measure developed by Minnesota Community Measurement (NQF #0712). Learn more at MNCM.org. First implemented in HEDIS 2016.

The percentage of members 12 years of age and older with a diagnosis of depression, who had an outpatient encounter with a PHQ-9 score present in their record in the same assessment period as the encounter.

Denominator: All members age ≥12 who had an encounter during a 4-month period with a diagnosis of major depressive disorder or dysthymia. 

Numerator: Documented results of a PHQ-9 tool that was administered at least once during the 4-month period. 

Depression Remission or Response for Adolescents and Adults
This measure is adapted from depression measures developed by Minnesota Community Measurement (NQF #0711 and #1884). Learn more at MNCM.org. First implemented in HEDIS 2017.

The percentage of members 12 years of age and older with a diagnosis of depression and an elevated PHQ-9 score, who had evidence of response or remission within 4–8 months after the initial elevated PHQ-9 score. 

Denominator: All members age ≥12 with a diagnosis of major depressive disorder or dysthymia who had an initial elevated PHQ-9 score of >9. 

Numerator: A follow-up PHQ-9 score documented at 4-8 months after the initial elevated score; a PHQ-9 score <5 documented at 4-8 months following the initial elevated score; a ≥50% reduction in the PHQ-9 score documented at 4-8 months following the initial elevated score.  

How can I access the Depression Care Measures? 

All three depression care measures can be found in HEDIS 2018 Volume 2. To access measure specifications for Depression Screening and Follow-Up for Adolescents and Adults (DSF), Utilization of PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS), and Depression Remission or Response for Adolescents and Adults (DRR) measures, please click here. Measure packages include: ECDS Guidelines, HEDIS measure descriptions, and logic calculations.