Writing Committee. ACP Performance Measurement Committee Members*

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1 Performance Measurement Diagnosis and Treatment of Depression: Review of the Performance Measures by the Performance Measurement Committee of the American College of Physicians Writing Committee Amir Qaseem, MD, Eileen D. Barrett, MD, J. Thomas Cross, MD, Andrew Dunn, MD, Nick Fitterman, MD, Robert A. Gluckman, MD, Susan Thompson Hingle, MD, Kesavan Kutty, MD, Eve A. Kerr, MD, Ana Maria López, MD, Catherine MacLean, MD, Stephen D. Persell, MD, and Terrence Shaneyfelt, MD, and Sarah West, RN ACP Performance Measurement Committee Members* Eve A. Kerr, MD, MPH (Chair); Catherine MacLean, MD, PhD (Vice Chair); Eileen D. Barrett, MD, MPH; J. Thomas Cross, MD, MPH; Andrew Dunn, MD; Nick Fitterman, MD; Robert A. Gluckman, MD; Susan Thompson Hingle, MD; Kesavan Kutty, MD; Ana Maria López, MD, MPH; Stephen D. Persell, MD, MPH; and Terrence Shaneyfelt, MD, MPH Corresponding author: A. Qaseem 190 N. Independence Mall West Philadelphia, PA * Individuals who served on the Performance Measurement Committee from initiation of the project until its approval

2 ACP does not support NQF 0710: Depression: Remission at Twelve Months. ACP does not support this measure because the threshold of reaching a specific PHQ-9 score (<5) is arbitrary and does not take into account the individual starting points for each patient. For example, a reduction from 6 to 5 can be considered as less progress than a reduction from a 9 to 6; however, this measure would reward the former and penalize the latter. ACP would be amenable to using this measure as a tracking mechanism, but opposes any linkage to performance and payment. NQF 0710: Depression: Remission at Twelve Months Status: NQF Endorsed, Last Updated Mar 06, 2015 (MU2 EHR Incentive Program) Description: Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at twelve months defined as a PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment. This measure additionally promotes ongoing contact between the patient and provider as patients who do not have a follow-up PHQ-9 score at twelve months (+/- 30 days) are also included in the denominator. Numerator Adults age 18 and older with a diagnosis of major depression or dysthymia and an initial PHQ-9 score greater than nine who achieve remission at twelve months as demonstrated by a twelve month (+/- 30 days) PHQ-9 score of less than five. Denominator Adults age 18 and older with a diagnosis of major depression or dysthymia and an initial (index) PHQ-9 score greater than nine. Patient Reported Outcome

3 ACP supports NQF 0712: Depression: Utilization of the PHQ-9 Tool. ACP supports this measure. Evidence supports utilization of the PHQ-9 tool for monitoring the treatment progress in patients with depression. Furthermore, this measure has potential to lead to an accurate outcome measure by determining well validated levels of depression severity. NQF 0712: Depression: Utilization of the PHQ-9 Tool Status: NQF Endorsed, Last Updated Mar 06, 2015 Description: Numerator Denominator four month measurement period. The Patient Health Questionnaire (PHQ- 9) tool is a widely accepted, standardized tool that is completed by the patient, ideally at each visit, and utilized by the provider to monitor treatment progress. four month measurement period. dysthymia. Process

4 ACP does not support NQF 1885: Depression Remission at Twelve Months: Progress towards Remission. ACP does not support this measure. It is an unrealistic expectation for patients to achieve a 50% reduction rate from the initial PHQ- 9 score. It would be meaningful to re-evaluate this measure after receiving the evidence on well validated reduction rates. NQF 1885: Depression Remission at Twelve Months: Progress Towards Remission Status: NQF Endorsed, Last Updated Mar 02, 2015 Description: Numerator Denominator four month measurement period. The Patient Health Questionnaire (PHQ- 9) tool is a widely accepted, standardized tool that is completed by the patient, ideally at each visit, and utilized by the provider to monitor treatment progress. four month measurement period. dysthymia. Process

5 Financial Financial support for the Performance Measurement Committee comes exclusively from the ACP operating budget. Conflicts of Interest: Any financial and nonfinancial conflicts of interest of the group members were declared, discussed, and resolved. A record of conflicts of interest is kept for each PMC meeting and conference call and can be viewed at: tm APPROVED BY THE ACP BOARD OF REGENTS ON: November 7, 2015 Members of the PMC: Individuals who served on the Performance Measurement Committee from initiation of the project until its approval: Eileen D. Barrett, MD, MPH J. Thomas Cross, Jr., MD, MPH Andrew Dunn, MD Nick Fitterman, MD Robert A. Gluckman, MD Susan Thompson Hingle, MD Kesavan Kutty, MD Eve Askanas Kerr, MD, MPH Ana María López, MD, MPH Catherine MacLean, MD, PhD Stephen D. Persell, MD, MPH Terrence Shaneyfelt, MD, MPH Requests and inquiries: Amir Qaseem, MD, PhD, MHA, FACP, American College of Physicians, 190. N Independence Mall West, Philadelphia, PA 19106: , aqaseem@acponline.org