2017 CMS Web Interface

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1 CMS Web Interface PREV-12 (NQF 0418): Preventive Care and Screening: Screening fr Depressin and Fllw-Up Measure Steward: CMS Web Interface V1.0 Page 1 f 22 11/15/2016

2 Cntents INTRODUCTION... 3 WEB INTERFACE SAMPLING INFORMATION... 4 BENEFICIARY SAMPLING... 4 NARRATIVE MEASURE SPECIFICATION... 5 DESCRIPTION:... 5 IMPROVEMENT NOTATION:... 5 INITIAL POPULATION:... 5 DENOMINATOR:... 5 DENOMINATOR EXCLUSIONS:... 5 DENOMINATOR EXCEPTIONS:... 5 NUMERATOR: NUMERATOR EXCLUSIONS:... 5 DEFINITIONS:... 5 GUIDANCE:... 6 SUBMISSION GUIDANCE... 7 PATIENT CONFIRMATION... 7 SUBMISSION GUIDANCE... 8 DENOMINATOR CONFIRMATION... 8 SUBMISSION GUIDANCE... 9 NUMERATOR REPORTING... 9 SUBMISSION GUIDANCE NUMERATOR REPORTING DOCUMENTATION REQUIREMENTS APPENDIX I: PERFORMANCE CALCULATION FLOW APPENDIX II: DOWNLOADABLE RESOURCE MAPPING TABLE APPENDIX III: MEASURE RATIONALE AND CLINICAL RECOMMENDATION STATEMENTS RATIONALE: CLINICAL RECOMMENDATION STATEMENTS: APPENDIX IV: USE NOTICES, COPYRIGHTS, AND DISCLAIMERS COPYRIGHT Web Interface V1.0 Page 2 f 22 11/15/2016

3 INTRODUCTION There are a ttal f 15 individual measures (including ne cmpsite cnsisting f tw measures) included in the CMS Web Interface targeting high-cst chrnic cnditins, preventive care, and patient safety. The measures dcuments are represented individually and cntain measure specific infrmatin. The crrespnding cding dcuments are psted separately in an Excel frmat. The Measure Dcuments are being prvided t allw grup practices and Accuntable Care Organizatins (ACOs) an pprtunity t better understand each f the 15 individual measures included in the CMS Web Interface data submissin methd. Each Measure Dcument cntains infrmatin necessary t submit data thrugh the CMS Web Interface. Narrative specificatins, supprting submissin dcumentatin, and calculatin flws are prvided within each dcument. Please review all f the measure dcumentatin in its entirety t ensure cmplete understanding f these measures. Web Interface V1.0 Page 3 f 22 11/15/2016

4 WEB INTERFACE SAMPLING INFORMATION BENEFICIARY SAMPLING Fr mre infrmatin n the sampling prcess and methdlgy please refer t the Web Interface Sampling Dcument, available at CMS.gv. Web Interface V1.0 Page 4 f 22 11/15/2016

5 NARRATIVE MEASURE SPECIFICATION DESCRIPTION: Percentage f patients aged 12 years and lder screened fr depressin n the date f the encunter using an age apprpriate standardized depressin screening tl AND if psitive, a fllw-up plan is dcumented n the date f the psitive screen IMPROVEMENT NOTATION: Higher scre indicates better quality INITIAL POPULATION: All patients aged 12 years and lder befre the beginning f the measurement perid with at least ne eligible encunter during the measurement perid DENOMINATOR: Equals Initial Ppulatin DENOMINATOR EXCLUSIONS: Patients with an active diagnsis fr Depressin r a diagnsis f Biplar Disrder DENOMINATOR EXCEPTIONS: Patient Reasn(s): Patient refuses t participate OR Medical Reasn(s): Patient is in an urgent r emergent situatin where time is f the essence and t delay treatment wuld jepardize the patient s health status OR Situatins where the patient s functinal capacity r mtivatin t imprve may impact the accuracy f results f standardized depressin assessment tls. Fr example: certain curt appinted cases r cases f delirium NUMERATOR: Patients screened fr depressin n the date f the encunter using an age apprpriate standardized tl AND if psitive, a fllw-up plan is dcumented n the date f the psitive screen NUMERATOR EXCLUSIONS: Nt Applicable DEFINITIONS: Screening: Cmpletin f a clinical r diagnstic tl used t identify peple at risk f develping r having a certain disease r cnditin, even in the absence f symptms. Standardized Depressin Screening Tl A nrmalized and validated depressin screening tl develped fr the patient ppulatin in which it is being utilized. Examples f depressin screening tls include but are nt limited t: Adlescent Screening Tls (12-17 years) Patient Health Questinnaire fr Adlescents (PHQ-A) Beck Depressin Inventry-Primary Care Versin (BDI-PC) Md Feeling Questinnaire (MFQ) Center fr Epidemilgic Studies Depressin Scale (CES-D) Patient Health Questinnaire (PHQ-9) Pediatric Symptm Checklist (PSC-17) PRIME MD-PHQ-2 Web Interface V1.0 Page 5 f 22 11/15/2016

6 Adult Screening Tls (18 years and lder) Patient Health Questinnaire (PHQ-9) Beck Depressin Inventry (BDI r BDI-II) Center fr Epidemilgic Studies Depressin Scale (CES-D) Depressin Scale (DEPS) Duke Anxiety-Depressin Scale (DADS) Geriatric Depressin Scale (GDS) Crnell Scale Screening PRIME MD-PHQ-2 Fllw-Up : Dcumented fllw-up fr a psitive depressin screening must include ne r mre f the fllwing: Additinal evaluatin fr depressin Suicide Risk Assessment Referral t a practitiner wh is qualified t diagnse and treat depressin Pharmaclgical interventins Other interventins r fllw-up fr the diagnsis r treatment f depressin GUIDANCE: A depressin screen is cmpleted n the date f the encunter using an age apprpriate standardized depressin screening tl AND if psitive, a fllw-up plan is dcumented n the date f the psitive screen. Screening Tls: The name f the age apprpriate standardized depressin screening tl utilized must be dcumented in the medical recrd The depressin screening must be reviewed and addressed in the ffice f the prvider filing the cde, n the date f the encunter The screening and encunter must ccur n the same date Standardized Depressin Screening Tls shuld be nrmalized and validated fr the age apprpriate patient ppulatin in which they are used and must be dcumented in the medical recrd Fllw-Up : The fllw-up plan must be related t a psitive depressin screening, example: Patient referred fr psychiatric evaluatin due t psitive depressin screening. Web Interface V1.0 Page 6 f 22 11/15/2016

7 PATIENT CONFIRMATION SUBMISSION GUIDANCE Establishing patient eligibility fr reprting requires the fllwing: Guidance Determine if the patient s medical recrd can be fund OR OR If yu can lcate the medical recrd select Yes If yu cannt lcate the medical recrd select N - Medical Recrd Nt Fund Determine if the patient is qualified fr the sample If the patient is deceased, in hspice, mved ut f the cuntry r was enrlled in HMO select Nt Qualified fr Sample, select the applicable reasn frm the prvided drp-dwn menu, and enter the date the patient became ineligible Patient Cnfirmatin If N Medical Recrd Nt Fund r Nt Qualified fr Sample is selected, the patient is cmpleted but nt cnfirmed. The patient will be skipped and anther patient must be reprted in their place, if available. The Web Interface will autmatically skip any patient fr whm N Medical Recrd Nt Fund r Nt Qualified fr Sample is selected in all ther measures int which they have sampled. If Nt Qualified fr Sample is selected and the date is unknwn, yu may enter the last date f the measurement perid (i.e., 12/31/). The Measurement Perid is defined as January 1 December 31,. NOTE: - In Hspice: Select this ptin if the patient is nt qualified fr sample due t being in hspice care at any time during the measurement perid (this includes nn-hspice patients receiving palliative gals r cmfrt care) - Mved ut f Cuntry: Select this ptin if the patient is nt qualified fr sample because they mved ut f the cuntry any time during the measurement perid - Deceased: Select this ptin if the patient died during the measurement perid - HMO Enrllment: Select this ptin if the patient was enrlled in an HMO at any time during the measurement perid (i.e., Medicare Advantage, nn-medicare HMOs, etc.) Web Interface V1.0 Page 7 f 22 11/15/2016

8 DENOMINATOR CONFIRMATION SUBMISSION GUIDANCE Determine if the patient is qualified fr the measure OR OR If the patient is qualified fr this measure select Yes If there is a denminatr exclusin fr patient disqualificatin frm the measure select Denminatr Exclusin If there is an ther CMS apprved reasn fr patient disqualificatin frm the measure select N - Other CMS Apprved Reasn Denminatr Exclusin cdes can be fund in the Web Interface PREV Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance Denminatr If Denminatr Exclusin r N Other CMS Apprved Reasn is selected, the patient will be skipped and anther patient must be reprted in their place, if available. The patient will nly be remved frm the measure fr which ne f these ptins was selected, nt all Web Interface measures. CMS Apprved Reasn may nly be selected when apprved by CMS. T request a CMS Apprved Reasn, yu wuld need t prvide the patient rank, measure and reasn fr request in a Quality Payment Prgram Service Desk inquiry. CMS decisin will be prvided in the reslutin f the inquiry. Patients fr whm CMS Apprved Reasn is selected are n lnger qualified fr the measure. The patient will be skipped and anther patient must be reprted in their place, if available. NOTE: - The term active diagnsis is defined as a diagnsis that is either n the patient s prblem list, a diagnsis cde listed n the encunter, r is dcumented in a prgress nte indicating that the patient is being treated r managed fr the disease r cnditin during the denminatr identificatin measurement perid Web Interface V1.0 Page 8 f 22 11/15/2016

9 NUMERATOR REPORTING Denminatr Exceptins SUBMISSION GUIDANCE Determine if the patient was screened fr depressin using an age apprpriate standardized tl during the measurement perid OR OR OR If the patient was nt screened fr depressin using a standardized tl select N If the patient was dcumented as having been screened fr depressin using ne f the standardized tls select Yes If the patient was nt screened fr depressin using a standardized tl due t a medical reasn select N - Denminatr Exceptin Medical Reasns If the patient was nt screened fr depressin using a standardized tl due t a patient reasn select N - Denminatr Exceptin Patient Reasns Numeratr and Denminatr Exceptin cdes can be fund in the Web Interface PREV Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance Numeratr NOTE: - Use mst recent screening fr depressin - Althugh the patient may have access t the depressin screening tl in advance f the appintment the depressin screening results must be dcumented n the date f the encunter (date f appintment).the results must be reviewed/verified and dcumented by the eligible prfessinal in the medical recrd n the date f the encunter t meet the screening prtin f this measure - Screening fr depressin may be cmpleted during a telehealth encunter Web Interface V1.0 Page 9 f 22 11/15/2016

10 NUMERATOR REPORTING SUBMISSION GUIDANCE Determine if the screen was psitive fr depressin during the measurement perid OR If the patient's screen was nt psitive fr depressin using a standardized tl select N If the patient's screen was psitive fr depressin using a standardized tl select Yes IF YES Determine if a fllw-up plan fr depressin was dcumented during the measurement perid If a fllw-up plan fr depressin is nt dcumented select N OR If a fllw-up plan fr depressin is dcumented select Yes Numeratr cdes can be fund in the Web Interface PREV Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance NOTE: Numeratr - Dcumentatin f recmmended fllw-up plan fr a psitive depressin screen may be cmpleted during a telehealth encunter Web Interface V1.0 Page 10 f 22 11/15/2016

11 DOCUMENTATION REQUIREMENTS When submitting data thrugh the CMS Web Interface, the expectatin is that medical recrd dcumentatin is available that supprts the actin reprted in the Web Interface i.e., medical recrd dcumentatin is necessary t supprt the infrmatin that has been submitted. Web Interface V1.0 Page 11 f 22 11/15/2016

12 Appendix I: Perfrmance Calculatin Flw Web Interface V1.0 Page 12 f 22 11/15/2016

13 Web Interface V1.0 Page 13 f 22 11/15/2016

14 Web Interface V1.0 Page 14 f 22 11/15/2016

15 Patient Cnfirmatin Flw Fr, cnfirmatin f the Medical Recrd Fund, r indicating the patient is Nt Qualified fr Sample with a reasn f In Hspice, Mved ut f Cuntry, Deceased, r HMO Enrllment, will nly need t be dne nce per patient. Refer t the Measure Reprting Dcument fr further instructins. 1. Start Patient Cnfirmatin Flw. 2. Check t determine if Medical Recrd can be fund. a. If n, Medical Recrd nt fund, mark apprpriately fr cmpletin and stp abstractin. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. Stp prcessing. b. If yes, Medical Recrd fund, cntinue prcessing. 3. Check t determine if Patient Qualified fr the sample. a. If n, the patient des nt qualify fr the sample, select the reasn why and enter the date (if date is unknwn, enter 12/31/) the patient became ineligible fr sample. Fr example; In Hspice, Mved ut f Cuntry, Deceased, HMO Enrllment. Mark apprpriately fr cmpletin and stp abstractin. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. Stp prcessing. b. If yes, the patient des qualify fr the sample; cntinue t the Measure Cnfirmatin Flw fr PREV-12. Web Interface V1.0 Page 15 f 22 11/15/2016

16 Measure Cnfirmatin Flw fr PREV-12 Fr, measure specific reasns a patient is Nt Cnfirmed r excluded fr Denminatr Exclusin r Other CMS Apprved Reasn will need t be dne fr each measure where the patient appears. Refer t the Measure Reprting Dcument fr further instructins. 1. Start Measure Cnfirmatin Flw fr PREV-12. Cmplete fr cnsecutively ranked patients aged 12 years and lder at the beginning f the measurement perid. Further infrmatin regarding patient selectin fr specific disease and patient care measures can be fund in the Web Interface Sampling Methdlgy Dcument. Fr patients wh have the incrrect date f birth listed, a change f the patient date f birth by the abstractr may result in the patient n lnger qualifying fr the PREV-12 measure. If this is the case, the system will autmatically remve the patient frm the measure requirements. 2. Check t determine if the patient qualifies fr the measure (Denminatr Exclusin). a. If n, the patient des nt qualify fr the measure select: Denminatr Exclusin fr patient disqualificatin. Mark apprpriately fr cmpletin and stp abstractin. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. Stp prcessing. b. If yes, the patient des qualify fr the measure, cntinue prcessing. 3. Check t determine if the patient qualifies fr the measure (Other CMS Apprved Reasn). a. If n, the patient des nt qualify fr the measure select: N Other CMS Apprved Reasn fr patient disqualificatin. Mark apprpriately fr cmpletin and stp abstractin. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. Other CMS Apprved Reasn may nly be selected if yu have received an apprval frm CMS in the reslutin f a requested Quality Payment Prgram Service Desk Inquiry at QPP Service Desk. Stp prcessing. b. If yes, the patient des qualify fr the measure, cntinue t the PREV-12 measure flw. Web Interface V1.0 Page 16 f 22 11/15/2016

17 Measure Flw fr PREV-12 The measure diagrams were develped by CMS as a supplemental resurce t be used in cnjunctin with the measure specificatins. They shuld nt be used as a substitutin fr the measure specificatins. Fr Dwnladable Resurce Mapping Table, g t Appendix II and use the Variable Names lcated in the appendix alng with the applicable tabs within the PREV Cding Dcument. 1. Start prcessing PREV-12 (NQF 0418) Flw fr the patients that qualified fr sample in the Patient Cnfirmatin Flw and the Measure Cnfirmatin Flw fr PREV-12. Nte: Include remainder f patients listed in the Web Interface that were cnsecutively cnfirmed and cmpleted fr this measure in the denminatr. Fr the sample calculatin in the flw these patients wuld fall int the d categry (eligible denminatr, i.e. 227 patients). 2. Check t determine if the patient was screened fr depressin using an age apprpriate standardized tl during the measurement perid. a. If n, the patient was nt screened fr depressin using an age apprpriate standardized tl during the measurement perid, cntinue prcessing and prceed t step 5. b. If yes, the patient was screened fr depressin using an age apprpriate standardized tl during the measurement perid, cntinue prcessing. 3. Check t determine if the patient had a psitive screen fr depressin during the measurement perid. a. If n, the patient did nt have a psitive screen fr depressin during the measurement perid, perfrmance is met and the patient will be included in the numeratr. Fr the sample calculatin in the flw these patients wuld fall int the a¹ categry (numeratr, i.e. 50 patients). Stp prcessing. b. If yes, patient had a psitive screen fr depressin during the measurement perid, cntinue prcessing. 4. Check t determine if the patient had a fllw-up plan fr depressin dcumented n the date f the psitive screen. a. If n, the patient did nt have a fllw-up plan fr depressin dcumented n the date f the psitive screen, perfrmance is nt met and the patient shuld nt be included in the numeratr. Stp prcessing. b. If yes, the patient had a fllw-up plan fr depressin dcumented n the date f the psitive screen, perfrmance is met and the patient will be included in the numeratr. Fr the sample calculatin in the flw these patients wuld fall int the a² categry (numeratr, i.e. 116 patients). Stp prcessing. 5. Check t determine if the patient was Nt screened fr depressin using a standardized tl fr a denminatr exceptin, medical reasn(s). a. If n, the patient was Nt screened fr depressin using a standardized tl fr a denminatr exceptin, medical reasn(s), cntinue prcessing. b. If yes, the patient was Nt screened fr depressin using a standardized tl fr a denminatr exceptin, medical reasn(s), this is a denminatr exceptin and the case shuld be subtracted frm the denminatr. Fr the sample calculatin in the flw these patients wuld fall int the b¹ categry (denminatr exceptin, i.e. 18 patients). Stp prcessing. 6. Check t determine if the patient was Nt screened fr depressin using a standardized tl fr a denminatr exceptin, patient reasn(s). Web Interface V1.0 Page 17 f 22 11/15/2016

18 a. If n, the patient Nt screened fr depressin using a standardized tl fr a denminatr exceptin, patient reasn(s), perfrmance is nt met and the patient shuld nt be included in the numeratr. Stp prcessing. b. If yes, the patient was Nt screened fr depressin using a standardized tl fr a denminatr exceptin, patient reasn(s), this is a denminatr exceptin and the case shuld be subtracted frm the denminatr. Fr the sample calculatin in the flw these patients wuld fall int the b² categry (denminatr exceptin, i.e. 23 patients). Stp prcessing. Sample Calculatin Perfrmance Rate Equals Perfrmance Met is categry a¹ plus a² in the measure flw (166 patients) Denminatr is categry d in the measure flw (227 patients) Denminatr Exceptin is categry b¹ plus b² in the measure flw (41 patients) 166 (Perfrmance Met) divided by 186 (Denminatr minus Denminatr Exceptin) equals a perfrmance rate f percent Calculatin May Change Pending Perfrmance Met Web Interface V1.0 Page 18 f 22 11/15/2016

19 Appendix II: Dwnladable Resurce Mapping Table Each data element within this measure s denminatr r numeratr is defined as a pre-determined set f clinical cdes. These cdes can be fund in the Web Interface PREV Cding Dcument. *PREV-12: Preventive Care and Screening: Screening fr Depressin and Fllw-Up Measure Cmpnent/Excel Tab Data Element Variable Name Cding System(s) Denminatr Exclusin/ Denminatr Exclusin Cdes Exclusin BIPOLAR_DX_CODE I9 I10 SNM DEPRESSION_DX_CODE I9 I10 SNM Numeratr/Numeratr Depressin SCREENING_CODE LN Cdes/Numeratr Drug Cdes Screen NEG_SCREENING_CODE SNM POS_SCREENING_CODE SNM Psitive Screen POS_SCREENING_CODE SNM Fllw-up ADDITIONAL_EVAL_CODE SNM FOLLOW_UP_CODE SNM REFERRAL_CODE SNM SUICIDE_RISK_CODE SNM DEP_DRUG_CODE RxNrm (Drug EX=N) Denminatr Exceptin/ Medical Reasn MEDICAL_OTHER_REASON SNM Denminatr Exceptin Cdes Patient Reasn PATIENT_REASON_REFUSED SNM * Fr EHR mapping, the cding within PREV-12 is cnsidered t be all inclusive Web Interface V1.0 Page 19 f 22 11/15/2016

20 Appendix III: Measure Ratinale and Clinical Recmmendatin Statements RATIONALE: In 2008, the Geriatric Mental Fundatin reprted that f the ppulatin aged 65 and lder in the United States, percent f adults had experienced depressin (Geriatric Mental Health Fundatin, 2008), while 7 millin f the same ppulatin were affected by depressin (Steinman, 2007, p. 175) and accunted fr 16 percent f suicide deaths in 2004 (Centers fr Disease Cntrl and Preventin, 2007). The Wrld Health Organizatin (WHO), as cited by Pratt & Brdy (2008), fund that majr depressin was the leading cause f disability wrldwide. "Overall, apprximately 80% f persns with depressin reprted sme level f difficulty in functining because f their depressive symptms. In additin, 35% f males and 22% f females with depressin reprted that their depressive symptms make it very r extremely difficult fr them t wrk, get things dne at hme, r get alng with ther peple. Mre than ne-half f all persns with mild depressive symptms als reprted sme difficulty in daily functining attributable t their symptms" (Pratt & Brdy, 2008, p.2). Pratt & Brdy (2008) fund that depressin rates were higher in the age brackets, is mre cmmn in females than in males, and higher in nn- Hispanic black persns than in their nn-hispanic white cunterparts (Pratt & Brdy, 2008, p. 2). Disparities due t incme have als been bserved, as thse with lwer incme (belw the federal pverty line) in the and age brackets, whm experience higher depressin rates than thse with higher incme. This disparity is nt bservable in ther age categries (Pratt & Brdy, 2008, p. 2). Amng children, the rate f current r recent depressin stands at 3% and at 6% fr adlescents, whse lifetime incidence rate f majr depressive disrder (MDD) culd be as high as 20% (Williams et al., 2009, p. e716). Brner (2010), states that 20% f adlescents are likely t have experienced depressin by the time they are 18 years ld and that there is an bserved increased nset arund puberty. Onset f MDD during adlescence is particularly significant because it is assciated with higher risks f suicide attempt, death by suicide and MDD recurrence in yung adulthd. Additinally MDD is "assciated with early pregnancy, decreased schl perfrmance, and impaired wrk, scial, and family functining during yung adulthd" (Williams et al., 2009, p. e716). Accrding t Zalsman et al., (2006) as reprted in Brner et al. (2010), "depressin ranks amng the mst cmmnly reprted mental health prblems in adlescent girls" (p. 947). "The negative utcmes assciated with early nset depressin, make it crucial t identify and treat depressin in its early stages" (Brner, 2010, p. 948). While Primary Care Prviders (PCPs) serve as the first line f defense in the detectin f depressin, studies shw that PCPs fail t recgnize up t 50% f depressed patients, purprtedly because f time cnstraints and a lack f brief, sensitive, easy-t administer psychiatric screening instruments" (Brner, 2010, p. 948). "Cyle et al. (2003), suggested that the picture is mre grim fr adlescents, and that mre than 70% f children and adlescents suffering frm serius md disrders g unrecgnized r inadequately treated" (Brner, 2010, p. 948). The substantial ecnmic burden f depressin fr individuals and sciety alike makes a case fr screening fr depressin n a regular basis. This measure seeks t achieve this gal and aligns with the Healthy Peple 2020 recmmendatin fr rutine screening fr mental health prblems as a part f primary care fr bth children and adults (U.S. Department f Health and Human Services, 2014). The measure makes imprtant cntributin t the quality dmain f cmmunity and ppulatin health. CLINICAL RECOMMENDATION STATEMENTS: Adlescent Recmmendatin (12-18 years) The USPSTF recmmends screening f adlescents (12-18 years f age) fr majr depressive disrder (MDD) when systems are in place t ensure accurate diagnsis, psychtherapy (cgnitive-behaviral r interpersnal), and fllw-up (AHRQ, 2010, p.141). Web Interface V1.0 Page 20 f 22 11/15/2016

21 Clinicians and health care systems shuld try t cnsistently screen adlescents, ages 12-18, fr majr depressive disrder, but nly when systems are in place t ensure accurate diagnsis, careful selectin f treatment, and clse fllw-up (ICSI, 2013, p. 16). Adult Recmmendatin (18 years and lder) The USPSTF recmmends screening adults fr depressin when staff-assisted depressin care supprts are in place t assure accurate diagnsis, effective treatment, and fllw-up (AHRQ, 2010, p.136). A system that has embedded the elements f best practice and has capacity t effectively manage the vlume, shuld cnsider rutine screening f all patients based n the recmmendatins f the U.S. Preventive Services Task Frce (ICSI, 2013, p. 7). Clinicians shuld use a standardized instrument t screen fr depressin if it is suspected, based n risk factrs r presentatin. Clinicians shuld assess and treat fr depressin in patients with sme cmrbidities. Clinicians shuld acknwledge the impact f culture and cultural differences n physician and mental health. Clinicians shuld screen and mnitr depressin in pregnant and pst-partum wmen (ICSI, 2013, p. 4). Web Interface V1.0 Page 21 f 22 11/15/2016

22 Appendix IV: Use Ntices, Cpyrights, and Disclaimers COPYRIGHT These measures were develped by Quality Insights f Pennsylvania as a special prject under the Quality Insights' Medicare Quality Imprvement Organizatin (QIO) cntract HHSM PA001C with the Centers fr Medicare & Medicaid Services. These measures are in the public dmain. Limited prprietary cding is cntained in the measure specificatins fr cnvenience. Users f the prprietary cde sets shuld btain all necessary licenses frm the wners f these cde sets. Quality Insights f Pennsylvania disclaims all liability fr use r accuracy f any Current Prcedural Terminlgy (CPT [R]) r ther cding cntained in the specificatins. CPT cntained in the Measures specificatins is cpyright American Medical Assciatin. All Rights Reserved. These perfrmance measures are nt clinical guidelines and d nt establish a standard f medical care, and have nt been tested fr all ptential applicatins. THE MEASURES AND SPECIFICATIONS ARE PROVIDED AS IS WITHOUT WARRANTY OF ANY KIND. Web Interface V1.0 Page 22 f 22 11/15/2016

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