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Measure Summary
This measure is endorsed by the National Quality Forum
Title
Child and adolescent major depressive disorder: percentage of patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder with an assessment for suicide risk.
Source(s)
Physician Consortium for Performance Improvement®. Child and adolescent major depressive disorder physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2010 Sep. 30 p. [13 references]

Measure Domain

Primary Measure Domain
Clinical Quality Measures: Process
Secondary Measure Domain
Does not apply to this measure

Brief Abstract

Description

This measure is used to assess the percentage of patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder with an assessment for suicide risk.

Rationale

Research has shown that patients with major depressive disorder are at a high risk for suicide, which makes this assessment an important aspect of care that should be assessed at each visit.

The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines and represent the evidence base for the measure:

The evaluation must include assessment for the presence of harm to self or others. (American Academy of Child and Adolescent Psychiatry [AACAP], 2007)

Suicidal behavior exists along a continuum from passive thoughts of death to a clearly developed plan and intent to carry out that plan. Because depression is closely associated with suicidal thoughts and behavior, it is imperative to evaluate these symptoms at the initial and subsequent assessments. For this purpose, low burden tools to track suicidal ideation and behavior such as the Columbia-Suicidal Severity Rating Scale can be used. Also, it is crucial to evaluate the risk (e.g., age, sex, stressors, comorbid conditions, hopelessness, impulsivity) and protective factors (e.g., religious belief, concern not to hurt family) that might influence the desire to attempt suicide. The risk for suicidal behavior increases if there is a history of suicide attempts, comorbid psychiatric disorders (e.g., disruptive disorders, substance abuse), impulsivity and aggression, availability of lethal agents (e.g., firearms), exposure to negative events (e.g., physical or sexual abuse, violence), and a family history of suicidal behavior. (AACAP, 2007)

The American Psychiatric Association recommends that psychiatric management include an evaluation of the safety of the patient and others. The components of an evaluation for suicide risk should include 1) an assessment of the presence of suicidal or homicidal ideation, intent, or plans, 2) access to means for suicide and the lethality of those means, 3) presence of psychotic symptoms, command hallucinations, or severe anxiety, 4) presence of alcohol or substance use, 5) history and seriousness of previous attempts, and 6) family history or recent exposure to suicide. (American Psychiatric Association [APA], 2000)

Evidence for Rationale
American Psychiatric Association (APA). Practice guideline for the treatment of patients with major depressive disorder (revision). American Psychiatric Association. Am J Psychiatry. 2000 Apr;157(4 Suppl):1-45. [325 references] PubMed External Web Site Policy

Birmaher B, Brent D, AACAP Work Group on Quality Issues, Bernet W, Bukstein O, Walter H, Benson RS, Chrisman A, Farchione T, Greenhill L, Hamilton J, Keable H, Kinlan J, Schoettle U, Stock S, Ptakowski KK, Medicus J. Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry. 2007 Nov;46(11):1503-26. PubMed External Web Site Policy

Physician Consortium for Performance Improvement®. Child and adolescent major depressive disorder physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2010 Sep. 30 p. [13 references]
Primary Health Components

Child and adolescent major depressive disorder; suicide risk assessment

Denominator Description

All patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder

Note: Refer to the original measure documentation for administrative codes.

Numerator Description

Patient visits with an assessment for suicide risk

Note: Refer to the original measure documentation for administrative codes.

Evidence Supporting the Measure

Type of Evidence Supporting the Criterion of Quality for the Measure
  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use of the Measure

State of Use
Current routine use
Current Use
Internal quality improvement
Pay-for-reporting
Professional certification
Public reporting

Application of the Measure in its Current Use

Measurement Setting
Ambulatory/Office-based Care
Professionals Involved in Delivery of Health Services
Physicians
Least Aggregated Level of Services Delivery Addressed
Individual Clinicians or Public Health Professionals
Statement of Acceptable Minimum Sample Size
Does not apply to this measure
Target Population Age

Ages 6 through 17 years

Target Population Gender
Either male or female

National Strategy for Quality Improvement in Health Care

National Quality Strategy Aim
Better Care
National Quality Strategy Priority
Making Care Safer
Prevention and Treatment of Leading Causes of Mortality

Institute of Medicine (IOM) National Health Care Quality Report Categories

IOM Care Need
Getting Better
IOM Domain
Effectiveness
Safety

Data Collection for the Measure

Case Finding Period

Unspecified

Denominator Sampling Frame
Patients associated with provider
Denominator (Index) Event or Characteristic
Clinical Condition
Encounter
Patient/Individual (Consumer) Characteristic
Denominator Time Window
Does not apply to this measure
Denominator Inclusions/Exclusions

Inclusions
All patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder

Note: Refer to the original measure documentation for administrative codes.

Exclusions
None

Exclusions/Exceptions
Unspecified
Numerator Inclusions/Exclusions

Inclusions
Patient visits with an assessment for suicide risk

Note: Refer to the original measure documentation for administrative codes.

Exclusions
None

Numerator Search Strategy
Fixed time period or point in time
Data Source
Administrative clinical data
Electronic health/medical record
Paper medical record
Type of Health State
Does not apply to this measure
Instruments Used and/or Associated with the Measure

Unspecified

Computation of the Measure

Measure Specifies Disaggregation
Does not apply to this measure
Scoring
Rate/Proportion
Interpretation of Score
Desired value is a higher score
Allowance for Patient or Population Factors
Unspecified
Standard of Comparison
Internal time comparison

Identifying Information

Original Title

Measure #3: suicide risk assessment.

Submitter
American Medical Association on behalf of the Physician Consortium for Performance Improvement® - Medical Specialty Society
Developer
Physician Consortium for Performance Improvement® - Clinical Specialty Collaboration
Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Richard Hellman, MD, FACP, FACE (Co-chair) (methodologist; clinical endocrinology); John Oldham, MD (Co-chair) (psychiatry); Boris Birmaher, MD (child/adolescent psychiatry); Mary Dobbins, MD, FAAP (pediatrics/psychiatry); Scott Endsley, MD, MSc (family medicine); William E. Golden, MD, FACP (internal medicine); Margaret L. Keeler, MD, MS, FACEP (emergency, medicine); Louis J. Kraus, MD (child/adolescent psychiatry); Laurent S. Lehmann, MD (psychiatry); Karen Pierce, MD (child/adolescent psychiatry); Reed E. Pyeritz, MD, PhD, FACP, FACMG (medical genetics); Laura Richardson, MD, MPH (internal medicine/pediatrics); Sam J.W. Romeo, MD, MBA (family medicine); Carl A. Sirio, MD (critical care medicine); Sharon Sweede, MD (family medicine); Scott Williams, PsyD (The Joint Commission)

American Medical Association: Heidi Bossley, MSN, MBA; Joseph Gave, MPH; Karen Kmetik, PhD; Shannon Sims, MD, PhD; Samantha Tierney, MPH

American Psychiatric Association: Robert Plovnick, MD, MS

National Committee for Quality Assurance: Phil Renner, MBA

Consultants: Timothy Kresowik, MD; Rebecca Kresowik

Financial Disclosures/Other Potential Conflicts of Interest

Conflicts, if any, are disclosed in accordance with the Physician Consortium for Performance Improvement® conflict of interest policy.

Endorser
National Quality Forum
NQF Number
1365
Date of Endorsement

2011 Aug 15

Measure Initiative(s)
Physician Quality Reporting System
Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC
2010 Sep
Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The Physician Consortium for Performance Improvement reaffirmed the currency of this measure in November 2011.

Source(s)
Physician Consortium for Performance Improvement®. Child and adolescent major depressive disorder physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2010 Sep. 30 p. [13 references]
Measure Availability

The individual measure, "Measure #3: Suicide Risk Assessment," is published in "Child and Adolescent Major Depressive Disorder Physician Performance Measurement Set." This document and technical specifications are available in Portable Document Format (PDF) from the American Medical Association (AMA)-convened Physician Consortium for Performance Improvement® Web site: www.physicianconsortium.org External Web Site Policy.

For further information, please contact AMA staff by e-mail at cqi@ama-assn.org.

NQMC Status

This NQMC summary was completed by ECRI Institute on March 2, 2009. The information was verified by the measure developer on April 13, 2009. This NQMC summary was retrofitted into the new template on May 10, 2011. The information was reaffirmed by the measure developer on November 30, 2011. This NQMC summary was edited by ECRI Institute on April 27, 2012.

Copyright Statement

© 2008 American Medical Association. All Rights Reserved.

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