INTRODUCTION: The Patient Health Questionnaire-9 (PHQ-9) is a tool used to help diagnose depression and assess a patient’s response to treatment. Quality metric (QM) 371 is a measure of PHQ-9 utilization in patients with depression, and Medical City Family Medicine tracks QM 371 in order to improve the quality of care provided to our patients. This project sought to assess utilization of the PHQ-9 in our clinical practice. At the time of this QI project’s inception, QM 371 was reporting at 0%.
METHODS: Our intervention was to give an educational presentation regarding depression, the PHQ-9, as well as how to properly document the PHQ-9 in eClinicalWorks (eCW) for data tracking. QM 371 is calculated as follow: the denominator includes patients 12 years and older with a diagnosis of Major Depression or Dysthymia within the eligible 4-month period, and the numerator includes all patients age 12 and older that have completed the PHQ-9 at least once within the 4-month period. Our educational presentation was given on Sept 1st at the start of the reporting period for QM 371 and included screen shots depicting the workflow for inputting the PHQ-9 into the eCW smart form.
RESULTS: A data query 2 months in showed that QM 371 continued to measure 0%, however the authors of this study knew that a value of 0% should not be possible. We at least, were properly documenting PHQ-9 utilization. The query was escalated multiple times until it was discovered that Centers for Medicare and Medicaid Services (CMS) discontinued QM 371. The Division Director of Quality Initiatives provided us with the data that QM 371 would have been tracking if it were still in use. The results indicate that all three clinical sites, at the time of the data query, were close-to or at the goal of 22.09%. Data received mid-November showed the Arlington site at 17.82%, the North Hills site at 26.32% and the Denton site at 22.41% year-to-date (YTD).
CONCLUSION: It was discovered that QM 371 was discontinued by CMS, unbeknownst to anyone in our organization. Our QI project identified a major gap between our clinical practices, in this case use of the PHQ-9, and the clinical informatics that were being reported. Awareness of this gap creates opportunity to determine a new way to measure and improve the quality of care we provide to patients with depression.