Description :  The percentage of members 18 years of age and older who were treated with antidepressant medication, had a diagnosis of 

major depression and who remained on an antidepressant medication treatment. Two rates are reported.


  1. Effective Acute Phase Treatment. The percentage of members who remained on an antidepressant medication for at least 84 days (12 weeks).
  2. Effective Continuation Phase Treatment. The percentage of members who remained on an antidepressant medication for at least 180 days (6 months).


Denominator:  


Product lines
Commercial, Medicaid, Medicare (report each product line separately).
Ages
18 years and older as of April 30 of the measurement year.
Continuous enrollment
105 days prior to the IPSD through 231 days after the IPSD.
Allowable gap
One gap in enrollment of up to 45 days. To determine continuous enrollment for a Medicaid beneficiary for whom enrollment is verified monthly, the member may not
have more than a 1-month gap in coverage (i.e., a member whose coverage lapses for 2 months [60 days] is not considered continuously enrolled).


Anchor date
IPSD.
Benefits
Medical and pharmacy.
Event/diagnosis
Follow the steps below to identify the eligible population, which is used for both rates.

Step 1

Determine the IPSD. Identify the date of the earliest dispensing event for an antidepressant medication (Table AMM-C) during the Intake Period.

Step 2: Required exclusion

Exclude members who did not have a diagnosis of major depression in an inpatient, outpatient, ED, intensive outpatient or partial hospitalization setting during the 121-day period from 60 days prior to the IPSD, through the IPSD and the 60 days after the IPSD. Members who meet any of the following criteria remain in the eligible population:
  • An outpatient visit, intensive outpatient encounter or partial hospitalization with any diagnosis of major depression. Either of the following code combinations meets criteria:
    • AMM Stand Alone Visits Value SetwithMajor Depression Value Set.
    • AMM Visits Value SetwithAMM POS Value SetandMajor Depression Value Set.
  • An ED visit (ED Value Set) with any diagnosis of major depression (Major Depression Value Set).
  • An acute or nonacute inpatient stay with any diagnosis of major depression (Major Depression Value Set). To identify acute and nonacute inpatient stays:
  1. Identify all acute and nonacute inpatient stays (Inpatient Stay Value Set).
  2. Identify the admission and discharge dates for the stay. Either an admission or discharge during the required time frame meets criteria.

Step 3

Test for Negative Medication History. Exclude members who filled a prescription for an antidepressant medication 105 days prior to the IPSD.

Step 4

Calculate continuous enrollment. Members must be continuously enrolled for 105 days prior to the IPSD to 231 days after the IPSD.


Denominator Exclusions (when applicable)  Note: Members in hospice are excluded from the eligible 

population. Refer to General Guideline 20: Members in Hospice.


Numerator:  


Effective Acute Phase Treatment

At least 84 days (12 weeks) of treatment with antidepressant medication (Table AMM-C), beginning on the IPSD through 114 days after the IPSD (115 total days). This allows gaps in medication treatment up to a total of 31 days during the 115-day period. Gaps can include either washout period gaps to change medication or treatment gaps to refill the same medication.

Table AMM-C: Antidepressant Medications

Description
Prescription

Miscellaneous antidepressants
Bupropion
Vilazodone
Vortioxetine

Monoamine oxidase inhibitors
Isocarboxazid
Phenelzine
Selegiline
Tranylcypromine

Phenylpiperazine antidepressants
Nefazodone
Trazodone

Psychotherapeutic combinations
Amitriptyline-chlordiazepoxide
Amitriptyline-perphenazine
Fluoxetine-olanzapine

SNRI antidepressants
Desvenlafaxine
Duloxetine
Levomilnacipran
Venlafaxine


SSRI antidepressants
Citalopram
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline

Tetracyclic antidepressants
Maprotiline
Mirtazapine

Tricyclic antidepressants
Amitriptyline
Amoxapine
Clomipramine
Desipramine
Doxepin (>6 mg)
Imipramine
Nortriptyline
Protriptyline
Trimipramine

 Continuation Phase Treatment

At least 180 days (6 months) of treatment with antidepressant medication (Table AMM-C) beginning on the IPSD through 231 days after the IPSD (232 total days). This allows gaps in medication treatment up to a total of 52 days during the 232-day period. Gaps can include either washout period gaps to change medication or treatment gaps to refill the same medication.



Note

Organizations may have different methods for billing intensive outpatient encounters and partial hospitalizations. Some methods may be comparable to outpatient billing, with separate claims for each date of service; others may be comparable to inpatient billing, with an admission date, a discharge date and units of service. Organizations whose billing methods are comparable to inpatient billing may count each unit of service as an individual visit. The unit of service must have occurred during the period specified.