Changes to the Patient Health Questionnaire – 9 (PHQ-9) will be made to help providers meet the requirements for NQF 0418: Screening for Depression and Follow-Up Plan and NQF 0710: Depression Remission at Twelve Months.
When documenting an Ad Hoc form for PHQ-9 the person documenting must choose the reason for completing the questionnaire; Screening or Remission Evaluation (see Figure 1).
Depending on the choice 1 of 2 versions of the PHQ-9 will open. The PHQ-9 itself is unchanged. However, the reasons available for excluding the patient from the screening are different on the two forms.
Appropriate exclusion criteria for not completing a routine screening include (see Figure 2)-
- Active diagnosis for depression or bipolar disorder
- Patient refuses to participate
- Patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient’s health status
- Situations where the patient’s functional capacity or motivation to improve may impact the accuracy of results of standardized depression assessment tool. Example: certain court appointed case or cases of delirium.[i]
Appropriate exclusion criteria for not completing an evaluation for depression remission include (see Figure 3)-
- Patients with a diagnosis of bipolar disorder
- Patients with a diagnosis of personality disorder
- Patients who were permanent nursing home residents[ii]
Figure 1 PHQ-9 Decision Tree
Figure 2 PHQ-9 Screening
Figure 3 PHQ-9 Remission Assessment
