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