Percent of Residents Who Have Depressive Symptoms (Long Stay)
Background
The Long Stay Quality Measure, Percent of Residents Who Have Depressive Symptoms reports the percentage of long-stay residents – those whose stay is 101 days or more – who have had symptoms of depression during the 2 weeks preceding the MDS 3.0 target assessment date. The measure involves a Resident Mood Interview [PHQ-9] (Condition A) or a Staff Assessment of Resident Mood [PHQ-9-OV] (Condition B). This measure is reported on CASPER Reports and Nursing Home Compare.
Rationale for this Quality Measure
Depression is a medical problem of the brain that can affect how one thinks, feels, and behaves. Signs of depression may include fatigue, a loss of interest in normal activities, poor appetite, and problems with concentration and sleeping. Feeling depressed can lessen one’s quality of life and lead to other health problems. Nursing home residents are at high risk for developing depression and anxiety for many reasons, such as receiving a terminal diagnosis, loss of a spouse/family member/friend, chronic pain and illness, increased isolation as a result of the COVID-19 pandemic, difficulty adjusting to the nursing home, and frustration with memory loss. Identifying depression can be difficult in residents because the signs may be confused with the normal aging process, a side effect of medication, or the result of a medical condition. Proper treatment may include medication, therapy, or an increase in social support.
Assessment
Included in determining symptom presence and frequency are items in Section D of the Minimum Data Set (MDS). The items in this section address indicators of mood distress. It is important to note that coding the presence of indicators in Section D does not automatically mean that the resident has a diagnosis of depression or other mood disorder. Per the RAI Manual, assessors do not make or assign a diagnosis in Section D; they simply record the presence or absence of specific clinical mood indicators. Facility staff should recognize these indicators and consider them when developing the resident’s individualized care plan. Assessors should attempt to conduct the interview with all residents. This interview is conducted during the look-back period of the Assessment Reference Date (ARD) and is not contingent upon item B0700, Makes Self Understood.
Quality Measure Specifications
Numerator- describes the target process, condition, event, or outcome expected for the targeted population.
A Long-Stay resident will trigger this measure on the MDS 3.0 Facility Level Quality Measure Report if the most recent MDS 3.0 (Target Assessment) meets either of the following two conditions (A or B):
CONDITION A: The Resident Mood Interview (PHQ-9) must meet Part 1 and Part 2 below:
CONDITION B: The Staff Assessment of Resident Mood (PHQ-9-OV) must meet Part 1 and Part 2 below:
Denominator- Describes the population of residents or encounters for which the measure applies.
In this case, all long-stay residents with a selected target assessment, except those with exclusions.
Exclusions-Not included in the numerator or denominator due to a certain diagnosis or condition.
The resident is excluded if:
- Comatose or comatose status is missing (B0100 = [1, -]).
- The resident is not included in the numerator (the resident did not meet the depression symptom conditions for the numerator) and both of the following are true:
- (D0200A2 = [^, -]) or (D0200B2 = [^, -]) or (D0300 = [99. ^, -]).
- (D0500A2 = [^, -]) or (D0500B2 = [^, -]) or (D0600 = [^, -]).
Covariates – There are no covariates for this quality measure.
How can we improve our performance in this area?
Quality Measures are the result of actions/events that occurred and are captured through data collection. Creating a collaborative team environment that involves all members of the IDT will facilitate solution-oriented standards of excellence. Ways to improve quality measures include:
- Review CASPER reports regularly (e.g., monthly) and track and trend facility data
- Develop internal auditing and monitoring processes that include periodic competency reviews of
- PHQ-9 mood interviews (see Appendix D of the RAI manual – Interviewing To Increase Resident Voice – for appropriate interview techniques)
- Systems for ensuring the accuracy of MDS coding
- Staff facilities to match resident acuity
- Establish effective, continuous quality improvement programs
- Utilize QMs in your QA process
- Implement Trauma Informed Care best practices including, but not limited to resident assessment protocols and competency based training of staff
- Develop a complete Depression plan of care, including symptoms the resident exhibits, the current PHQ-9 score, and individualized interventions
- Refer the resident to practitioner(s) specializing in mental health as needed
Resources
- 5 Star Technical User’s Guide. (2020) https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/downloads/usersguide.pdf
- MDS 3.0 QM User’s Manual Version 13.0 (2020) https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIQualityMeasures
- MDS 3.0 QM User’s Manual Version 13.0 Appendix D, MDS 3.0 Quality Measures User’s Manual V 13.0 (2020) https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIQualityMeasures
Blog by Jessica Cairns, RN, RAC-CT, CMAC, Proactive Medical Review
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