OASIS-Central

CMS implemented the depression screening process measure because it believed that depression was being underdiagnosed in elderly patients and that addressing it would support improvement in other patient outcomes. According to CMS, depression can affect a patient’s ability to “learn and perform self-care skills necessary to remain in the home.” By including a depression screening process measure, CMS intends to focus agencies on this important issue. Information gathered will be measured and analyzed to help agencies develop best practices that will lead to better treatment of homebound patients.

Data element M1730 addresses depression screening. This question, which applies to start of care and recertification, asks whether the homecare patient has been screened for depression using a standardized screening tool. A standardized screening tool is one that has been validated and includes a standard response scale, supporting accurate evaluation rather than subjective judgment of a patient’s condition.

M1730 allows the clinician to respond in one of the following four ways:

* 0: No screening was conducted. Clinicians will also choose “0″ if a nonstandardized depression screening was conducted.

* 1: Yes, the PHQ-2 Pfizer scale was used.

* 2: Yes, another standardized assessment was used, and there is need for further evaluation.

* 3: Yes, another standardized tool was used, and there is no need for further evaluation.

CMS has not mandated that any particular tool be used, and home health agencies can decide which tool they prefer. M1730 includes Pfizer’s PHQ-2 scale, a simple tool commonly used in other outpatient settings. Its use promotes consistency, and clinicians can administer it without any psychiatric or behavioral training.

To complete the PHQ-2, the clinician asks the patient, “Over the last two weeks, how often have you been bothered by any of the following problems?” The first question measures how often the patient has little interest or pleasure in doing activities. The second question measures how often the patient feels down, depressed, or hopeless. The scale includes five answer ranges: not at all (0–1), several days (2–6), more than half of the days (7–11), nearly every day (12–14), and N/A, unable to respond. Each response has a score. A total score of 3 or more indicates the patient needs further evaluation. It is important to remember that answers to the particular questions will not be reported on OASIS-C, only whether the assessment was given and whether follow-up assistance was recommended and received.

This is an excerpt from the article “Depression Screening in OASIS-C”, which originally appeared in the February 2010 edition of Homecare Administrator. Learn more about Homecare Administrator here!