Relevant Medicare Measures - Home Health:
- How often the home health team checked patients for depression
Home-based care organizations have an important role in identifying depression in home care patients and coordinating access to treatment. Depression is a prevalent co-morbidity with heart disease, cancer and diabetes that affects between 14 to 46 percent of the homebound elderly. It contributes to increased medical and functional disabilities and increased risk for falls. Estimates of the direct and indirect medical costs of patients with depression were approximately 83.1 billion in the year 2000 (USPSTF, 2009).
Depression can have a negative effect on dementia symptoms--and conversely, dementia symptoms can be helped by treating depression (Qiu, et al., 2010). Addressing depression is a prerequisite to effective patient engagement and is associated with reduced hospitalization. Managing depression is similar to managing other chronic conditions; interventions include both medication management strategies and behavioral change.
The role of the home-based care organizations includes:
(1) Screening, symptom assessment
(2) Case coordination
(3) Medication management
(4) Education of patients and families
(5) Identifying community and clinical resources
(6) Patient goal setting and motivational interviewing to facilitate adherence to goals
Use Blueprint tools and resources to establish effective, consistent processes in depression screening for home health patients. Management of depression can enhance health outcomes, advance patient engagement and self-management and reduce hospitalizations.
Best Practice Recommendations:
- All patients will be screened using the PHQ-2 scale (OASIS question M1730). A score of 3 or more indicates the need for additional screenings.
- Follow-up screening should be done with the PHQ9 for patients 64 and under and the Geriatric Depression Scale (GDS) for patients 65 and older to determine depression severity.
- Build sceening and depression monitoring tools in EMR if possible.
- Notify the primary care physician (PCP) of both the initial and follow-up screening scores.
- Care planning should include a request for MSW referral for community resources, mental health follow up based on available resources and medication monitoring.
- Obtain a prescription order from the PCP or specialist if appropriate.
- For those patients receiving mental health follow-up treatment, the agency may utilize secondary screening at discharge to determine if depression has been reduced.
- Monitor cognitive changes. Dementia symptoms can be impacted by depression and the improvement of dementia symptoms can be helped by treating depression.