QCDR Name: MBHR Mental and Behavioral Health Registry
| Measure Title | Use of Anxiety Severity Measure |
| NQS Domain | Community/Population Health |
| Measure ID | MBHR1 |
| NQF ID | n/a |
| Measure Type | Process |
| High Priority? | No |
| Description | The percentage of adult patients (18 years and older) with an anxiety disorder diagnosis (e.g. generalized anxiety disorder, social anxiety disorder, or panic disorder) who have completed a standardized tool (e.g., GAD-7, BAI) during measurement period. To see additional details, please view the workflow diagram for this measure: View diagram |
| Denominator | Patients aged ≥ 18 years on date of encounter
AND AND INCLUDES TELEHEALTH? YES |
| Denominator Exclusions | • Patients who die OR • Are enrolled in hospice OR • Are unable to complete an anxiety measure due to cognitive deficit, visual deficit, motor deficit, language barrier, or low reading level, AND a suitable recorder (e.g., advocate) is not available |
| Numerator | Adult patients (18 years of age or older) included in the denominator who have at least one standardized tool administered and completed during a four-month measurement period. If positive (e.g, a score equal to or greater than 10 on the GAD-7), this suggests a probable anxiety diagnosis which requires documentation of an appropriate follow-up plan such as further evaluation or referral to treatment.
Numerator Exclusions: None |
| Data Source | Claims, EHR, Paper Medical Record, Registry |
| Meaningful Measure Area | Prevention, Treatment, and Management of Mental Health |
| Meaningful Measure Rationale | Utilization of an anxiety severity assessment tool (e.g.,GAD-7) with individuals who are diagnosed with an anxiety disorder will improve the quality of care transitions and communications across care settings, and improve quality of life for patients with anxiety by identifying and addressing appropriate treatment needs. This provides a standardized way to communicate status which will improve both quality of treatment and efficient use of resources. |
| Inverse Measure? | No |
| Proportional Measure? | Yes |
| Continuous Variable Measure? | No |
| Ratio Measure | No |
| Number of Performance Rates | 1 |
| Risk Adjusted | No |
| Preferred Specialty | mental and behavioral health |
| Applicable Specialties | Family Practice, Internal Medicine, Geriatric Medicine, Psychiatry, Mental/Behavioral Health |
| Care Settings | Ambulatory Care: Hospital; Inpatient; Rehabilitation Facility; Nursing Home; Outpatient Services; Long Term Care |
Measure Justification
Numerous guidelines have recommended assessing for clinically relevant anxiety in a variety of populations, including individuals who positively screen for depression [1], patients who present for initial psychiatric evaluations [2], individuals at risk for suicide [3], and as part of a comprehensive pain assessment in older adults [4]. A guideline from the American Society of Clinical Oncology [5], recommends that “all health care providers should routinely screen for the presence of emotional distress and specifically symptoms of anxiety…use(ing) the Generalized Anxiety Disorder (GAD)-7 scale” in adults with cancer. In addition, the Women’s Preventive Services Initiative [6] recommends assessing anxiety severity in women and adolescent girls, including pregnant and postpartum women.
1. U.S. Preventive Services Task Force. Screening for depression in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009; 151(11):784-792. Updated 2016 Jan [8 p].
2. American Psychiatric Association (APA). Practice guidelines for the psychiatric evaluation of adults, third edition. Arlington (VA): American Psychiatric Association (APA); 2015. 164 p.
3. Assessment and Management of Risk for Suicide Working Group. VA/DoD clinical practice guideline for assessment and management of patients at risk for suicide. Washington (DC): Department of Veterans Affairs, Department of Defense; 2013 Jun. 190 p.
4. Comprehensive Pain Assessment (American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons, 009 [Level I]; Herr et al., “Pain assessment,” 2006 [Level I]; Pasero & McCaffery, 2011 [Level VI])
5. Andersen BL, DeRubeis RJ, Berman BS, Gruman J, Champion VL, Massie MJ, Holland JC, Partridge AH, Bak K, Somerfield MR, Rowland JH, American Society of Clinical Oncology. Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J Clin Oncol. 2014 ;32(15):1605-19.
6. Gregory KD, Chelmow D, Nelson HD, Van Niel MS, Conry JA, Garcia F, et al. Screening for anxiety in adolescent and adult women: A recommendation from the Women’s Preventive Services Initiative. Annals of Internal Medicine, 2020; 173 (1): 48-56. https://doi.org/10.7326/M20-0580
Based on a gap analysis, the MBHR Advisory Committee selected Anxiety Disorders as the domain most in need of measure development, given the MIPS program did not yet address this area as of 2017. Further, no quality measures specific to anxiety were/are endorsed by National Quality Forum (NQF) or other organizations (e.g., Agency for Healthcare Research and Quality [AHRQ]). The omission of any quality measures for anxiety in MIPS is surprising given that anxiety disorders are highly prevalent mental health problems, affecting approximately 18% of the adult population in the United States (Kessler, Chiu, Dernier, & Walters, 2005), and are highly treatable (Bandelow, Michaelis, & Wedekind, 2017). Although more common than mood disorders, anxiety disorders have received less attention, leading to under-detection and lack of treatment, particularly in primary care settings (Goldberg et al., 2017; Kessler, Lloyd, Lewis, & Gray, 1999) and palliative care (Atkin, Vickerstaff, & Candy, 2017). Anxiety disorders can be disabling, having a substantial impact on patient functioning, work productivity, and health care utilization (Dark et al., 2017; Kroenke, Spitzer, Williams, Monahan, & Lowe, 2007). Moreover, anxiety disorders cost the United States an estimated $42 billion dollars per year (Greenberg et al., 1999; also see Bui et al., 2017). Although there is some diagnostic overlap between anxiety and depression, which has existing quality measures, anxiety is a conceptually distinct domain with different treatment planning, treatment goals/foci, and interventions (Beard et al., 2017). Accordingly, a need to assess for and treat anxiety symptoms rapidly in diverse treatment settings is essential to address the mental health needs of the public (Gregory et al., 2020).
- Atkin, N., Vickerstaff, V., & Candy, B. (2017). Worried to death: The assessment and management of anxiety in patients with advanced life-limiting disease, a national survey of palliative medicine physicians. BMC Palliative Care, 16:69. doi 10.1186/s12904-017-0245-5
- Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 19, 93-107.
- Beard, C., Millner, A.J., Forgeard, M.J.C., Fried, E.I., Hsu, K.J., Treadway, M., et al. (2017). Network analysis of depression and anxiety symptom relations in a psychiatric sample. Psychological Medicine, 46, 3359-3369. doi:10.1017/S0033291716002300
- Bui, A. L.,Dieleman, J. L.,Hamavid,H., Birger,M., Chapin, A., Duber, H. C.,… Murray, C. J. (2017). Spending on children’s personal health care in the United States, 1996–2013. JAMA Pediatrics, 171(2), 181–189.
- Dark, T., Flynn, H. A., Rust, G., Kinsell, H., & Harman, J. S. (2017). Epidemiology of emergency department visits for anxiety in the United States: 2009–2011. Psychiatric Services, 68(3), 238–244.
- Goldberg, D.P., Reed, G.M., Robles, R., Minhas, F., Razzaque, B., Fortes, S., et al., 2017. Screening for anxiety, depression, and anxious depression in primary care: a field study for ICD-11 PHC. Journal of Affective Disorders, 213, 199–206. https://doi.org/10. 1016/j.jad.2017.02.025.
- Greenberg, P. E., Sisitsky, T., Kessler, R. C., Finkelstein, S.N., Berndt, E. R., Davidson, J. R., et al. (1999). The economic burden of anxiety disorders in the 1990s. Journal of Clinical Psychiatry, 60, 427-435.
- Gregory KD et al. (2020). Screening for anxiety in adolescent and adult women: A recommendation from the Women’s Preventive Services Initiative. Annals of Internal Medicine, 173 (1), 48-56. https://doi.org/10.7326/M20-0580
- Kessler, R.C., Chiu, W.T., Dernier, O., & Walters, E.E. (2005). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62, 617-627.
- Kessler, D., Lloyd, K., Lewis, G., & Gray, D. P. (1999). Cross sectional study of symptomattribution and recognition of depression and anxiety in primary care. BMJ, 318, 436-439.
- Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O., & Lowe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, Comorbidity, and detection. Annals of Internal Medicine, 146, 317-325.