Q: Why is the PHQ-2 TO 9 important in nursing homes?

A:The Patient Health Questionnaire-9, or PHQ-2 to 9, is a widely used screening tool for depression, and in the context of nursing homes and PDPM it takes on even greater importance. This nine-question self-report tool screens for symptoms of depression in residents and provides a standardized severity score and a rating for evidence of a depressive disorder. 

The interview covers various aspects of depression, including mood fluctuations, sleep patterns, and appetite changes, among others. Completing the PHQ-2 to 9 effectively is crucial for accurate assessment and quality care under PDPM.

PDPM categorizes residents into payment groups. Clinical assessments, including the PHQ-2 to 9, can influence the placement of residents into the proper category. Accurate assessment is crucial to ensure residents receive the care they need, and that you are appropriately reimbursed for it.

Staff who are conducting interviews should follow guidance in Appendix D of the RAI, Interviewing to Increase Resident Voice in MDS Assessments. This guidance should be reviewed routinely, along with Steps for Assessment for conducting the PHQ-2 to 9. Interview techniques to include “disentangling” and “unfolding” will be important as indicators of moderate to severe depression (total severity score = ≥10). If identified through the PHQ-2 to 9, that can increase daily reimbursement by approximately $40 per PPS day to support the services that residents experiencing moderate to severe depression require.

Effectively addressing depression also can enhance your facility’s “Percentage of Residents Who Have Depression Symptoms” quality measure. This measure utilizes two questions from the PHQ-2 to 9 and considers the total severity score.