Generated Narrative: Group

name: Recommend bariatric surgery if BMI 35 or higher

title: RecommendationEligibilityCriteria: Eligibility Criteria for Bariatric Surgery (ADA Recommendation 8.16)

status: active

publisher: Computable Publishing LLC

contact: support@computablepublishing.com

description: Inclusion Criteria: [[1]] Adults. [[2]] Diagnosed with type 2 diabetes. [[3]] Body Mass Index (BMI) ≥ 40.0 kg/m2 (BMI ≥ 37.5 kg/m2 in Asian Americans), or BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 (BMI 32.5-37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods. [[4]] Screened surgical candidates.

copyright: https://creativecommons.org/licenses/by-nc-sa/4.0/

type: person

membership: definitional

combinationMethod: all-of

characteristic

code: Age (SNOMED CT#397669002)

value: >=18 years (Details: UCUM code a = 'a')

exclude: false

description: Adult

characteristic

code: Disease (disorder) (SNOMED CT#64572001)

value: Diabetes mellitus type 2 (disorder) (SNOMED CT#44054006)

exclude: false

description: Diabetes mellitus type 2 (disorder)

characteristic

code: Defined by Reference ()

value:

title: Body Mass Index (BMI) ≥ 40.0 kg/m2 (BMI ≥ 37.5 kg/m2 in Asian Americans), or BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 (BMI 32.5-37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities with nonsurgical methods

description: Body Mass Index (BMI) ≥ 40.0 kg/m2 (BMI ≥ 37.5 kg/m2 in Asian Americans), or BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 (BMI 32.5-37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods.

membership: conceptual

combinationMethod: any-of

characteristic

code: Defined by Reference ()

value: #BMI-Based-Criteria: CohortDefinition: BMI-based Criteria

exclude: false

characteristic

code: Defined by Reference ()

value: #BMI-Asian-Americans: CohortDefinition: BMI ≥ 37.5 kg/m2 in Asian Americans

exclude: false

characteristic

code: Defined by Reference ()

value: #BMI-35-to-less-than-40: BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 who do not achieve durable weight loss and improvement in comorbidities with nonsurgical methods

exclude: false

characteristic

code: Defined by Reference ()

value: #BMI-32.5-to-less-than-37.5: BMI ≥ 32.5 kg/m2 and ≤ 37.4 kg/m2 in Asian Americans who do not achieve durable weight loss and improvement in comorbidities with nonsurgical methods

exclude: false

exclude: false

characteristic

code: Disease (disorder) (SNOMED CT#64572001)

value: Diabetes mellitus type 2 (disorder) (SNOMED CT#44054006)

exclude: false

description: Diabetes mellitus type 2 (disorder)

characteristic

code: Defined by Reference ()

value:

title: Cardiovascular event (any of: myocardial infarction, acute coronary syndrome, coronary artery angioplasty or bypass, stroke)

description: Cardiovascular event (any of: myocardial infarction, acute coronary syndrome, coronary artery angioplasty or bypass, stroke). Placeholder for now to represent 'screened surgical candidate'.

membership: conceptual

combinationMethod: any-of

characteristic

code: Disease (disorder) (SNOMED CT#64572001)

value: ValueSet/Acute-Coronary-Heart-Disease-Value-Set: Acute Coronary Heart Disease Value Set

exclude: false

description: acute coronary heart disease (a value set covering many forms)

characteristic

code: Procedure (procedure) (SNOMED CT#71388002)

value: Heart revascularization (procedure) (SNOMED CT#81266008)

exclude: false

characteristic

code: Disease (disorder) (SNOMED CT#64572001)

value: Cerebrovascular accident (disorder) (SNOMED CT#230690007)

exclude: false

exclude: true

description: Cardiovascular event (myocardial infarction, acute coronary syndrome, coronary artery angioplasty or bypass, stroke) in the past six months.

Timings

-	Offset[x]	Text
*	-6-0 months	in the past six months

characteristic

code: Disease (disorder) (SNOMED CT#64572001)

value: Current evidence of congestive heart failure, angina pectoris, or symptomatic peripheral vascular disease. ()

exclude: true

description: Current evidence of congestive heart failure, angina pectoris, or symptomatic peripheral vascular disease. This may be possible to encode as presence of Disease(disorder) without 'in remission. Placeholder for now to represent 'screened surgical candidate'.

characteristic

code: Disease (disorder) (SNOMED CT#64572001)

value: Cardiac stress test indicating that surgery or IMM would not be safe. ()

exclude: true

description: Cardiac stress test indicating that surgery or IMM would not be safe. Placeholder for now to represent 'screened surgical candidate'.

characteristic

code: Disease (disorder) (SNOMED CT#64572001)

value: Pulmonary embolism (disorder) (SNOMED CT#59282003)

exclude: true

description: Pulmonary embolus in the past six months. Placeholder for now to represent 'screened surgical candidate'.

Timings

-	Offset[x]	Text
*	-6-0 months	in the past six months

characteristic

code: Disease (disorder) (SNOMED CT#64572001)

value: Thrombophlebitis (disorder) (SNOMED CT#64156001)

exclude: true

description: Thrombophlebitis in the past six months. Placeholder for now to represent 'screened surgical candidate'.

Timings

-	Offset[x]	Text
*	-6-0 months	in the past six months

characteristic

code: Defined by Reference ()

value:

title: Cancer of any kind (except basal cell skin cancer or cancer in situ) unless documented to be disease-free for five years

description: Cancer of any kind (except basal cell skin cancer or cancer in situ) unless documented to be disease-free for five years. This combination logic fails if the patient has both a basal cell skin cancer or cancer in situ and a cancer of another kind. Placeholder for now to represent 'screened surgical candidate'.

membership: conceptual

combinationMethod: all-of

characteristic

code: Disease (disorder) (SNOMED CT#64572001)

value: Malignant neoplastic disease (disorder) (SNOMED CT#363346000)

exclude: false

description: Cancer of any kind

characteristic

code: Disease (disorder) (SNOMED CT#64572001)

value: Basal cell carcinoma of skin (disorder) (SNOMED CT#254701007)

exclude: true

description: (except basal cell skin cancer)

characteristic

code: Disease (disorder) (SNOMED CT#64572001)

value: Carcinoma in situ (disorder) (SNOMED CT#109355002)

exclude: true

description: (except cancer in situ)

characteristic

code: Defined by CodeableConcept ()

value: No evidence of cancer found (situation) (SNOMED CT#395100000)

exclude: true

description: unless documented to be disease-free for five years

Timings

-	Offset[x]	Text
*	-5-0 years	for five years

exclude: true

characteristic

code: Defined by CodeableConcept ()

value: history of coagulopathy ()

exclude: true

description: History of coagulopathy. Placeholder for now to represent 'screened surgical candidate'.

characteristic

code: Hemoglobin [Mass/volume] in Blood (LOINC#718-7)

value: <=-1 GramsPerDeciLiter (Details: UCUM code g/dL = 'g/dL')

exclude: true

description: Significant anemia (hemoglobin 1.0 g or more below normal range). Placeholder for now to represent 'screened surgical candidate'.

offset: Lower Normal Limit (Characteristic Offset#LNL)

characteristic

code: Creatinine [Mass/volume] in Serum or Plasma (LOINC#2160-0)

value: >=1.5 MilliGramsPerDeciLiter (Details: UCUM code mg/dL = 'mg/dL')

exclude: true

description: Serum creatinine ≥ 1.5 mg/dl. Placeholder for now to represent 'screened surgical candidate'.

Generated Narrative: Group #BMI-Based-Criteria

title: CohortDefinition: BMI-based Criteria

membership: conceptual

Characteristics

-	Code	Value[x]	Exclude	Description
*	Body mass index (BMI) [Ratio] (LOINC#39156-5)	>=40 kg/m2 (Details: UCUM code kg/m2 = 'kg/m2')	false	Body Mass Index (BMI) ≥ 40.0 kg/m2

Generated Narrative: Group #BMI-Asian-Americans

title: CohortDefinition: BMI ≥ 37.5 kg/m2 in Asian Americans

membership: conceptual

combinationMethod: all-of

characteristic

code: Body mass index (BMI) [Ratio] (LOINC#39156-5)

value: >=37.5 kilogram per square meter (kg/m2) (Details: UCUM code kg/m2 = 'kg/m2')

exclude: false

description: BMI ≥ 37.5 kg/m2

characteristic

code: Race (SNOMED CT#103579009)

value: Asian American (SNOMED CT#103579009; CDC Race and Ethnicity#2028-9 "Asian")

exclude: false

description: Asian American. The evidence and guideline panel decision to modify the BMI threshold for Asian Americans is based on data mostly from Asian Americans not generally including Native Hawaiians and other Pacific Islanders, so it is not explicit whether the modified thresholds apply to Native Hawaiians and other Pacific Islanders. See https://diabetesjournals.org/care/article/38/1/150/37769/BMI-Cut-Points-to-Identify-At-Risk-Asian-Americans for details

Generated Narrative: Group #BMI-35-to-less-than-40

title: BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 who do not achieve durable weight loss and improvement in comorbidities with nonsurgical methods

description: BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods.

membership: conceptual

combinationMethod: all-of

characteristic

code: Body mass index (BMI) [Ratio] (LOINC#39156-5)

value: 35-39.9 kilogram per square meter (kg/m2)

exclude: false

description: BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2

characteristic

code: Defined by CodeableConcept ()

value: achieving durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods ()

exclude: true

description: who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods.

Generated Narrative: Group #BMI-32.5-to-less-than-37.5

title: BMI ≥ 32.5 kg/m2 and ≤ 37.4 kg/m2 in Asian Americans who do not achieve durable weight loss and improvement in comorbidities with nonsurgical methods

description: BMI ≥ 32.5 kg/m2 and ≤ 37.4 kg/m2 in Asian Americans who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods.

membership: conceptual

combinationMethod: all-of

characteristic

code: Body mass index (BMI) [Ratio] (LOINC#39156-5)

value: 32.5-37.4 kilogram per square meter (kg/m2)

exclude: false

description: BMI ≥ 32.5 kg/m2 and ≤ 37.4 kg/m2

characteristic

code: Race (SNOMED CT#103579009)

value: Asian American (SNOMED CT#103579009; CDC Race and Ethnicity#2028-9 "Asian")

exclude: false

description: Asian American. The evidence and guideline panel decision to modify the BMI threshold for Asian Americans is based on data mostly from Asian Americans not generally including Native Hawaiians and other Pacific Islanders, so it is not explicit whether the modified thresholds apply to Native Hawaiians and other Pacific Islanders. See https://diabetesjournals.org/care/article/38/1/150/37769/BMI-Cut-Points-to-Identify-At-Risk-Asian-Americans for details

characteristic

code: Defined by CodeableConcept ()

value: achieving durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods ()

exclude: true

description: who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods.

Generated Narrative: Group #BMI-Qualifying-Group

title: Body Mass Index (BMI) ≥ 40.0 kg/m2 (BMI ≥ 37.5 kg/m2 in Asian Americans), or BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 (BMI 32.5-37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities with nonsurgical methods

description: Body Mass Index (BMI) ≥ 40.0 kg/m2 (BMI ≥ 37.5 kg/m2 in Asian Americans), or BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 (BMI 32.5-37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods.

membership: conceptual

combinationMethod: any-of

characteristic

code: Defined by Reference ()

value: #BMI-Based-Criteria: CohortDefinition: BMI-based Criteria

exclude: false

characteristic

code: Defined by Reference ()

value: #BMI-Asian-Americans: CohortDefinition: BMI ≥ 37.5 kg/m2 in Asian Americans

exclude: false

characteristic

code: Defined by Reference ()

value: #BMI-35-to-less-than-40: BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 who do not achieve durable weight loss and improvement in comorbidities with nonsurgical methods

exclude: false

characteristic

code: Defined by Reference ()

value: #BMI-32.5-to-less-than-37.5: BMI ≥ 32.5 kg/m2 and ≤ 37.4 kg/m2 in Asian Americans who do not achieve durable weight loss and improvement in comorbidities with nonsurgical methods

exclude: false

Generated Narrative: Group #Certain-Cardiovascular-Events

title: Cardiovascular event (any of: myocardial infarction, acute coronary syndrome, coronary artery angioplasty or bypass, stroke)

description: Cardiovascular event (any of: myocardial infarction, acute coronary syndrome, coronary artery angioplasty or bypass, stroke). Placeholder for now to represent 'screened surgical candidate'.

membership: conceptual

combinationMethod: any-of

characteristic

code: Disease (disorder) (SNOMED CT#64572001)

value: ValueSet/Acute-Coronary-Heart-Disease-Value-Set: Acute Coronary Heart Disease Value Set

exclude: false

description: acute coronary heart disease (a value set covering many forms)

characteristic

code: Procedure (procedure) (SNOMED CT#71388002)

value: Heart revascularization (procedure) (SNOMED CT#81266008)

exclude: false

characteristic

code: Disease (disorder) (SNOMED CT#64572001)

value: Cerebrovascular accident (disorder) (SNOMED CT#230690007)

exclude: false

Generated Narrative: Group #Cancer

title: Cancer of any kind (except basal cell skin cancer or cancer in situ) unless documented to be disease-free for five years

description: Cancer of any kind (except basal cell skin cancer or cancer in situ) unless documented to be disease-free for five years. This combination logic fails if the patient has both a basal cell skin cancer or cancer in situ and a cancer of another kind. Placeholder for now to represent 'screened surgical candidate'.

membership: conceptual

combinationMethod: all-of

characteristic

code: Disease (disorder) (SNOMED CT#64572001)

value: Malignant neoplastic disease (disorder) (SNOMED CT#363346000)

exclude: false

description: Cancer of any kind

characteristic

code: Disease (disorder) (SNOMED CT#64572001)

value: Basal cell carcinoma of skin (disorder) (SNOMED CT#254701007)

exclude: true

description: (except basal cell skin cancer)

characteristic

code: Disease (disorder) (SNOMED CT#64572001)

value: Carcinoma in situ (disorder) (SNOMED CT#109355002)

exclude: true

description: (except cancer in situ)

characteristic

code: Defined by CodeableConcept ()

value: No evidence of cancer found (situation) (SNOMED CT#395100000)

exclude: true

description: unless documented to be disease-free for five years

Timings

-	Offset[x]	Text
*	-5-0 years	for five years