Proportion

increase

process

define "Initial Population":   exists ( ["Patient"] BirthDate         where Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( BirthDate.birthDate ), start of "Measurement Period" ) >= 18     )       and ( Count("Office Based Visit During Measurement Period")>= 2           or exists "Preventive Visit During Measurement Period"       )

define "Denominator 1":   "Initial Population"

define "Denominator Exceptions 1":   exists "Medical Reason for Not Screening for Tobacco Use"       or "Has Limited Life Expectancy"

define "Numerator 1":   "Most Recent Tobacco Use Screening Indicates Tobacco Non User" is not null       or "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null

define "Initial Population":   exists ( ["Patient"] BirthDate         where Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( BirthDate.birthDate ), start of "Measurement Period" ) >= 18     )       and ( Count("Office Based Visit During Measurement Period")>= 2           or exists "Preventive Visit During Measurement Period"       )

define "Denominator 2":   "Initial Population"       and "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null

define "Denominator Exceptions 2":   exists "Medical Reason for Not Counseling Tobacco User"       or exists "Medical Reason for Not Ordering Tobacco Cessation Pharmacotherapy"       or "Has Limited Life Expectancy"

define "Numerator 2":   exists "Tobacco Cessation Counseling Given"       or exists "Tobacco Cessation Pharmacotherapy Ordered"

define "Initial Population":   exists ( ["Patient"] BirthDate         where Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( BirthDate.birthDate ), start of "Measurement Period" ) >= 18     )       and ( Count("Office Based Visit During Measurement Period")>= 2           or exists "Preventive Visit During Measurement Period"       )

define "Denominator 3":   "Initial Population"

define "Denominator Exceptions 3":   exists "Medical Reason for Not Screening for Tobacco Use"       or exists "Medical Reason for Not Counseling Tobacco User"       or exists "Medical Reason for Not Ordering Tobacco Cessation Pharmacotherapy"       or "Has Limited Life Expectancy"

define "Numerator 3":   "Most Recent Tobacco Use Screening Indicates Tobacco Non User" is not null       or ( "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null           and ( exists "Tobacco Cessation Counseling Given"               or exists "Tobacco Cessation Pharmacotherapy Ordered"               //or exists "Active Pharmacotherapy for Tobacco Cessation"           )       )

define "Most Recent Tobacco Use Screening Indicates Tobacco Non User":   ( Last(["Observation": "Tobacco Use Screening"] TobaccoUseScreening         where Global."Normalize Interval"(TobaccoUseScreening.effective)overlaps "Measurement Period"         sort by start of Global."Normalize Interval"(effective)     )) MostRecentTobaccoUseScreening       where MostRecentTobaccoUseScreening.value in "Tobacco Non-User"

define "Most Recent Tobacco Use Screening Indicates Tobacco User":   ( Last(["Observation": "Tobacco Use Screening"] TobaccoUseScreening         where Global."Normalize Interval"(TobaccoUseScreening.effective)overlaps "Measurement Period"         sort by start of Global."Normalize Interval"(effective)     )) MostRecentTobaccoUseScreening       where MostRecentTobaccoUseScreening.value in "Tobacco User"

// MedicationStatement is not available in R5, known publication issue //define "Active Pharmacotherapy for Tobacco Cessation": //  ["MedicationStatement": "Tobacco Use Cessation Pharmacotherapy"] TakingCessationPharmacotherapy //      where Global."Normalize Interval" ( TakingCessationPharmacotherapy.effective ) overlaps after "Measurement Period" //        and TakingCessationPharmacotherapy.status in { 'active', 'completed' } define "Tobacco Cessation Counseling Given":   ["Encounter": "Tobacco Use Cessation Counseling"] TobaccoCessationCounseling       where TobaccoCessationCounseling.period during "Measurement Period"         and TobaccoCessationCounseling.status = 'finished'

define "Tobacco Cessation Pharmacotherapy Ordered":   ["MedicationRequest": "Tobacco Use Cessation Pharmacotherapy"] CessationPharmacotherapyOrdered       where CessationPharmacotherapyOrdered.authoredOn during "Measurement Period"         and CessationPharmacotherapyOrdered.status = 'active'

define "Numerator 3":   "Most Recent Tobacco Use Screening Indicates Tobacco Non User" is not null       or ( "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null           and ( exists "Tobacco Cessation Counseling Given"               or exists "Tobacco Cessation Pharmacotherapy Ordered"               //or exists "Active Pharmacotherapy for Tobacco Cessation"           )       )

define "Medical Reason for Not Screening for Tobacco Use":   ["Observation": "Tobacco Use Screening"] NoTobaccoUseScreening       where NoTobaccoUseScreening.issued during "Measurement Period"         and "Not Done"(NoTobaccoUseScreening)         and "Not Done Reason in Medical Reason"(NoTobaccoUseScreening)         and NoTobaccoUseScreening.status = 'final'

//or exists "Active Pharmacotherapy for Tobacco Cessation" define "Has Limited Life Expectancy":   exists ( ["Condition"] LimitedLifeExpectancy         where Global."Prevalence Period" ( LimitedLifeExpectancy ) overlaps after "Measurement Period"           and LimitedLifeExpectancy.clinicalStatus ~ ToConcept(Global."active")     )

define "Denominator Exceptions 1":   exists "Medical Reason for Not Screening for Tobacco Use"       or "Has Limited Life Expectancy"

define "Numerator 1":   "Most Recent Tobacco Use Screening Indicates Tobacco Non User" is not null       or "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null

define "Numerator 2":   exists "Tobacco Cessation Counseling Given"       or exists "Tobacco Cessation Pharmacotherapy Ordered"

define "SDE Race":   (flatten (       Patient.extension Extension         where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race'           return Extension.extension     )) E       where E.url = 'ombCategory'         or E.url = 'detailed'       return E.value as Coding

define "SDE Race":   SDE."SDE Race"

define "SDE Sex":   case       when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }       when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }       else null     end

define "SDE Sex":   SDE."SDE Sex"

define "Office Based Visit During Measurement Period":   ( ["Encounter": "Health behavior intervention, individual, face-to-face; initial 30 minutes"]       union ["Encounter": "Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)"]       union ["Encounter": "Home Healthcare Services"]       union ["Encounter": "Occupational Therapy Evaluation"]       union ["Encounter": "Office Visit"]       union ["Encounter": "Ophthalmological Services"]       union ["Encounter": "Physical Therapy Evaluation"]       union ["Encounter": "Psych Visit - Diagnostic Evaluation"]       union ["Encounter": "Psych Visit - Psychotherapy"]       union ["Encounter": "Psychoanalysis"]       union ["Encounter": "Speech and Hearing Evaluation"] ) OfficeBasedEncounter       where OfficeBasedEncounter.period during "Measurement Period"         and OfficeBasedEncounter.status = 'finished'

define "Preventive Visit During Measurement Period":   ( ["Encounter": "Annual Wellness Visit"]       union ["Encounter": "Preventive Care Services - Established Office Visit, 18 and Up"]       union ["Encounter": "Preventive Care Services - Group Counseling"]       union ["Encounter": "Preventive Care Services - Other"]       union ["Encounter": "Preventive Care Services-Individual Counseling"]       union ["Encounter": "Preventive Care Services-Initial Office Visit, 18 and Up"] ) PreventiveEncounter       where PreventiveEncounter.period during "Measurement Period"         and PreventiveEncounter.status = 'finished'

define "Initial Population":   exists ( ["Patient"] BirthDate         where Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( BirthDate.birthDate ), start of "Measurement Period" ) >= 18     )       and ( Count("Office Based Visit During Measurement Period")>= 2           or exists "Preventive Visit During Measurement Period"       )

define "Denominator 3":   "Initial Population"

define "Denominator 2":   "Initial Population"       and "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null

define "SDE Payer":   [Coverage: type in "Payer"] Payer         return {           code: Payer.type,           period: Payer.period         }

define "SDE Payer":   SDE."SDE Payer"

define "SDE Ethnicity":   (flatten (       Patient.extension Extension         where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity'           return Extension.extension     )) E       where E.url = 'ombCategory'         or E.url = 'detailed'       return E.value as Coding

define "SDE Ethnicity":   SDE."SDE Ethnicity"

define "Medical Reason for Not Counseling Tobacco User":   ["Procedure": "Tobacco Use Cessation Counseling"] NoTobaccoCessationCounseling       where Global."Normalize Interval" ( NoTobaccoCessationCounseling.performed ) starts during "Measurement Period"         and ( ( NoTobaccoCessationCounseling.status = 'not-done'               and NoTobaccoCessationCounseling.statusReason in "Medical Reason"           )             or ( "Not Done"(NoTobaccoCessationCounseling)                 and "Not Done Reason in Medical Reason"(NoTobaccoCessationCounseling)             )         )

define "Medical Reason for Not Ordering Tobacco Cessation Pharmacotherapy":   ["MedicationRequest": "Tobacco Use Cessation Pharmacotherapy"] NoCessationPharmacotherapyOrdered       where NoCessationPharmacotherapyOrdered.authoredOn during "Measurement Period"         and NoCessationPharmacotherapyOrdered.status = 'completed'         and ( ( "Not Done"(NoCessationPharmacotherapyOrdered)               and "Not Done Reason in Medical Reason"(NoCessationPharmacotherapyOrdered)           )             or ( NoCessationPharmacotherapyOrdered.doNotPerform = true                 and NoCessationPharmacotherapyOrdered.statusReason in "Medical Reason"             )         )

define "Denominator Exceptions 2":   exists "Medical Reason for Not Counseling Tobacco User"       or exists "Medical Reason for Not Ordering Tobacco Cessation Pharmacotherapy"       or "Has Limited Life Expectancy"

define "Denominator Exceptions 3":   exists "Medical Reason for Not Screening for Tobacco Use"       or exists "Medical Reason for Not Counseling Tobacco User"       or exists "Medical Reason for Not Ordering Tobacco Cessation Pharmacotherapy"       or "Has Limited Life Expectancy"

define "Denominator 1":   "Initial Population"