library DischargedonAntithromboticTherapyFHIR version '0.8.000'

/* based upon FHIR library DischargedonAntithromboticTherapyFHIR4 version '0.4.000' */
/* 2023 AU */

using QICore version '4.1.1'

include FHIRHelpers version '4.3.000' called FHIRHelpers
include CQMCommon version '1.4.000' called CQMCommon
include QICoreCommon version '1.5.000' called QICoreCommon
include SupplementalDataElements version '3.4.000' called SDE
include TJCOverall version '8.9.000' called TJC

valueset "Antithrombotic Therapy for Ischemic Stroke": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62'
valueset "Medical Reason For Not Providing Treatment": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.473'
valueset "Patient Refusal": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93'
valueset "Pharmacological Contraindications For Antithrombotic Therapy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52'
valueset "Nonelective Inpatient Encounter": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424'
valueset "Hemorrhagic Stroke": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.212'
valueset "Ischemic Stroke": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247'

parameter "Measurement Period" Interval<DateTime>
  default Interval[@2024-01-01T00:00:00.0, @2025-01-01T00:00:00.0)

context Patient

define PatientName: Patient.name.first().family // + ', ' + Combine(Patient.name.first().given, ' ')

define "Initial Population":
  TJC."Encounter with Principal Diagnosis and Age"

define "Denominator":
  TJC."Ischemic Stroke Encounter"

define "Denominator Exclusions":
  TJC."Ischemic Stroke Encounters with Discharge Disposition"
    union "Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke"

define "Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke":
  "Denominator" Encounter
    with TJC."Intervention Comfort Measures" ComfortMeasure
      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during Encounter.hospitalizationWithObservation ( )

define "Numerator":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with ["MedicationRequest": "Antithrombotic Therapy for Ischemic Stroke"] DischargeAntithrombotic
      such that DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period

/*
define "Denominator Exceptions":
  "Encounter with Documented Reason for No Antithrombotic At Discharge"
  union "Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge"

define "Encounter with Documented Reason for No Antithrombotic At Discharge":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with "Reason for Not Giving Antithrombotic at Discharge" NoDischargeAntithrombotic
      such that NoDischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period

define "Reason for Not Giving Antithrombotic at Discharge":
  ["MedicationNotRequested": "Antithrombotic Therapy for Ischemic Stroke"] NoAntithromboticDischarge
    where ( NoAntithromboticDischarge.reasonCode in "Medical Reason For Not Providing Treatment"
        or NoAntithromboticDischarge.reasonCode in "Patient Refusal"
    )
      and ( NoAntithromboticDischarge.isCommunity ( )
          or NoAntithromboticDischarge.isDischarge ( )
      )
      and NoAntithromboticDischarge.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }

define "Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with "Pharmacological Contraindications for Antithrombotic Therapy at Discharge" DischargePharmacological
      such that DischargePharmacological.authoredOn during IschemicStrokeEncounter.period

define "Pharmacological Contraindications for Antithrombotic Therapy at Discharge":
  ["MedicationRequest": "Pharmacological Contraindications For Antithrombotic Therapy"] Pharmacological
    where ( Pharmacological.isCommunity ( )
        or Pharmacological.isDischarge ( )
    )
      and Pharmacological.status in { 'active', 'completed' }
      and Pharmacological.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
      and Pharmacological.doNotPerform is not true
*/
define "SDE Ethnicity":
  SDE."SDE Ethnicity"

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

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

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