DementiaCognitiveAssessmentFHIR
type: Measure
node role: treeRoot
id:
  v: DementiaCognitiveAssessmentFHIR
meta:
  profile:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm
    l: computable-measure-cqfm
  profile:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm
    l: publishable-measure-cqfm
  profile:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm
    l: executable-measure-cqfm
text:
  status:
    v: extensions
  div:
    v: Title: Dementia: Cognitive AssessmentFHIR Id: DementiaCognitiveAssessmentFHIR Download cql: DementiaCognitiveAssessmentFHIR.cql Version: 0.0.004 Url: Dementia: Cognitive AssessmentFHIR short-name identifier: CMS149FHIR version-independent identifier: urn:uuid:5dd075c9-2ce3-49be-a219-055e2444cfea version-specific identifier: urn:uuid:0207eaf9-c365-4740-b5db-fc41f8aa9906 endorser (NQF) identifier: 2872e publisher (CMS) identifier: 149FHIR Effective Period: 2024-01-01 ..2024-12-31 Status: draft Date: 2023-10-27 08:12:31+0000 Approval Date: 2023-08-14 Last Review Date: 2023-08-14 Name: DementiaCognitiveAssessmentFHIR Publisher: American Academy of Neurology Author: American Academy of Neurology: www.aan.com, American Medical Association (AMA): https://www.ama-assn.org/ Description: Percentage of patients, regardless of age, with a diagnosis of dementia for whom an assessment of cognition is performed and the results reviewed at least once within a 12-month period Use Context: code value program Purpose: UNKNOWN Copyright: Attribution: The American Psychiatric Association’s (APA), PCPI’s, and American Medical Association’s (AMA) significant past efforts and contributions to the development and updating of the Measure are acknowledged. Copyright: (C)2023 American Academy of Neurology Institute (AANI). All rights reserved. Disclaimer: Limited proprietary coding may be contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party’s use of Current Procedural Terminology (CPT[R]) or other proprietary code set contained in the Measure. Any other use of CPT or other coding by the third party is strictly prohibited. AANI, APA, AMA, and the former members of the PCPI disclaim all liability for use or accuracy of any CPT or other coding contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) is copyright 2004-2022 Regenstrief Institute, Inc. T…
contained: Library
  id:
    v: effective-data-requirements
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://hl7.org/fhir/v3/AdministrativeGender
        l: AdministrativeGender
      code:
        v: M
      display:
        v: Male
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://hl7.org/fhir/v3/AdministrativeGender
        l: AdministrativeGender
      code:
        v: F
      display:
        v: Female
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/condition-clinical
        l: condition-clinical
      code:
        v: active
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/condition-clinical
        l: condition-clinical
      code:
        v: recurrence
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/condition-clinical
        l: condition-clinical
      code:
        v: relapse
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/condition-ver-status
        l: condition-ver-status
      code:
        v: unconfirmed
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/condition-ver-status
        l: condition-ver-status
      code:
        v: refuted
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/condition-ver-status
        l: condition-ver-status
      code:
        v: entered-in-error
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: SupplementalDataElements
    extension:
      url:
        v: name
        l: name
      value: String
        v: SDE Sex
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "SDE Sex": case when Patient.gender = 'male' then "M" when Patient.gender = 'female' then "F" else null end
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 0
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: DementiaCognitiveAssessmentFHIR
    extension:
      url:
        v: name
        l: name
      value: String
        v: SDE Sex
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "SDE Sex": SDE."SDE Sex"
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 1
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: DementiaCognitiveAssessmentFHIR
    extension:
      url:
        v: name
        l: name
      value: String
        v: Encounter to Assess Cognition
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "Encounter to Assess Cognition": ["Encounter": "Psych Visit Diagnostic Evaluation"] union ["Encounter": "Nursing Facility Visit"] union ["Encounter": "Care Services in Long Term Residential Facility"] union ["Encounter": "Home Healthcare Services"] union ["Encounter": "Psych Visit Psychotherapy"] union ["Encounter": "Behavioral/Neuropsych Assessment"] union ["Encounter": "Occupational Therapy Evaluation"] union ["Encounter": "Office Visit"] union ["Encounter": "Outpatient Consultation"]
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 2
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: DementiaCognitiveAssessmentFHIR
    extension:
      url:
        v: name
        l: name
      value: String
        v: Dementia Encounter During Measurement Period

url:
  v: statement
  l: statement
value: String
  v: define "Dementia Encounter During Measurement Period": "Encounter to Assess Cognition" EncounterAssessCognition with [Condition: "Dementia & Mental Degenerations"] Dementia such that EncounterAssessCognition.period.toInterval ( ) during "Measurement Period" and Dementia.prevalenceInterval ( ) overlaps EncounterAssessCognition.period and Dementia.isActive ( ) and not ( Dementia.verificationStatus ~ QICoreCommon."unconfirmed" or Dementia.verificationStatus ~ QICoreCommon."refuted" or Dementia.verificationStatus ~ QICoreCommon."entered-in-error" )

url:
  v: displaySequence
  l: displaySequence
value: Integer
  v: 3

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: DementiaCognitiveAssessmentFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Assessment of Cognition Using Standardized Tools or Alternate Methods
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /***Definitions***/ define "Assessment of Cognition Using Standardized Tools or Alternate Methods": ( ["Observation": "Standardized Tools for Assessment of Cognition"] union ["Observation": "Cognitive Assessment"] ) CognitiveAssessment with "Dementia Encounter During Measurement Period" EncounterDementia such that CognitiveAssessment.issued.toInterval ( ) starts 12 months or less on or before day of end of EncounterDementia.period where CognitiveAssessment.value is not null and CognitiveAssessment.status in { 'final', 'amended', 'corrected', 'preliminary' }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 4
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: DementiaCognitiveAssessmentFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Numerator
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Numerator": exists "Assessment of Cognition Using Standardized Tools or Alternate Methods"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 5
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: DementiaCognitiveAssessmentFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Qualifying Encounter During Measurement Period
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Qualifying Encounter During Measurement Period": ( "Encounter to Assess Cognition" union ["Encounter": "Patient Provider Interaction"] ) ValidEncounter where ValidEncounter.period during "Measurement Period" and ValidEncounter.status = 'finished'
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 6
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: DementiaCognitiveAssessmentFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Initial Population
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /***Population Criteria***/ define "Initial Population": exists "Dementia Encounter During Measurement Period" and ( Count("Qualifying Encounter During Measurement Period") >= 2 )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 7
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: DementiaCognitiveAssessmentFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Denominator
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Denominator": "Initial Population"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 8
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SupplementalDataElements
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Payer
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 9
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: DementiaCognitiveAssessmentFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Payer
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Payer": SDE."SDE Payer"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 10
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SupplementalDataElements
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Ethnicity
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 11
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: DementiaCognitiveAssessmentFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Ethnicity
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Ethnicity": SDE."SDE Ethnicity"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 12
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SupplementalDataElements
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Race
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 13
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: DementiaCognitiveAssessmentFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Race
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Race": SDE."SDE Race"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 14
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: DementiaCognitiveAssessmentFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Patient Reason for Not Performing Assessment of Cognition Using Standardized Tools or Alternate Methods
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Patient Reason for Not Performing Assessment of Cognition Using Standardized Tools or Alternate Methods": ( [ObservationNotDone: code in "Standardized Tools for Assessment of Cognition"] union [ObservationNotDone: code in "Cognitive Assessment"] ) NoCognitiveAssessment with "Dementia Encounter During Measurement Period" EncounterDementia such that NoCognitiveAssessment.issued.toInterval ( ) during EncounterDementia.period where NoCognitiveAssessment.status = 'cancelled' and NoCognitiveAssessment.notDoneReason in "Patient Reason"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 15
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: DementiaCognitiveAssessmentFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Denominator Exceptions
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Denominator Exceptions": exists "Patient Reason for Not Performing Assessment of Cognition Using Standardized Tools or Alternate Methods"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 16
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: QICoreCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: toInterval
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval @comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible representations for timing-valued elements in QICore, allowing this function to be used across any resource. The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>. The intent of this function is to provide a clear and concise mechanism to treat single elements that have multiple possible representations as intervals so that logic doesn't have to account for the variability. More complex calculations (such as medication request period or dispense period calculation) need specific guidance and consideration. That guidance may make use of this function, but the focus of this function is on single element calculations where the semantics are unambiguous. If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime. If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age, and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later. If the input is a DateTime Interval, the result is the input. If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending immediately before one year later than the date the patient turned the age given as the end of the quantity interval. Any other input will reslt in a null DateTime Interval */ define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>>): case when choice is DateTim…
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 17
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: QICoreCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: prevalenceInterval
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Returns an interval representing the normalized prevalence period of a given Condition. @comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from onset to abatement as specified in the given Condition. If the condition is active, the resulting interval will have a closed ending boundary. If the condition is not active, the resulting interval will have an open ending boundary. */ define fluent function prevalenceInterval(condition Condition): if condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse" then Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()] else Interval[start of condition.onset.toInterval(), end of condition.abatementInterval())
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 18
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: QICoreCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: isActive
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* Candidates for FHIRCommon */ /* @description: Returns true if the given condition has a clinical status of active, recurrence, or relapse */ define fluent function isActive(condition Condition): condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 19
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToString
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToString(value uri): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 20
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToCode
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code. */ define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 21
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

v: active

coding:
  system:
    v: http://terminology.hl7.org/CodeSystem/library-type
    l: library-type
  code:
    v: module-definition

type:
  v: depends-on
display:
  v: Library SDE
resource:
  v: http://ecqi.healthit.gov/ecqms/Library/SupplementalDataElements|3.4.000
  l: http://ecqi.healthit.gov/ecqms/Library/SupplementalDataElements

type:
  v: depends-on
display:
  v: Library QICoreCommon
resource:
  v: http://ecqi.healthit.gov/ecqms/Library/QICoreCommon|1.5.000
  l: http://ecqi.healthit.gov/ecqms/Library/QICoreCommon

type:
  v: depends-on
display:
  v: Library FHIRHelpers
resource:
  v: http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers|4.3.000
  l: http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers

type:
  v: depends-on
display:
  v: Code system AdministrativeGender
resource:
  v: http://hl7.org/fhir/v3/AdministrativeGender
  l: AdministrativeGender

type:
  v: depends-on
display:
  v: Code system ConditionClinicalStatusCodes
resource:
  v: http://terminology.hl7.org/CodeSystem/condition-clinical
  l: condition-clinical

type:
  v: depends-on
display:
  v: Code system ConditionVerificationStatusCodes
resource:
  v: http://terminology.hl7.org/CodeSystem/condition-ver-status
  l: condition-ver-status

type:
  v: depends-on
display:
  v: Value set Standardized Tools for Assessment of Cognition
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1006
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1006

type:
  v: depends-on
display:
  v: Value set Cognitive Assessment
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1332
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1332

type:
  v: depends-on
display:
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v: 0.0.004

v: DementiaCognitiveAssessmentFHIR

v: Dementia: Cognitive AssessmentFHIR

v: draft

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v: 2023-10-27T08:12:31+00:00

v: American Academy of Neurology

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v: Percentage of patients, regardless of age, with a diagnosis of dementia for whom an assessment of cognition is performed and the results reviewed at least once within a 12-month period

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v: UNKNOWN

v: Use of a standardized tool or instrument to assess cognition other than those listed will meet numerator performance if mapped to the concept "Intervention, Performed": "Cognitive Assessment" included in the numerator logic below. The requirement of two or more visits is to establish that the eligible professional or eligible clinician has an existing relationship with the patient. In recognition of the growing use of integrated and team-based care, the diagnosis of dementia and the assessment of cognitive function need not be performed by the same provider or clinician. The DSM-5 has replaced the term dementia with major neurocognitive disorder and mild neurocognitive disorder. For the purposes of this measure, the terms are equivalent. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS149v12. Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html).

v: Attribution: The American Psychiatric Association’s (APA), PCPI’s, and American Medical Association’s (AMA) significant past efforts and contributions to the development and updating of the Measure are acknowledged. Copyright: (C)2023 American Academy of Neurology Institute (AANI). All rights reserved.

v: 2023-08-14

v: 2023-08-14

start:
  v: 2024-01-01
end:
  v: 2024-12-31

name:
  v: American Academy of Neurology
telecom:
  system:
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  value:
    v: www.aan.com

name:
  v: American Medical Association (AMA)
telecom:
  system:
    v: url
  value:
    v: https://www.ama-assn.org/

v: Limited proprietary coding may be contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party’s use of Current Procedural Terminology (CPT[R]) or other proprietary code set contained in the Measure. Any other use of CPT or other coding by the third party is strictly prohibited. AANI, APA, AMA, and the former members of the PCPI disclaim all liability for use or accuracy of any CPT or other coding contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) is copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2022 World Health Organization. All Rights Reserved.

v: An estimated 5.8 million of adults in the US were living with dementia in 2019. Dementia is often characterized by the gradual onset and continuing cognitive decline in one or more domains including memory, communication and language, ability to focus or pay attention, reasoning and judgment and visual perception (Alzheimer’s Association, 2019). Cognitive deterioration represents a major source of morbidity and mortality and poses a significant burden on affected individuals and their caregivers (Daviglus et al., 2010). Although cognitive deterioration follows a different course depending on the type of dementia, significant rates of decline have been reported. For example, one study found that the annual rate of decline for Alzheimer's disease patients was more than four times that of older adults with no cognitive impairment (Wilson et al., 2010). Nevertheless, measurable cognitive abilities remain throughout the course of dementia (American Psychiatric Association, 2007). Initial and ongoing assessments of cognition are fundamental to the proper management of patients with dementia. These assessments serve as the basis for identifying treatment goals, developing a treatment plan, monitoring the effects of treatment, and modifying treatment as appropriate.

v: Ongoing assessment includes periodic monitoring of the development and evolution of cognitive and noncognitive psychiatric symptoms and their response to intervention (Category I). Both cognitive and noncognitive neuropsychiatric and behavioral symptoms of dementia tend to evolve over time, so regular monitoring allows detection of new symptoms and adaptation of treatment strategies to current needs... Cognitive symptoms that almost always require assessment include impairments in memory, executive function, language, judgment, and spatial abilities. It is often helpful to track cognitive status with a structured simple examination (American Psychiatric Association, 2007). The American Psychiatric Association recommends that patients with dementia be assessed for the type, frequency, severity, pattern, and timing of symptoms (Category 1C). Quantitative measures provide a structured replicable way to document the patient's baseline symptoms and determine which symptoms (if any) should be the target of intervention based on factors such as frequency of occurrence, magnitude, potential for associated harm to the patient or others, and associated distress to the patient. The exact frequency at which measures are warranted will depend on clinical circumstances. However, use of quantitative measures as treatment proceeds allows more precise tracking of whether nonpharmacological and pharmacological treatments are having their intended effect or whether a shift in the treatment plan is needed (American Psychiatric Association, 2016). Conduct and document an assessment and monitor changes in cognitive status using a reliable and valid instrument, e.g., Montreal Cognitive Assessment (MoCA), Ascertain Dementia 8 (AD8) or other tool. Cognitive status should be reassessed periodically to identify sudden changes, as well as to monitor the potential beneficial or harmful effects of environmental changes (including safety, care needs, and abuse and/or neglect), specific medication…

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extension:
  url:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type
    l: cqfm-type
  value: CodeableConcept
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-type
        l: measure-type
      code:
        v: process
      display:
        v: Process
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: initial-population
      display:
        v: Initial Population
  description:
    v: All patients, regardless of age, with a diagnosis of dementia who have two or more visits during the measurement period
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Initial Population
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: denominator
      display:
        v: Denominator
  description:
    v: Equals Initial Population
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Denominator
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: denominator-exclusion
      display:
        v: Denominator Exclusion
  criteria:
    language:
      v: text/cql-identifier
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: numerator
      display:
        v: Numerator
  description:
    v: Patients for whom an assessment of cognition is performed and the results reviewed at least once within a 12-month period
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Numerator
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: numerator-exclusion
      display:
        v: Numerator Exclusion
  criteria:
    language:
      v: text/cql-identifier
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: denominator-exception
      display:
        v: Denominator Exception
  description:
    v: Documentation of patient reason(s) for not assessing cognition
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Denominator Exceptions

id:
  v: sde-ethnicity
usage:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-data-usage
      l: measure-data-usage
    code:
      v: supplemental-data
description:
  v: SDE Ethnicity
criteria:
  language:
    v: text/cql-identifier
  expression:
    v: SDE Ethnicity

id:
  v: sde-payer
usage:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-data-usage
      l: measure-data-usage
    code:
      v: supplemental-data
description:
  v: SDE Payer
criteria:
  language:
    v: text/cql-identifier
  expression:
    v: SDE Payer

id:
  v: sde-race
usage:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-data-usage
      l: measure-data-usage
    code:
      v: supplemental-data
description:
  v: SDE Race
criteria:
  language:
    v: text/cql-identifier
  expression:
    v: SDE Race

id:
  v: sde-sex
usage:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-data-usage
      l: measure-data-usage
    code:
      v: supplemental-data
description:
  v: SDE Sex
criteria:
  language:
    v: text/cql-identifier
  expression:
    v: SDE Sex