Title: Discharged on Antithrombotic TherapyFHIR Id: DischargedonAntithromboticTherapyFHIR Download cql: DischargedonAntithromboticTherapyFHIR.cql Version: 0.8.000 Url: Discharged on Antithrombotic TherapyFHIR short-name identifier: CMS104FHIR version-independent identifier: urn:uuid:4f57e4a2-097b-45f8-9c85-91b35ea92dc1 version-specific identifier: urn:uuid:e0b5379f-4b9c-4177-a530-d744fa95d080 publisher (CMS) identifier: 104FHIR Effective Period: 2024-01-01 ..2024-12-31 Status: draft Date: 2023-10-27 08:12:31+0000 Approval Date: 2023-08-01 Last Review Date: 2023-08-01 Name: DischargedonAntithromboticTherapyFHIR Publisher: The Joint Commission Author: The Joint Commission: https://www.jointcommission.org/ Description: Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge Use Context: code value program Purpose: UNKNOWN Copyright: Measure specifications are in the Public Domain LOINC(R) 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 copyright 2021 World Health Organization. All Rights Reserved. Disclaimer: These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty. Rationale: The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist. or patients with a stroke due to a cardioembolic source (e.g. atrial fibrillation, mechanical heart valve), warfarin is recommended unless contraindicated. In recent years, novel oral anticoagulant agents (NOACs) have been developed and approved by the U.S. Food and Drug Administration (FDA) for stroke prevention, and may be considered as an alternative to warfarin for select patients. Anticoagulation therapy is not generally recommended for secondary stroke prevention in patients presumed to have a non-cardioembolic stroke. Anticoagulants at doses to prevent venous thromboembolism are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or transient ischemic attack (TIA). Clinical recommendation statement: Clinical trial results suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist Guidance (Usage): The "Nonelective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions. The "MedicationRequest" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use. The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS104v12. 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). Population Criteria: 64403d17d4d7050edabb0562 Initial Population: Inpatient hospitalizations for patients age 18 and older, discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less than or equal to 120 days that ends during the measurement period Denominator: Inpatient hospitalizations for patients with a principal diagnosis of Ischemic stroke Denominator Exclusion: - Inpatient hospitalizations for patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations. - Inpatient hospitalizations for patients discharged to another hospital - Inpatient hospitalizations for patients who left against medical advice - Inpatient hospitalizations for patients who expired - Inpatient hospitalizations for patients discharged to home for hospice care - Inpatient hospitalizations for patients discharged to a health care facility for hospice care - Inpatient hospitalizations for patients with comfort measures documented Denominator Exception: - Inpatient hospitalizations for patients with a documented reason for not prescribing antithrombotic therapy at discharge. - Inpatient hospitalizations for patients who receive Prasugrel as an antithrombotic therapy at discharge. Numerator: Inpatient hospitalizations for patients prescribed or continuing to take antithrombotic therapy at hospital discharge Numerator Exclusion: None Supplemental Data Guidance : Patient's Ethnicity: Hispanic or Latino Not Hispanic or Latino Patient's Payer: Categories of types of health care payer entities as defined by the US Public Health Data Consortium SOP code system Patient's Race: Native Hawaiian or Other Pacific Islander Asian American Indian or Alaska Native Other Race White Black or African American Patient's Sex: Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories. Supplemental Data Elements: SDE Ethnicity SDE Payer SDE Race SDE Sex Libraries: DischargedonAntithromboticTherapyFHIR Related Artifact Dependencies: SupplementalDataElements version: 3.4.000 TJCOverall version: 8.9.000 FHIRHelpers version: 4.3.000 CQMCommon version: 1.4.000 QICoreCommon version: 1.5.000 http://hl7.org/fhir/v3/AdministrativeGender Non-Elective Inpatient Encounter Hemorrhagic Stroke Ischemic Stroke Antithrombotic Therapy for Ischemic Stroke Payer Discharge To Acute Care Facility Left Against Medical Advice Patient Expired Discharged to Home for Hospice Care Discharged to Health Care Facility for Hospice Care Comfort Measures Observation Services Emergency Department Visit Parameters: name use min max type Measurement Period In 0 1 Period SDE Sex Out 0 1 Coding Numerator Out 0 * Resource Denominator Out 0 * Resource SDE Payer Out 0 * Resource Initial Population Out 0 * Resource SDE Ethnicity Out 0 1 Resource Denominator Exclusions Out 0 * Resource SDE Race Out 0 1 Resource DataRequirements: Type Elements Valueset Name Valueset Patient(QICorePatient) ethnicity race Encounter(QICoreEncounter) type period rank rank.value condition condition.reference condition.reference.value hospitalization hospitalization.dischargeDisposition Nonelective Inpatient Encounter Non-Elective Inpatient Encounter Encounter(QICoreEncounter) type status status.value period rank rank.value condition condition.reference condition.reference.value hospitalization hospitalization.dischargeDisposition Observation Services Observation Services Encounter(QICoreEncounter) type status status.value period rank rank.value condition condition.reference condition.reference.value hospitalization hospitalization.dischargeDisposition Emergency Department Visit Emergency Department Visit Condition(QICoreCondition) id id.value Medication(QICoreMedication) id MedicationRequest(QICoreMedicationRequest) medication.reference authoredOn authoredOn.value MedicationRequest(QICoreMedicationRequest) medication authoredOn authoredOn.value Antithrombotic Therapy for Ischemic Stroke Antithrombotic Therapy for Ischemic Stroke Coverage(QICoreCoverage) type period Payer Type Payer ServiceRequest(QICoreServiceRequest) code status status.value intent intent.value doNotPerform doNotPerform.value Comfort Measures Comfort Measures Procedure(QICoreProcedure) code status status.value Comfort Measures Comfort Measures Direct Reference Codes: display code system Male M http://hl7.org/fhir/v3/AdministrativeGender Female F http://hl7.org/fhir/v3/AdministrativeGender Logic Definitions: Group Scoring Population Criteria Expression 64403d17d4d7050edabb0562 Group scoring: proportion Initial Population // + ', ' + Combine(Patient.name.first().given, ' ') define "Initial Population": TJC."Encounter with Principal Diagnosis and Age" Denominator define "Denominator": TJC."Ischemic Stroke Encounter" Denominator Exclusion define "Denominator Exclusions": TJC."Ischemic Stroke Encounters with Discharge Disposition" union "Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke" Denominator Exception Numerator define "Numerator": TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter with ["MedicationRequest": "Antithrombotic Therapy for Ischemic Stroke"] DischargeAntithrombotic such that DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period Numerator Exclusion None Library Name Name SupplementalDataElements SDE Sex define "SDE Sex": case when Patient.gender = 'male' then "M" when Patient.gender = 'female' then "F" else null end Library Name Name DischargedonAntithromboticTherapyFHIR SDE Sex define "SDE Sex": SDE."SDE Sex" Library Name Name TJCOverall Non Elective Inpatient Encounter define "Non Elective Inpatient Encounter": ["Encounter": "Nonelective Inpatient Encounter"] NonElectiveEncounter where NonElectiveEncounter.period ends during day of "Measurement Period" Library Name Name TJCOverall All Stroke Encounter define "All Stroke Encounter": "Non Elective Inpatient Encounter" NonElectiveEncounter let ConditionCode: NonElectiveEncounter.principalDiagnosis().code where ( ConditionCode in "Hemorrhagic Stroke" or ConditionCode in "Ischemic Stroke" ) Library Name Name TJCOverall Encounter with Principal Diagnosis and Age define "Encounter with Principal Diagnosis and Age": "All Stroke Encounter" AllStrokeEncounter where AgeInYearsAt(date from start of AllStrokeEncounter.period ) >= 18 Library Name Name TJCOverall Ischemic Stroke Encounter define "Ischemic Stroke Encounter": "Encounter with Principal Diagnosis and Age" EncounterWithAge where EncounterWithAge.principalDiagnosis().code in "Ischemic Stroke" Library Name Name DischargedonAntithromboticTherapyFHIR Numerator define "Numerator": TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter with ["MedicationRequest": "Antithrombotic Therapy for Ischemic Stroke"] DischargeAntithrombotic such that DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period Library Name Name DischargedonAntithromboticTherapyFHIR Denominator define "Denominator": TJC."Ischemic Stroke Encounter" Library Name Name SupplementalDataElements SDE Payer define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period } Library Name Name DischargedonAntithromboticTherapyFHIR SDE Payer define "SDE Payer": SDE."SDE Payer" Library Name Name DischargedonAntithromboticTherapyFHIR Initial Population // + ', ' + Combine(Patient.name.first().given, ' ') define "Initial Population": TJC."Encounter with Principal Diagnosis and Age" Library Name Name SupplementalDataElements SDE Ethnicity define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text } Library Name Name DischargedonAntithromboticTherapyFHIR SDE Ethnicity /* 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" Library Name Name TJCOverall Ischemic Stroke Encounters with Discharge Disposition define "Ischemic Stroke Encounters with Discharge Disposition": "Ischemic Stroke Encounter" IschemicStrokeEncounter let DischDisp: IschemicStrokeEncounter.hospitalization.dischargeDisposition where DischDisp in "Discharge To Acute Care Facility" or DischDisp in "Left Against Medical Advice" or DischDisp in "Patient Expired" or DischDisp in "Discharged to Home for Hospice Care" or DischDisp in "Discharged to Health Care Facility for Hospice Care" Library Name Name TJCOverall Intervention Comfort Measures define "Intervention Comfort Measures": ( ["ServiceRequest": code in "Comfort Measures"] SR where SR.status in { 'active', 'completed', 'on-hold' } and SR.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' } and SR.doNotPerform is not true ) union ( ["Procedure": "Comfort Measures"] InterventionPerformed where InterventionPerformed.status in { 'completed', 'in-progress' } ) Library Name Name DischargedonAntithromboticTherapyFHIR 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 ( ) Library Name Name DischargedonAntithromboticTherapyFHIR Denominator Exclusions define "Denominator Exclusions": TJC."Ischemic Stroke Encounters with Discharge Disposition" union "Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke" Library Name Name SupplementalDataElements SDE Race define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text } Library Name Name DischargedonAntithromboticTherapyFHIR SDE Race define "SDE Race": SDE."SDE Race" Library Name Name CQMCommon principalDiagnosis /* @description: Returns the condition that is specified as the principal diagnosis for the encounter */ define fluent function principalDiagnosis(Encounter Encounter ): singleton from ((Encounter.diagnosis D where D.rank = 1) PD return singleton from ([Condition] C where C.id = PD.condition.reference.getId()) ) Library Name Name QICoreCommon getId /* @description: Returns the tail of the given uri (i.e. everything after the last slash in the URI). @comment: This function can be used to determine the logical id of a given resource. It can be used in a single-server environment to trace references. However, this function does not attempt to resolve or distinguish the base of the given url, and so cannot be used safely in multi-server environments. */ define fluent function getId(uri String): Last(Split(uri, '/')) Library Name Name FHIRHelpers ToString define function ToString(value uri): value.value Library Name Name FHIRHelpers ToCode /* @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 } Library Name Name CQMCommon hospitalizationWithObservation /* @description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter */ define fluent function hospitalizationWithObservation(TheEncounter Encounter ): TheEncounter Visit let ObsVisit: Last([Encounter: "Observation Services"] LastObs where LastObs.status = 'finished' and LastObs.period ends 1 hour or less on or before start of Visit.period sort by end of period ), VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period), EDVisit: Last([Encounter: "Emergency Department Visit"] LastED where LastED.status = 'finished' and LastED.period ends 1 hour or less on or before VisitStart sort by end of period ) return Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]
define "SDE Sex": case when Patient.gender = 'male' then "M" when Patient.gender = 'female' then "F" else null end
define "Non Elective Inpatient Encounter": ["Encounter": "Nonelective Inpatient Encounter"] NonElectiveEncounter where NonElectiveEncounter.period ends during day of "Measurement Period"
define "All Stroke Encounter": "Non Elective Inpatient Encounter" NonElectiveEncounter let ConditionCode: NonElectiveEncounter.principalDiagnosis().code where ( ConditionCode in "Hemorrhagic Stroke" or ConditionCode in "Ischemic Stroke" )
Encounter with Principal Diagnosis and Age
define "Encounter with Principal Diagnosis and Age": "All Stroke Encounter" AllStrokeEncounter where AgeInYearsAt(date from start of AllStrokeEncounter.period ) >= 18
define "Ischemic Stroke Encounter": "Encounter with Principal Diagnosis and Age" EncounterWithAge where EncounterWithAge.principalDiagnosis().code in "Ischemic Stroke"
define "Numerator": TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter with ["MedicationRequest": "Antithrombotic Therapy for Ischemic Stroke"] DischargeAntithrombotic such that DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period
define "Denominator": TJC."Ischemic Stroke Encounter"
define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period }
// + ', ' + Combine(Patient.name.first().given, ' ') define "Initial Population": TJC."Encounter with Principal Diagnosis and Age"
define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text }
/* 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"
Ischemic Stroke Encounters with Discharge Disposition
define "Ischemic Stroke Encounters with Discharge Disposition": "Ischemic Stroke Encounter" IschemicStrokeEncounter let DischDisp: IschemicStrokeEncounter.hospitalization.dischargeDisposition where DischDisp in "Discharge To Acute Care Facility" or DischDisp in "Left Against Medical Advice" or DischDisp in "Patient Expired" or DischDisp in "Discharged to Home for Hospice Care" or DischDisp in "Discharged to Health Care Facility for Hospice Care"
define "Intervention Comfort Measures": ( ["ServiceRequest": code in "Comfort Measures"] SR where SR.status in { 'active', 'completed', 'on-hold' } and SR.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' } and SR.doNotPerform is not true ) union ( ["Procedure": "Comfort Measures"] InterventionPerformed where InterventionPerformed.status in { 'completed', 'in-progress' } )
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 "Denominator Exclusions": TJC."Ischemic Stroke Encounters with Discharge Disposition" union "Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke"
define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text }
/* @description: Returns the condition that is specified as the principal diagnosis for the encounter */ define fluent function principalDiagnosis(Encounter Encounter ): singleton from ((Encounter.diagnosis D where D.rank = 1) PD return singleton from ([Condition] C where C.id = PD.condition.reference.getId()) )
/* @description: Returns the tail of the given uri (i.e. everything after the last slash in the URI). @comment: This function can be used to determine the logical id of a given resource. It can be used in a single-server environment to trace references. However, this function does not attempt to resolve or distinguish the base of the given url, and so cannot be used safely in multi-server environments. */ define fluent function getId(uri String): Last(Split(uri, '/'))
define function ToString(value uri): value.value
/* @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 }
/* @description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter */ define fluent function hospitalizationWithObservation(TheEncounter Encounter ): TheEncounter Visit let ObsVisit: Last([Encounter: "Observation Services"] LastObs where LastObs.status = 'finished' and LastObs.period ends 1 hour or less on or before start of Visit.period sort by end of period ), VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period), EDVisit: Last([Encounter: "Emergency Department Visit"] LastED where LastED.status = 'finished' and LastED.period ends 1 hour or less on or before VisitStart sort by end of period ) return Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]
Value set Nonelective Inpatient Encounter
Value set Antithrombotic Therapy for Ischemic Stroke
Value set Discharge To Acute Care Facility
Value set Discharged to Home for Hospice Care
Value set Discharged to Health Care Facility for Hospice Care
Error attempting to determine filter value: toFhirValue not implemented for Subtract
Patient's Ethnicity: Hispanic or Latino Not Hispanic or Latino Patient's Payer: Categories of types of health care payer entities as defined by the US Public Health Data Consortium SOP code system Patient's Race: Native Hawaiian or Other Pacific Islander Asian American Indian or Alaska Native Other Race White Black or African American Patient's Sex: Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.
Discharged on Antithrombotic TherapyFHIR
Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge
The "Nonelective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions. The "MedicationRequest" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use. The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS104v12. 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).
Measure specifications are in the Public Domain LOINC(R) 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 copyright 2021 World Health Organization. All Rights Reserved.
These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.
The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist. or patients with a stroke due to a cardioembolic source (e.g. atrial fibrillation, mechanical heart valve), warfarin is recommended unless contraindicated. In recent years, novel oral anticoagulant agents (NOACs) have been developed and approved by the U.S. Food and Drug Administration (FDA) for stroke prevention, and may be considered as an alternative to warfarin for select patients. Anticoagulation therapy is not generally recommended for secondary stroke prevention in patients presumed to have a non-cardioembolic stroke. Anticoagulants at doses to prevent venous thromboembolism are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or transient ischemic attack (TIA).
Clinical trial results suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist
Inpatient hospitalizations for patients age 18 and older, discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less than or equal to 120 days that ends during the measurement period
Inpatient hospitalizations for patients with a principal diagnosis of Ischemic stroke
- Inpatient hospitalizations for patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations. - Inpatient hospitalizations for patients discharged to another hospital - Inpatient hospitalizations for patients who left against medical advice - Inpatient hospitalizations for patients who expired - Inpatient hospitalizations for patients discharged to home for hospice care - Inpatient hospitalizations for patients discharged to a health care facility for hospice care - Inpatient hospitalizations for patients with comfort measures documented
- Inpatient hospitalizations for patients with a documented reason for not prescribing antithrombotic therapy at discharge. - Inpatient hospitalizations for patients who receive Prasugrel as an antithrombotic therapy at discharge.
Inpatient hospitalizations for patients prescribed or continuing to take antithrombotic therapy at hospital discharge