DischargedonAntithromboticTherapyFHIR
type: Measure
node role: treeRoot
id:
  v: DischargedonAntithromboticTherapyFHIR
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: 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 a…
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:
    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: DischargedonAntithromboticTherapyFHIR
    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: TJCOverall
    extension:
      url:
        v: name
        l: name
      value: String
        v: Non Elective Inpatient Encounter
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "Non Elective Inpatient Encounter": ["Encounter": "Nonelective Inpatient Encounter"] NonElectiveEncounter where NonElectiveEncounter.period ends during day of "Measurement Period"
    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: TJCOverall
    extension:
      url:
        v: name
        l: name
      value: String
        v: All Stroke Encounter
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "All Stroke Encounter": "Non Elective Inpatient Encounter" NonElectiveEncounter let ConditionCode: NonElectiveEncounter.principalDiagnosis().code where ( ConditionCode in "Hemorrhagic Stroke" or ConditionCode in "Ischemic Stroke" )
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 3
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: TJCOverall
    extension:
      url:
        v: name
        l: name
      value: String
        v: Encounter with Principal Diagnosis and Age
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "Encounter with Principal Diagnosis and Age": "All Stroke Encounter" AllStrokeEncounter where AgeInYearsAt(date from start of AllStrokeEncounter.period ) >= 18
    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:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: TJCOverall
    extension:
      url:
        v: name
        l: name
      value: String
        v: Ischemic Stroke Encounter
    extension:
      url:
        v: statement
        l: statement
      value: String

String
v: define "Ischemic Stroke Encounter": "Encounter with Principal Diagnosis and Age" EncounterWithAge where EncounterWithAge.principalDiagnosis().code in "Ischemic Stroke"

url:
  v: displaySequence
  l: displaySequence
value: Integer
  v: 5

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: DischargedonAntithromboticTherapyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Numerator
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Numerator": TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter with ["MedicationRequest": "Antithrombotic Therapy for Ischemic Stroke"] DischargeAntithrombotic such that DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period
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: DischargedonAntithromboticTherapyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Denominator
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Denominator": TJC."Ischemic Stroke Encounter"
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: 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: 8
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: DischargedonAntithromboticTherapyFHIR
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: 9
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: DischargedonAntithromboticTherapyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Initial Population
extension:
  url:
    v: statement
    l: statement
  value: String
    v: // + ', ' + Combine(Patient.name.first().given, ' ') define "Initial Population": TJC."Encounter with Principal Diagnosis and Age"
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: DischargedonAntithromboticTherapyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Ethnicity
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* 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"
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: TJCOverall
extension:
  url:
    v: name
    l: name
  value: String
    v: Ischemic Stroke Encounters with Discharge Disposition
extension:
  url:
    v: statement
    l: statement
  value: String
    v: 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"
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: TJCOverall
extension:
  url:
    v: name
    l: name
  value: String
    v: Intervention Comfort Measures
extension:
  url:
    v: statement
    l: statement
  value: String
    v: 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' } )
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: DischargedonAntithromboticTherapyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke
extension:
  url:
    v: statement
    l: statement
  value: String
    v: 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 ( )
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: DischargedonAntithromboticTherapyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Denominator Exclusions
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Denominator Exclusions": TJC."Ischemic Stroke Encounters with Discharge Disposition" union "Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke"
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: 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: 17
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: DischargedonAntithromboticTherapyFHIR
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: 18
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: CQMCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: principalDiagnosis
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @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()) )
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: QICoreCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: getId
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @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, '/'))
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: 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: 21
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: 22
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: CQMCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: hospitalizationWithObservation
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @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]
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 23
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 TJC
resource:
  v: http://ecqi.healthit.gov/ecqms/Library/TJCOverall|8.9.000
  l: http://ecqi.healthit.gov/ecqms/Library/TJCOverall

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: Library CQMCommon
resource:
  v: http://ecqi.healthit.gov/ecqms/Library/CQMCommon|1.4.000
  l: http://ecqi.healthit.gov/ecqms/Library/CQMCommon

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: Code system AdministrativeGender
resource:
  v: http://hl7.org/fhir/v3/AdministrativeGender
  l: AdministrativeGender

type:
  v: depends-on
display:
  v: Value set Nonelective Inpatient Encounter
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424

type:
  v: depends-on
display:
  v: Value set Hemorrhagic Stroke
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.212
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.212

type:
  v: depends-on
display:
  v: Value set Ischemic Stroke
resource:
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  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247

type:
  v: depends-on
display:
  v: Value set Antithrombotic Therapy for Ischemic Stroke
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62

type:
  v: depends-on
display:
  v: Value set Payer Type
resource:
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  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591

type:
  v: depends-on
display:
  v: Value set Discharge To Acute Care Facility
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87

type:
  v: depends-on
display:
  v: Value set Left Against Medical Advice
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.308
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.308

type:
  v: depends-on
display:
  v: Value set Patient Expired
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309

type:
  v: depends-on
display:
  v: Value set Discharged to Home for Hospice Care
resource:
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  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.209

type:
  v: depends-on
display:
  v: Value set Discharged to Health Care Facility for Hospice Care
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.207
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.207

type:
  v: depends-on
display:
  v: Value set Comfort Measures
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45
  l: http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45

type:
  v: depends-on
display:
  v: Value set Observation Services
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143

type:
  v: depends-on
display:
  v: Value set Emergency Department Visit
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292

name:
  v: Measurement Period
use:
  v: in
min:
  v: 0
max:
  v: 1
type:
  v: Period

name:
  v: SDE Sex
use:
  v: out
min:
  v: 0
max:
  v: 1
type:
  v: Coding

name:
  v: Numerator
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Resource

name:
  v: Denominator
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Resource

name:
  v: SDE Payer
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Resource

name:
  v: Initial Population
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Resource

name:
  v: SDE Ethnicity
use:
  v: out
min:
  v: 0
max:
  v: 1
type:
  v: Resource

name:
  v: Denominator Exclusions
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Resource

name:
  v: SDE Race
use:
  v: out
min:
  v: 0
max:
  v: 1
type:
  v: Resource

type:
  v: Patient
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
  l: qicore-patient
must support:
  v: ethnicity
must support:
  v: race

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: period
must support:
  v: rank
must support:
  v: rank.value
must support:
  v: condition
must support:
  v: condition.reference
must support:
  v: condition.reference.value
must support:
  v: hospitalization
must support:
  v: hospitalization.dischargeDisposition
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424
date filter:
  path:
    v: period
  value: Period
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/cqf-expression
        l: cqf-expression
      value: Expression

v: text/cql-identifier

v: Measurement Period

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: status
must support:
  v: status.value
must support:
  v: period
must support:
  v: rank
must support:
  v: rank.value
must support:
  v: condition
must support:
  v: condition.reference
must support:
  v: condition.reference.value
must support:
  v: hospitalization
must support:
  v: hospitalization.dischargeDisposition
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143
code filter:
  path:
    v: status.value
  code:
    code:
      v: finished

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: status
must support:
  v: status.value
must support:
  v: period
must support:
  v: rank
must support:
  v: rank.value
must support:
  v: condition
must support:
  v: condition.reference
must support:
  v: condition.reference.value
must support:
  v: hospitalization
must support:
  v: hospitalization.dischargeDisposition
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292
code filter:
  path:
    v: status.value
  code:
    code:
      v: finished
date filter:
  path:
    v: period
  value: Period
    extension:
      url:
        v: http://hl7.org/fhir/uv/crmi-analysisException
        l: crmi-analysisException
      value: String
        v: Error attempting to determine filter value: toFhirValue not implemented for Subtract

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition
  l: qicore-condition
must support:
  v: id
must support:
  v: id.value

extension:
  extension:
    url:
      v: targetId
      l: targetId
    value: String
      v: G10002
  extension:
    url:
      v: targetProperty
      l: targetProperty
    value: String
      v: medication
  url:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-relatedRequirement
    l: cqfm-relatedRequirement
type:
  v: Medication
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication
  l: qicore-medication
must support:
  v: id

id:
  v: G10002
type:
  v: MedicationRequest
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest
  l: qicore-medicationrequest
must support:
  v: medication.reference
must support:
  v: authoredOn
must support:
  v: authoredOn.value

type:
  v: MedicationRequest
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest
  l: qicore-medicationrequest
must support:
  v: medication
must support:
  v: authoredOn
must support:
  v: authoredOn.value
code filter:
  path:
    v: medication
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62

type:
  v: Coverage
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage
  l: qicore-coverage
must support:
  v: type
must support:
  v: period
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591

type:
  v: ServiceRequest
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest
  l: qicore-servicerequest
must support:
  v: code
must support:
  v: status
must support:
  v: status.value
must support:
  v: intent
must support:
  v: intent.value
must support:
  v: doNotPerform
must support:
  v: doNotPerform.value
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45
    l: http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45

type:
  v: Procedure
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure
  l: qicore-procedure
must support:
  v: code
must support:
  v: status
must support:
  v: status.value
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45
    l: http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45

id:
  v: supplementalDataGuidance
extension:
  url:
    v: guidance
    l: guidance
  value: String
    v: 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.
extension:
  url:
    v: usage
    l: usage
  value: CodeableConcept
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-data-usage
        l: measure-data-usage
      code:
        v: supplemental-data
      display:
        v: Supplemental Data
    text:
      v: Supplemental Data Guidance
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance
  l: cqfm-supplementalDataGuidance

url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem
  l: cqfm-softwaresystem
value: Reference
  l: cqf-tooling
  reference:
    v: Device/cqf-tooling

id:
  v: effective-data-requirements
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements
  l: cqfm-effectiveDataRequirements
value: Reference
  l: effective-data-requirements
  reference:
    v: #effective-data-requirements

use:
  v: usual
type:
  coding:
    system:
      v: http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type
      l: identifier-type
    code:
      v: short-name
system:
  v: https://madie.cms.gov/measure/shortName
  l: shortName
value:
  v: CMS104FHIR

use:
  v: official
type:
  coding:
    system:
      v: http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type
      l: identifier-type
    code:
      v: version-independent
system:
  v: urn:ietf:rfc:3986
  l: 3986

use:
  v: official
type:
  coding:
    system:
      v: http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type
      l: identifier-type
    code:
      v: version-specific
system:
  v: urn:ietf:rfc:3986
  l: 3986

use:
  v: official
type:
  coding:
    system:
      v: http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type
      l: identifier-type
    code:
      v: publisher
system:
  v: https://madie.cms.gov/measure/cmsId
  l: cmsId
value:
  v: 104FHIR
assigner:
  display:
    v: CMS

v: 0.8.000

v: DischargedonAntithromboticTherapyFHIR

v: Discharged on Antithrombotic TherapyFHIR

v: draft

v: false

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

v: The Joint Commission

telecom:
  system:
    v: url
  value:
    v: https://www.jointcommission.org/

v: Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge

code:
  system:
    v: http://terminology.hl7.org/CodeSystem/usage-context-type
    l: usage-context-type
  code:
    v: program
value: CodeableConcept
  coding:
    system:
      v: http://hl7.org/fhir/us/cqfmeasures/CodeSystem/quality-programs
      l: quality-programs
    code:
      v: eh-cah
    display:
      v: EH/CAH

v: UNKNOWN

v: 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).

v: 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.

v: 2023-08-01

v: 2023-08-01

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

name:
  v: The Joint Commission
telecom:
  system:
    v: url
  value:
    v: https://www.jointcommission.org/

v: 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.

v: 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).

v: 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

id:
  v: 64403d17d4d7050edabb0562
extension:
  url:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring
    l: cqfm-scoring
  value: CodeableConcept
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-scoring
        l: measure-scoring
      code:
        v: proportion
      display:
        v: Proportion
extension:
  url:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis
    l: cqfm-populationBasis
  value: Code
    v: Encounter
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: 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
  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: Inpatient hospitalizations for patients with a principal diagnosis of Ischemic stroke
  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
  description:
    v: - 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
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Denominator Exclusions
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: - 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.
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Denominator Exceptions
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: numerator
      display:
        v: Numerator
  description:
    v: Inpatient hospitalizations for patients prescribed or continuing to take antithrombotic therapy at hospital discharge
  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

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