Title: Severe Obstetric ComplicationsFHIR Id: SevereObstetricComplicationsFHIR Download cql: SevereObstetricComplicationsFHIR.cql Version: 0.0.007 Url: Severe Obstetric ComplicationsFHIR short-name identifier: CMS1028FHIR version-independent identifier: urn:uuid:6cf03fe2-b962-4f83-ac37-26d7477183c7 version-specific identifier: urn:uuid:2c92808482ead7c5018384daff512547 publisher (CMS) identifier: 1028FHIR Effective Period: 2024-01-01 ..2024-12-31 Status: draft Date: 2023-08-08 18:35:06+0000 Approval Date: 2023-08-21 Last Review Date: 2023-08-21 Name: SevereObstetricComplicationsFHIR Publisher: The Joint Commission Author: The Joint Commission: https://www.jointcommission.org/, Centers for Medicare & Medicaid Services (CMS): https://www.cms.gov/, Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation: https://medicine.yale.edu/core/ Description: Patients with severe obstetric complications which occur during the inpatient delivery hospitalization 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 2022 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. Risk Adjustment Factor: Risk Variable Lab and Physical Exam Results Risk Adjustment Factor: Risk Variable Anemia Risk Adjustment Factor: Risk Variable Asthma Risk Adjustment Factor: Risk Variable Autoimmune Disease Risk Adjustment Factor: Risk Variable Bariatric Surgery Risk Adjustment Factor: Risk Variable Bleeding Disorder Risk Adjustment Factor: Risk Variable Morbid Obesity Risk Adjustment Factor: Risk Variable Cardiac Disease Risk Adjustment Factor: Risk Variable Economic Housing Instability Risk Adjustment Factor: Risk Variable Gastrointestinal Disease Risk Adjustment Factor: Risk Variable Gestational Diabetes Risk Adjustment Factor: Risk Variable HIV Risk Adjustment Factor: Risk Variable Hypertension Risk Adjustment Factor: Risk Variable Long Term Anticoagulant Use Risk Adjustment Factor: Risk Variable Mental Health Disorder Risk Adjustment Factor: Risk Variable Multiple Pregnancy Risk Adjustment Factor: Risk Variable Neuromuscular Risk Adjustment Factor: Risk Variable Obstetrical VTE Risk Adjustment Factor: Risk Variable Placenta Previa Risk Adjustment Factor: Risk Variable Placental Abruption Risk Adjustment Factor: Risk Variable Placental Accreta Spectrum Risk Adjustment Factor: Risk Variable Preexisting Diabetes Risk Adjustment Factor: Risk Variable Previous Cesarean Risk Adjustment Factor: Risk Variable Pulmonary Hypertension Risk Adjustment Factor: Risk Variable Renal Disease Risk Adjustment Factor: Risk Variable Severe Preeclampsia Risk Adjustment Factor: Risk Variable Substance Abuse Risk Adjustment Factor: Risk Variable Thyrotoxicosis Risk Adjustment Factor: Risk Variable Other Preeclampsia Risk Adjustment Factor: Risk Variable Preterm Birth Risk Adjustment Factor: Risk Variable First Hematocrit Lab Test Risk Adjustment Factor: Risk Variable First White Blood Cell Count Lab Test Risk Adjustment Factor: Risk Variable Heart Rate Risk Adjustment Factor: Risk Variable Systolic Blood Pressure Rationale: The United States (US) experiences higher rates of maternal morbidity and mortality than most other developed countries. These rates have continued to trend upward in recent decades (CDC, n.d.). Research indicates that the overall rate of severe maternal morbidity (SMM) increased by almost 200% between 1993 and 2014 to 144 per 10,000 delivery hospitalizations (CDC, n.d.), with more than 25,000 women per year experiencing obstetric complications (U.S. Department of Health and Human Services, 2020). Recent maternal mortality data from 2018 reveal that 658 women in the US died from maternal causes, resulting in a rate of 17.4 deaths per 100,000 live births, with 77% of the deaths attributed to direct obstetric causes like hemorrhage, preeclampsia, obstetric embolism, and other complications (Hoyert & Minino, 2018). 144 per 10,000 women hospitalized for delivery have experienced SMM, including hemorrhage, embolism, hypertension, stroke, and other serious complications (CDC,2020). Racial and ethnic disparities for Black women and Hispanic women are at a significantly higher risk for developing these complications than are Non-Hispanic White women (Leonard et al., 2019). Increasing rates of SMM are resulting in increased healthcare costs, longer hospitalization stays and impacts on a woman's health. There is limited national evaluation of hospitals' performance on maternal morbidity and mortality although SMM is widely used at the population level. SMM is linked to maternal mortality, varies significantly among hospitals, and has significant racial/ethnic and urban/rural disparities. SMM is a cost driver for both Medicaid and commercial plans. This measure is important as it will assist in the discovery and understanding of SMM patterns which can lead to improvements in the safety and quality of maternal care necessary to reduce SMM rates. Clinical recommendation statement: Healthy People 2030 Measure (MICH-05): Reduce severe maternal complications identified during delivery hospitalizations The American College of Obstetricians and Gynecologists (the College) and the Society for Maternal-Fetal Medicine (SMFM) recommend identifying potential cases of severe maternal morbidity for further review, with a focus on outcomes and complications, and consider this an important step toward promoting safe obstetric care. Guidance (Usage): This measure allows for 3 approaches to determine gestational age (GA) in the following order of precedence: 1. The GA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.* 2. The GA is obtained from a discrete field in the electronic health record. This option is only used when the calculated GA is not available. 3. The GA is based on ICD10 or SNOMED codes indicative of weeks gestation. This option is only used when results from items #1 and #2 (see above) are not available. Wherever gestational age is mentioned, relative to the delivery, the intent is to capture the last estimated gestational age prior to or at the time of delivery. *ACOG ReVITALize Guidelines for Calculating Gestational Age: Gestational Age = (280-(Estimated Due Date minus Reference Date))/7 --Estimated Due Date (EDD): The best obstetrical EDD is determined by last menstrual period if confirmed by early ultrasound or no ultrasound performed, or early ultrasound if no known last menstrual period or the ultrasound is not consistent with last menstrual period, or known date of fertilization (e.g., assisted reproductive technology) --Reference Date is the date on which you are trying to determine gestational age. For purposes of this eCQM, Reference Date would be the Date of Delivery. Note however the calculation may yield a non-whole number and gestational age should be rounded off to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks. Definition: For this measure, specifications are modeled after the nationally available and adopted CDC definition for Severe Maternal Morbidity (SMM) with the addition of maternal mortality. At times, we may refer to the CDC indicators of morbidity as SMM, but the outcome of the measure, which includes morbidity and mortality, is referred to as Severe Obstetric Complications (SOC). 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 CMS1028v2. 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: 638907ab4ba3d47c885c02fd Initial Population: Inpatient hospitalizations for patients age greater than or equal to 8 years and less than 65 admitted to the hospital for inpatient acute care who undergo a delivery procedure with a discharge date that ends during the measurement period Denominator: Inpatient hospitalizations for patients delivering stillborn or live birth with greater than or equal to 20 weeks, 0 days gestation completed Denominator Exclusion: Inpatient hospitalizations for patients with confirmed diagnosis of COVID with COVID-related respiratory condition or patients with confirmed diagnosis of COVID with COVID-related respiratory procedure Numerator: Inpatient hospitalizations for patients with severe obstetric complications (not present on admission that occur during the current delivery encounter) including the following: - Severe maternal morbidity diagnoses (see list below) - Severe maternal morbidity procedures (see list below) - Discharge disposition of expired Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. Severe Maternal Morbidity Diagnoses: - Cardiac Acute heart failure Acute myocardial infarction Aortic aneurysm Cardiac arrest/ventricular fibrillation Heart failure/arrest during procedure or surgery - Hemorrhage Disseminated intravascular coagulation Shock - Renal Acute renal failure - Respiratory Adult respiratory distress syndrome Pulmonary edema - Sepsis - Other OB Air and thrombotic embolism Amniotic fluid embolism Eclampsia Severe anesthesia complications - Other Medical Puerperal cerebrovascular disorder Sickle cell disease with crisis Severe Maternal Morbidity Procedures: - Blood transfusion - Conversion of cardiac rhythm - Hysterectomy - Temporary tracheostomy - Ventilation Numerator Exclusion: None Denominator Exception: None Stratifier Criteria: : Stratum1: Delivery hospitalizations with severe obstetric complications excluding hospitalizations where transfusion was the only severe obstetric complication. Additionally, this measure will be stratified by race and ethnicity after measure submission. : 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. This definition establishes a variable of CGA (Calculated Gestational Age). CGA is a supplemental data element to store the calculated gestational age result from the "calculatedGestationalAge" function. The data element enables the capturing and saving of the CGA for data analysis post data receipt. Hospitals do not need to submit any additional data to comply with this definition. Risk Adjustment Variable Guidance : The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Lab and Physical Exam Results: Report the first resulted value 24 hours prior to start of encounter and before time of delivery in UCUM units specified: - Heart rate: {beats}/min - Systolic blood pressure: mm[Hg] - White blood cell count: 10*3/uL - Hematocrit: % The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. Supplemental Data Elements: SDE Ethnicity SDE Payer SDE Race SDE Sex Variable Calculated Gestational Age Libraries: SevereObstetricComplicationsFHIR Related Artifact Dependencies: Library/PCMaternal|5.10.000 Library/FHIRHelpers|4.3.000 Library/QICoreCommon|1.5.000 Library/CQMCommon|1.4.000 Library/QICoreCommon|1.5.000 Library/FHIRHelpers|4.3.000 Library/QICoreCommon|1.5.000 Library/SupplementalDataElements|3.4.000 Library/FHIRHelpers|4.3.000 LOINC Encounter Inpatient Delivery Procedures Observation Services ED Visit and OB Triage Estimated Gestational Age at Delivery 20 to 42 Plus Weeks Gestation Asthma Present On Admission is Yes or Exempt Substance Abuse Placenta Accreta Neuromuscular Disease Renal Disease Gastrointestinal Disease Hypertension Preterm Birth Pulmonary Hypertension Payer Thyrotoxicosis Mild or Moderate Preeclampsia Economic Housing Instability Placental Abruption COVID 19 Confirmed Respiratory Conditions Related to COVID 19 Respiratory Support Procedures Related to COVID 19 HIV in Pregnancy Childbirth and Puerperium Morbid or Severe Obesity Preexisting Diabetes Mental Health Disorder Venous Thromboembolism in Pregnancy Autoimmune Disease Bariatric Surgery Previous Cesarean Placenta Previa Gestational Diabetes Severe Maternal Morbidity Diagnoses Present on Admission is No or Unable To Determine Severe Maternal Morbidity Procedures Patient Expired Blood Transfusion Bleeding Disorder Multiple Pregnancy White blood cells count lab test Hematocrit lab test Anemia Severe Preeclampsia Cardiac Disease Long Term Anticoagulant Use Parameters: name use min max type Measurement Period In 0 1 Period Risk Variable Systolic Blood Pressure Out 0 1 Resource Risk Variable Asthma Out 0 * Resource Risk Variable Substance Abuse Out 0 * Resource Risk Variable Placental Accreta Spectrum Out 0 * Resource Risk Variable Neuromuscular Out 0 * Resource Risk Variable Renal Disease Out 0 * Resource Risk Variable Gastrointestinal Disease Out 0 * Resource Risk Variable Hypertension Out 0 * Resource Risk Variable Preterm Birth Out 0 * Resource Risk Variable Pulmonary Hypertension Out 0 * Resource Variable Calculated Gestational Age Out 0 * Resource SDE Payer Out 0 * Resource Risk Variable Thyrotoxicosis Out 0 * Resource Risk Variable Other Preeclampsia Out 0 * Resource Initial Population Out 0 * Resource Risk Variable Economic Housing Instability Out 0 * Resource Risk Variable Placental Abruption Out 0 * Resource Denominator Exclusion Out 0 * Resource Risk Variable HIV Out 0 * Resource Risk Variable Morbid Obesity Out 0 * Resource Risk Variable Preexisting Diabetes Out 0 * Resource Risk Variable Heart Rate Out 0 1 Resource Risk Variable Mental Health Disorder Out 0 * Resource Risk Variable Obstetrical VTE Out 0 * Resource Risk Variable Autoimmune Disease Out 0 * Resource Risk Variable Bariatric Surgery Out 0 * Resource Risk Variable Previous Cesarean Out 0 * Resource SDE Race Out 0 1 Resource Risk Variable Placenta Previa Out 0 * Resource SDE Sex Out 0 1 Coding Risk Variable Gestational Diabetes Out 0 * Resource Numerator Out 0 * Resource Stratum 1 Out 0 * Resource Risk Variable Bleeding Disorder Out 0 * Resource Risk Variable Multiple Pregnancy Out 0 * Resource Risk Variable First White Blood Cell Count Lab Test Out 0 1 Resource Denominator Out 0 * Resource Risk Variable First Hematocrit Lab Test Out 0 1 Resource SDE Ethnicity Out 0 1 Resource Risk Variable Anemia Out 0 * Resource Risk Variable Severe Preeclampsia Out 0 * Resource Risk Variable Cardiac Disease Out 0 * Resource Risk Variable Long Term Anticoagulant Use Out 0 * Resource DataRequirements: Type Elements Valueset Name Valueset Patient(QICorePatient) Encounter(QICoreEncounter) type status status.value period Encounter Inpatient Encounter Inpatient Encounter(QICoreEncounter) type period status status.value Observation Services Observation Services Encounter(QICoreEncounter) type period status status.value ED Visit and OB Triage ED Visit and OB Triage Encounter(QICoreEncounter) type period status status.value Observation Services Observation Services Encounter(QICoreEncounter) type period status status.value ED Visit and OB Triage ED Visit and OB Triage Procedure(QICoreProcedure) code status status.value performed Delivery Procedures Delivery Procedures Encounter(QICoreEncounter) type status status.value period Encounter Inpatient Encounter Inpatient Patient(QICorePatient) Patient(http://hl7.org/fhir/Patient) birthDate birthDate.value gender gender.value Observation(QICoreObservation) code value status status.value effective Observation(http://hl7.org/fhir/Observation) value Observation(QICoreObservation) code value status status.value effective Observation(QICoreObservation) code value status status.value effective Estimated Gestational Age at Delivery Estimated Gestational Age at Delivery Condition(QICoreCondition) id id.value uri(http://hl7.org/fhir/uri) value string(http://hl7.org/fhir/string) value Observation(Observation Blood Pressure Profile) effective status status.value component (http://hl7.org/fhir/Observation.Component) value Condition(QICoreCondition) id id.value Reference(http://hl7.org/fhir/Reference) reference reference.value Coverage(QICoreCoverage) type period Payer Type Payer Procedure(QICoreProcedure) code status status.value performed Respiratory Support Procedures Related to COVID 19 Respiratory Support Procedures Related to COVID 19 Observation(Observation Heart Rate Profile) effective status status.value value Patient(QICorePatient) Patient(QICorePatient) url extension Patient(QICorePatient) url extension Procedure(QICoreProcedure) code status status.value performed Severe Maternal Morbidity Procedures Severe Maternal Morbidity Procedures Procedure(QICoreProcedure) code status status.value performed Blood Transfusion Blood Transfusion Observation(US Core Laboratory Result Observation Profile) code issued issued.value status status.value value White blood cells count lab test White blood cells count lab test Observation(US Core Laboratory Result Observation Profile) code issued issued.value status status.value value Hematocrit lab test Hematocrit lab test Patient(QICorePatient) url extension Patient(QICorePatient) url extension Coverage(QICoreCoverage) type period Payer Type Payer Patient(QICorePatient) url extension Patient(QICorePatient) url extension Direct Reference Codes: display code system Date and time of obstetric delivery 93857-1 http://loinc.org Delivery date Estimated 11778-8 http://loinc.org Logic Definitions: Group Scoring Population Criteria Expression 638907ab4ba3d47c885c02fd Group scoring: proportion Initial Population define "Initial Population": PCMaternal."Delivery Encounter with Age Range" Denominator define "Denominator": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" Denominator Exclusion define "Denominator Exclusion": "Delivery Encounters with COVID and Respiratory Condition or Procedure" Numerator define "Numerator": "Delivery Encounters with Severe Obstetric Complications" Numerator Exclusion None Denominator Exception None None Library Name Name PCMaternal Encounter with Age Range define "Encounter with Age Range": ["Encounter": "Encounter Inpatient"] EncounterInpatient where EncounterInpatient.status = 'finished' and AgeInYearsAt(date from start of EncounterInpatient.period) in Interval[ 8, 65 ) and EncounterInpatient.period ends during day of "Measurement Period" Library Name Name PCMaternal Delivery Encounter with Age Range define "Delivery Encounter with Age Range": "Encounter with Age Range" EncounterWithAge with ["Procedure": "Delivery Procedures"] DeliveryProcedure such that DeliveryProcedure.status = 'completed' and DeliveryProcedure.performed.toInterval ( ) starts during day of EncounterWithAge.hospitalizationWithEDOBTriageObservation () Library Name Name SevereObstetricComplicationsFHIR Delivery Encounters with Calculated Gestational Age Greater than or Equal to 20 Weeks define "Delivery Encounters with Calculated Gestational Age Greater than or Equal to 20 Weeks": PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter where DeliveryEncounter.calculatedGestationalAge ( ) >= 20 Library Name Name SevereObstetricComplicationsFHIR Delivery Encounters with Estimated Gestational Age Assessment Greater than or Equal to 20 Weeks define "Delivery Encounters with Estimated Gestational Age Assessment Greater than or Equal to 20 Weeks": PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter where DeliveryEncounter.calculatedGestationalAge ( ) is null and ( DeliveryEncounter.lastEstimatedGestationalAge ( ) >= 20 weeks ) Library Name Name SevereObstetricComplicationsFHIR Delivery Encounters with Gestational Age Greater than or Equal to 20 Weeks Based on Coding define "Delivery Encounters with Gestational Age Greater than or Equal to 20 Weeks Based on Coding": PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter let CGA: DeliveryEncounter.calculatedGestationalAge ( ), EGA: DeliveryEncounter.lastEstimatedGestationalAge ( ) where CGA is null and EGA is null and exists ( ( DeliveryEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis where EncounterDiagnosis.code in "20 to 42 Plus Weeks Gestation" ) Library Name Name SevereObstetricComplicationsFHIR Delivery Encounters At Greater than or Equal to 20 Weeks Gestation define "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation": "Delivery Encounters with Calculated Gestational Age Greater than or Equal to 20 Weeks" union "Delivery Encounters with Estimated Gestational Age Assessment Greater than or Equal to 20 Weeks" union "Delivery Encounters with Gestational Age Greater than or Equal to 20 Weeks Based on Coding" Library Name Name SevereObstetricComplicationsFHIR Risk Variable Systolic Blood Pressure //First resulted value 24 hours prior to start of encounter and before time of delivery //Report systolic blood pressure as mm[Hg] define "Risk Variable Systolic Blood Pressure": First(from "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" Encounter, ["observation-bp"] BP where BP.effective.earliest() during Interval[start of Encounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, Encounter.lastTimeOfDelivery()) and BP.status in { 'final', 'amended', 'corrected' } return { EncounterId: Encounter.id, FirstResult: BP.SystolicBP.value as Quantity, Timing: BP.effective.earliest() } sort by Timing ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Asthma define "Risk Variable Asthma": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Acute or Persistent Asthma" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Substance Abuse define "Risk Variable Substance Abuse": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Substance Abuse" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Placental Accreta Spectrum define "Risk Variable Placental Accreta Spectrum": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Placental Accreta Spectrum" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Neuromuscular define "Risk Variable Neuromuscular": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Neuromuscular Disease" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Renal Disease define "Risk Variable Renal Disease": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Renal Disease" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Gastrointestinal Disease define "Risk Variable Gastrointestinal Disease": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Gastrointestinal Disease" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Hypertension define "Risk Variable Hypertension": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Hypertension" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Preterm Birth define "Risk Variable Preterm Birth": /* CGA = Calculated Gestational Age. EGA = Estimated Gestational Age. */ ( PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter let CGA: DeliveryEncounter.calculatedGestationalAge ( ), EGA: DeliveryEncounter.lastEstimatedGestationalAge ( ) where CGA in Interval[20, 36] or ( CGA is null and ( EGA >= 20 weeks and EGA <= 36 weeks ) ) ) union ( PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter let CGA: DeliveryEncounter.calculatedGestationalAge ( ), EGA: DeliveryEncounter.lastEstimatedGestationalAge ( ) where CGA is null and EGA is null and exists ( DeliveryEncounter.diagnosis DeliveryEncounterDiagnoses where DeliveryEncounterDiagnoses.condition.getCondition ( ).code in "Preterm Birth" and ( DeliveryEncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Pulmonary Hypertension define "Risk Variable Pulmonary Hypertension": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Pulmonary Hypertension" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name PCMaternal Variable Calculated Gestational Age define "Variable Calculated Gestational Age": //This definition establishes a variable of CGA (Calculated Gestational Age) for all patients for the sole purpose of displaying the Calculated Gestational Age. This definition is not used in the measure logic. "Delivery Encounter with Age Range" QualifyingEncounter let CGA: QualifyingEncounter.calculatedGestationalAge() // return { QualifyingEncounter, CGA } return { EncounterID: QualifyingEncounter.id, CalculatedCGA: CGA } Library Name Name SevereObstetricComplicationsFHIR Variable Calculated Gestational Age define "Variable Calculated Gestational Age": //This definition establishes a variable of CGA (Calculated Gestational Age). CGA is a supplemental data element to store the calculated gestational age result from the "CalculatedGestationalAge" function. The data element enables the capturing and saving of the CGA for data analysis post data receipt. Hospitals do not need to submit any additional data to comply with this definition. PCMaternal."Variable Calculated Gestational Age" 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 SevereObstetricComplicationsFHIR SDE Payer define "SDE Payer": SDE."SDE Payer" Library Name Name SevereObstetricComplicationsFHIR Risk Variable Thyrotoxicosis define "Risk Variable Thyrotoxicosis": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Thyrotoxicosis" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Other Preeclampsia define "Risk Variable Other Preeclampsia": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Mild or Moderate Preeclampsia" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Initial Population define "Initial Population": PCMaternal."Delivery Encounter with Age Range" Library Name Name SevereObstetricComplicationsFHIR Risk Variable Economic Housing Instability define "Risk Variable Economic Housing Instability": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Economic Housing Instability" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Placental Abruption define "Risk Variable Placental Abruption": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Placental Abruption" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Delivery Encounters with COVID and Respiratory Condition or Procedure define "Delivery Encounters with COVID and Respiratory Condition or Procedure": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( ( TwentyWeeksPlusEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis where EncounterDiagnosis.code in "COVID 19 Confirmed" ) and ( exists ( ( TwentyWeeksPlusEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis where EncounterDiagnosis.code in "Respiratory Conditions Related to COVID 19" ) or exists ( ["Procedure": "Respiratory Support Procedures Related to COVID 19"] EncounterProcedures where EncounterProcedures.status = 'completed' and EncounterProcedures.performed.toInterval ( ) starts during day of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( ) ) ) Library Name Name SevereObstetricComplicationsFHIR Denominator Exclusion define "Denominator Exclusion": "Delivery Encounters with COVID and Respiratory Condition or Procedure" Library Name Name SevereObstetricComplicationsFHIR Risk Variable HIV define "Risk Variable HIV": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "HIV in Pregnancy Childbirth and Puerperium" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Morbid Obesity define "Risk Variable Morbid Obesity": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Morbid or Severe Obesity" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Preexisting Diabetes define "Risk Variable Preexisting Diabetes": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Preexisting Diabetes" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Heart Rate //First resulted value 24 hours prior to start of encounter and before time of delivery //Report heart rate as beats/min define "Risk Variable Heart Rate": First(from "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" Encounter, ["observation-heartrate"] HeartRate where HeartRate.effective.earliest() during Interval[start of Encounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, Encounter.lastTimeOfDelivery()) and HeartRate.status in { 'final', 'amended', 'corrected' } return { EncounterId: Encounter.id, FirstResult: HeartRate.value as Quantity, Timing: HeartRate.effective.earliest() } sort by Timing ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Mental Health Disorder define "Risk Variable Mental Health Disorder": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Mental Health Disorder" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Obstetrical VTE define "Risk Variable Obstetrical VTE": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Venous Thromboembolism in Pregnancy" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Autoimmune Disease define "Risk Variable Autoimmune Disease": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Autoimmune Disease" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Bariatric Surgery define "Risk Variable Bariatric Surgery": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Bariatric Surgery" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Previous Cesarean define "Risk Variable Previous Cesarean": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Previous Cesarean" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) 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 SevereObstetricComplicationsFHIR SDE Race define "SDE Race": SDE."SDE Race" Library Name Name SevereObstetricComplicationsFHIR Risk Variable Placenta Previa define "Risk Variable Placenta Previa": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Placenta Previa" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SupplementalDataElements SDE Sex define "SDE Sex": case when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' } when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' } else null end Library Name Name SevereObstetricComplicationsFHIR SDE Sex define "SDE Sex": SDE."SDE Sex" Library Name Name SevereObstetricComplicationsFHIR Risk Variable Gestational Diabetes define "Risk Variable Gestational Diabetes": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Gestational Diabetes" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion define "Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Severe Maternal Morbidity Diagnoses" and EncounterDiagnoses.diagnosisPresentOnAdmission in "Present on Admission is No or Unable To Determine" ) //EncounterDiagnoses.diagnosisPresentOnAdmission ~ 'N') or exists ( ["Procedure": "Severe Maternal Morbidity Procedures"] EncounterProcedures where EncounterProcedures.status = 'completed' and EncounterProcedures.performed.toInterval ( ) starts during day of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( ) ) Library Name Name SevereObstetricComplicationsFHIR Delivery Encounters with Expiration define "Delivery Encounters with Expiration": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where TwentyWeeksPlusEncounter.hospitalization.dischargeDisposition in "Patient Expired" Library Name Name SevereObstetricComplicationsFHIR Delivery Encounters with Blood Transfusion define "Delivery Encounters with Blood Transfusion": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter with ["Procedure": "Blood Transfusion"] BloodTransfusion such that BloodTransfusion.status = 'completed' and BloodTransfusion.performed.toInterval ( ) starts during day of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( ) Library Name Name SevereObstetricComplicationsFHIR Delivery Encounters with Severe Obstetric Complications define "Delivery Encounters with Severe Obstetric Complications": "Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion" union "Delivery Encounters with Expiration" union "Delivery Encounters with Blood Transfusion" Library Name Name SevereObstetricComplicationsFHIR Numerator define "Numerator": "Delivery Encounters with Severe Obstetric Complications" Library Name Name SevereObstetricComplicationsFHIR Stratification Encounter define "Stratification Encounter": "Numerator" except "Denominator Exclusion" Library Name Name SevereObstetricComplicationsFHIR Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions define "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions": "Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion" union "Delivery Encounters with Expiration" Library Name Name SevereObstetricComplicationsFHIR Stratum 1 define "Stratum 1": //This logic identifies a subset of the numerator population with severe obstetric complications excluding cases where transfusion was the only severe obstetric complication. "Stratification Encounter" intersect "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions" Library Name Name SevereObstetricComplicationsFHIR Risk Variable Bleeding Disorder define "Risk Variable Bleeding Disorder": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Bleeding Disorder" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Multiple Pregnancy define "Risk Variable Multiple Pregnancy": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Multiple Pregnancy" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable First White Blood Cell Count Lab Test //First resulted value 24 hours prior to start of encounter and before time of delivery //Report white blood cell count as 10*3/uL define "Risk Variable First White Blood Cell Count Lab Test": First(from "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" Encounter, ["USCoreLaboratoryResultObservationProfile": "White blood cells count lab test"] WBC where WBC.issued during Interval[start of Encounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, Encounter.lastTimeOfDelivery()) and WBC.status in { 'final', 'amended', 'corrected' } return { EncounterId: Encounter.id, FirstResult: WBC.value as Quantity, Timing: WBC.issued } sort by Timing ) Library Name Name SevereObstetricComplicationsFHIR Denominator define "Denominator": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" Library Name Name SevereObstetricComplicationsFHIR Risk Variable First Hematocrit Lab Test //First resulted value 24 hours prior to start of encounter and before time of delivery //Report hematocrit as % define "Risk Variable First Hematocrit Lab Test": First(from "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" Encounter, ["USCoreLaboratoryResultObservationProfile": "Hematocrit lab test"] Hematocrit where Hematocrit.issued during Interval[start of Encounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, Encounter.lastTimeOfDelivery()) and Hematocrit.status in { 'final', 'amended', 'corrected' } return { EncounterId: Encounter.id, FirstResult: Hematocrit.value as Quantity, Timing: Hematocrit.issued } sort by Timing ) 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 SevereObstetricComplicationsFHIR SDE Ethnicity define "SDE Ethnicity": SDE."SDE Ethnicity" Library Name Name SevereObstetricComplicationsFHIR Risk Variable Anemia define "Risk Variable Anemia": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Anemia" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Severe Preeclampsia define "Risk Variable Severe Preeclampsia": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Severe Preeclampsia" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Cardiac Disease define "Risk Variable Cardiac Disease": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Cardiac Disease" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) Library Name Name SevereObstetricComplicationsFHIR Risk Variable Long Term Anticoagulant Use define "Risk Variable Long Term Anticoagulant Use": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Long Term Anticoagulant Use" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Encounter with Age Range": ["Encounter": "Encounter Inpatient"] EncounterInpatient where EncounterInpatient.status = 'finished' and AgeInYearsAt(date from start of EncounterInpatient.period) in Interval[ 8, 65 ) and EncounterInpatient.period ends during day of "Measurement Period"
define "Delivery Encounter with Age Range": "Encounter with Age Range" EncounterWithAge with ["Procedure": "Delivery Procedures"] DeliveryProcedure such that DeliveryProcedure.status = 'completed' and DeliveryProcedure.performed.toInterval ( ) starts during day of EncounterWithAge.hospitalizationWithEDOBTriageObservation ()
Delivery Encounters with Calculated Gestational Age Greater than or Equal to 20 Weeks
define "Delivery Encounters with Calculated Gestational Age Greater than or Equal to 20 Weeks": PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter where DeliveryEncounter.calculatedGestationalAge ( ) >= 20
Delivery Encounters with Estimated Gestational Age Assessment Greater than or Equal to 20 Weeks
define "Delivery Encounters with Estimated Gestational Age Assessment Greater than or Equal to 20 Weeks": PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter where DeliveryEncounter.calculatedGestationalAge ( ) is null and ( DeliveryEncounter.lastEstimatedGestationalAge ( ) >= 20 weeks )
Delivery Encounters with Gestational Age Greater than or Equal to 20 Weeks Based on Coding
define "Delivery Encounters with Gestational Age Greater than or Equal to 20 Weeks Based on Coding": PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter let CGA: DeliveryEncounter.calculatedGestationalAge ( ), EGA: DeliveryEncounter.lastEstimatedGestationalAge ( ) where CGA is null and EGA is null and exists ( ( DeliveryEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis where EncounterDiagnosis.code in "20 to 42 Plus Weeks Gestation" )
Delivery Encounters At Greater than or Equal to 20 Weeks Gestation
define "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation": "Delivery Encounters with Calculated Gestational Age Greater than or Equal to 20 Weeks" union "Delivery Encounters with Estimated Gestational Age Assessment Greater than or Equal to 20 Weeks" union "Delivery Encounters with Gestational Age Greater than or Equal to 20 Weeks Based on Coding"
//First resulted value 24 hours prior to start of encounter and before time of delivery //Report systolic blood pressure as mm[Hg] define "Risk Variable Systolic Blood Pressure": First(from "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" Encounter, ["observation-bp"] BP where BP.effective.earliest() during Interval[start of Encounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, Encounter.lastTimeOfDelivery()) and BP.status in { 'final', 'amended', 'corrected' } return { EncounterId: Encounter.id, FirstResult: BP.SystolicBP.value as Quantity, Timing: BP.effective.earliest() } sort by Timing )
define "Risk Variable Asthma": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Acute or Persistent Asthma" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Risk Variable Substance Abuse": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Substance Abuse" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
Risk Variable Placental Accreta Spectrum
define "Risk Variable Placental Accreta Spectrum": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Placental Accreta Spectrum" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Risk Variable Neuromuscular": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Neuromuscular Disease" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Risk Variable Renal Disease": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Renal Disease" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Risk Variable Gastrointestinal Disease": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Gastrointestinal Disease" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Risk Variable Hypertension": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Hypertension" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Risk Variable Preterm Birth": /* CGA = Calculated Gestational Age. EGA = Estimated Gestational Age. */ ( PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter let CGA: DeliveryEncounter.calculatedGestationalAge ( ), EGA: DeliveryEncounter.lastEstimatedGestationalAge ( ) where CGA in Interval[20, 36] or ( CGA is null and ( EGA >= 20 weeks and EGA <= 36 weeks ) ) ) union ( PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter let CGA: DeliveryEncounter.calculatedGestationalAge ( ), EGA: DeliveryEncounter.lastEstimatedGestationalAge ( ) where CGA is null and EGA is null and exists ( DeliveryEncounter.diagnosis DeliveryEncounterDiagnoses where DeliveryEncounterDiagnoses.condition.getCondition ( ).code in "Preterm Birth" and ( DeliveryEncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) ) )
define "Risk Variable Pulmonary Hypertension": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Pulmonary Hypertension" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Variable Calculated Gestational Age": //This definition establishes a variable of CGA (Calculated Gestational Age) for all patients for the sole purpose of displaying the Calculated Gestational Age. This definition is not used in the measure logic. "Delivery Encounter with Age Range" QualifyingEncounter let CGA: QualifyingEncounter.calculatedGestationalAge() // return { QualifyingEncounter, CGA } return { EncounterID: QualifyingEncounter.id, CalculatedCGA: CGA }
define "Variable Calculated Gestational Age": //This definition establishes a variable of CGA (Calculated Gestational Age). CGA is a supplemental data element to store the calculated gestational age result from the "CalculatedGestationalAge" function. The data element enables the capturing and saving of the CGA for data analysis post data receipt. Hospitals do not need to submit any additional data to comply with this definition. PCMaternal."Variable Calculated Gestational Age"
define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period }
define "Risk Variable Thyrotoxicosis": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Thyrotoxicosis" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Risk Variable Other Preeclampsia": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Mild or Moderate Preeclampsia" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Initial Population": PCMaternal."Delivery Encounter with Age Range"
Risk Variable Economic Housing Instability
define "Risk Variable Economic Housing Instability": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Economic Housing Instability" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Risk Variable Placental Abruption": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Placental Abruption" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
Delivery Encounters with COVID and Respiratory Condition or Procedure
define "Delivery Encounters with COVID and Respiratory Condition or Procedure": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( ( TwentyWeeksPlusEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis where EncounterDiagnosis.code in "COVID 19 Confirmed" ) and ( exists ( ( TwentyWeeksPlusEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis where EncounterDiagnosis.code in "Respiratory Conditions Related to COVID 19" ) or exists ( ["Procedure": "Respiratory Support Procedures Related to COVID 19"] EncounterProcedures where EncounterProcedures.status = 'completed' and EncounterProcedures.performed.toInterval ( ) starts during day of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( ) ) )
define "Denominator Exclusion": "Delivery Encounters with COVID and Respiratory Condition or Procedure"
define "Risk Variable HIV": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "HIV in Pregnancy Childbirth and Puerperium" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Risk Variable Morbid Obesity": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Morbid or Severe Obesity" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Risk Variable Preexisting Diabetes": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Preexisting Diabetes" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
//First resulted value 24 hours prior to start of encounter and before time of delivery //Report heart rate as beats/min define "Risk Variable Heart Rate": First(from "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" Encounter, ["observation-heartrate"] HeartRate where HeartRate.effective.earliest() during Interval[start of Encounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, Encounter.lastTimeOfDelivery()) and HeartRate.status in { 'final', 'amended', 'corrected' } return { EncounterId: Encounter.id, FirstResult: HeartRate.value as Quantity, Timing: HeartRate.effective.earliest() } sort by Timing )
define "Risk Variable Mental Health Disorder": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Mental Health Disorder" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Risk Variable Obstetrical VTE": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Venous Thromboembolism in Pregnancy" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Risk Variable Autoimmune Disease": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Autoimmune Disease" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Risk Variable Bariatric Surgery": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Bariatric Surgery" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Risk Variable Previous Cesarean": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Previous Cesarean" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text }
define "Risk Variable Placenta Previa": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Placenta Previa" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "SDE Sex": case when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' } when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' } else null end
define "Risk Variable Gestational Diabetes": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Gestational Diabetes" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion
define "Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Severe Maternal Morbidity Diagnoses" and EncounterDiagnoses.diagnosisPresentOnAdmission in "Present on Admission is No or Unable To Determine" ) //EncounterDiagnoses.diagnosisPresentOnAdmission ~ 'N') or exists ( ["Procedure": "Severe Maternal Morbidity Procedures"] EncounterProcedures where EncounterProcedures.status = 'completed' and EncounterProcedures.performed.toInterval ( ) starts during day of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( ) )
define "Delivery Encounters with Expiration": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where TwentyWeeksPlusEncounter.hospitalization.dischargeDisposition in "Patient Expired"
Delivery Encounters with Blood Transfusion
define "Delivery Encounters with Blood Transfusion": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter with ["Procedure": "Blood Transfusion"] BloodTransfusion such that BloodTransfusion.status = 'completed' and BloodTransfusion.performed.toInterval ( ) starts during day of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )
Delivery Encounters with Severe Obstetric Complications
define "Delivery Encounters with Severe Obstetric Complications": "Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion" union "Delivery Encounters with Expiration" union "Delivery Encounters with Blood Transfusion"
define "Numerator": "Delivery Encounters with Severe Obstetric Complications"
define "Stratification Encounter": "Numerator" except "Denominator Exclusion"
Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions
define "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions": "Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion" union "Delivery Encounters with Expiration"
define "Stratum 1": //This logic identifies a subset of the numerator population with severe obstetric complications excluding cases where transfusion was the only severe obstetric complication. "Stratification Encounter" intersect "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions"
define "Risk Variable Bleeding Disorder": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Bleeding Disorder" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Risk Variable Multiple Pregnancy": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Multiple Pregnancy" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
Risk Variable First White Blood Cell Count Lab Test
//First resulted value 24 hours prior to start of encounter and before time of delivery //Report white blood cell count as 10*3/uL define "Risk Variable First White Blood Cell Count Lab Test": First(from "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" Encounter, ["USCoreLaboratoryResultObservationProfile": "White blood cells count lab test"] WBC where WBC.issued during Interval[start of Encounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, Encounter.lastTimeOfDelivery()) and WBC.status in { 'final', 'amended', 'corrected' } return { EncounterId: Encounter.id, FirstResult: WBC.value as Quantity, Timing: WBC.issued } sort by Timing )
define "Denominator": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation"
//First resulted value 24 hours prior to start of encounter and before time of delivery //Report hematocrit as % define "Risk Variable First Hematocrit Lab Test": First(from "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" Encounter, ["USCoreLaboratoryResultObservationProfile": "Hematocrit lab test"] Hematocrit where Hematocrit.issued during Interval[start of Encounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, Encounter.lastTimeOfDelivery()) and Hematocrit.status in { 'final', 'amended', 'corrected' } return { EncounterId: Encounter.id, FirstResult: Hematocrit.value as Quantity, Timing: Hematocrit.issued } sort by Timing )
define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text }
define "SDE Ethnicity": SDE."SDE Ethnicity"
define "Risk Variable Anemia": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Anemia" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Risk Variable Severe Preeclampsia": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Severe Preeclampsia" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
define "Risk Variable Cardiac Disease": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Cardiac Disease" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
Risk Variable Long Term Anticoagulant Use
define "Risk Variable Long Term Anticoagulant Use": "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnosis EncounterDiagnoses where EncounterDiagnoses.condition.getCondition ( ).code in "Long Term Anticoagulant Use" and ( EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt" ) )
Value set Estimated Gestational Age at Delivery
Value set Present On Admission is Yes or Exempt
Value set Respiratory Conditions Related to COVID 19
Value set Respiratory Support Procedures Related to COVID 19
Value set HIV in Pregnancy Childbirth and Puerperium
Value set Venous Thromboembolism in Pregnancy
Value set Severe Maternal Morbidity Diagnoses
Value set Present on Admission is No or Unable To Determine
Value set Severe Maternal Morbidity Procedures
Value set White blood cells count lab test
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. This definition establishes a variable of CGA (Calculated Gestational Age). CGA is a supplemental data element to store the calculated gestational age result from the "calculatedGestationalAge" function. The data element enables the capturing and saving of the CGA for data analysis post data receipt. Hospitals do not need to submit any additional data to comply with this definition.
The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Lab and Physical Exam Results: Report the first resulted value 24 hours prior to start of encounter and before time of delivery in UCUM units specified: - Heart rate: {beats}/min - Systolic blood pressure: mm[Hg] - White blood cell count: 10*3/uL - Hematocrit: % The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission:. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data.
Patients with severe obstetric complications which occur during the inpatient delivery hospitalization
This measure allows for 3 approaches to determine gestational age (GA) in the following order of precedence: 1. The GA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.* 2. The GA is obtained from a discrete field in the electronic health record. This option is only used when the calculated GA is not available. 3. The GA is based on ICD10 or SNOMED codes indicative of weeks gestation. This option is only used when results from items #1 and #2 (see above) are not available. Wherever gestational age is mentioned, relative to the delivery, the intent is to capture the last estimated gestational age prior to or at the time of delivery. *ACOG ReVITALize Guidelines for Calculating Gestational Age: Gestational Age = (280-(Estimated Due Date minus Reference Date))/7 --Estimated Due Date (EDD): The best obstetrical EDD is determined by last menstrual period if confirmed by early ultrasound or no ultrasound performed, or early ultrasound if no known last menstrual period or the ultrasound is not consistent with last menstrual period, or known date of fertilization (e.g., assisted reproductive technology) --Reference Date is the date on which you are trying to determine gestational age. For purposes of this eCQM, Reference Date would be the Date of Delivery. Note however the calculation may yield a non-whole number and gestational age should be rounded off to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks. Definition: For this measure, specifications are modeled after the nationally available and adopted CDC definition for Severe Maternal Morbidity (SMM) with the addition of maternal mortality. At times, we may refer to the CDC indicators of morbidity as SMM, but the outcome of the measure, which includes morbidity and mortality, is referred to as Severe Obstetric Complications (SOC). 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 CMS1028v2. 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 2022 World Health Organization. All Rights Reserved.
Centers for Medicare & Medicaid Services (CMS)
Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation
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 United States (US) experiences higher rates of maternal morbidity and mortality than most other developed countries. These rates have continued to trend upward in recent decades (CDC, n.d.). Research indicates that the overall rate of severe maternal morbidity (SMM) increased by almost 200% between 1993 and 2014 to 144 per 10,000 delivery hospitalizations (CDC, n.d.), with more than 25,000 women per year experiencing obstetric complications (U.S. Department of Health and Human Services, 2020). Recent maternal mortality data from 2018 reveal that 658 women in the US died from maternal causes, resulting in a rate of 17.4 deaths per 100,000 live births, with 77% of the deaths attributed to direct obstetric causes like hemorrhage, preeclampsia, obstetric embolism, and other complications (Hoyert & Minino, 2018). 144 per 10,000 women hospitalized for delivery have experienced SMM, including hemorrhage, embolism, hypertension, stroke, and other serious complications (CDC,2020). Racial and ethnic disparities for Black women and Hispanic women are at a significantly higher risk for developing these complications than are Non-Hispanic White women (Leonard et al., 2019). Increasing rates of SMM are resulting in increased healthcare costs, longer hospitalization stays and impacts on a woman's health. There is limited national evaluation of hospitals' performance on maternal morbidity and mortality although SMM is widely used at the population level. SMM is linked to maternal mortality, varies significantly among hospitals, and has significant racial/ethnic and urban/rural disparities. SMM is a cost driver for both Medicaid and commercial plans. This measure is important as it will assist in the discovery and understanding of SMM patterns which can lead to improvements in the safety and quality of maternal care necessary to reduce SMM rates.
Healthy People 2030 Measure (MICH-05): Reduce severe maternal complications identified during delivery hospitalizations The American College of Obstetricians and Gynecologists (the College) and the Society for Maternal-Fetal Medicine (SMFM) recommend identifying potential cases of severe maternal morbidity for further review, with a focus on outcomes and complications, and consider this an important step toward promoting safe obstetric care.
Inpatient hospitalizations for patients age greater than or equal to 8 years and less than 65 admitted to the hospital for inpatient acute care who undergo a delivery procedure with a discharge date that ends during the measurement period
Inpatient hospitalizations for patients delivering stillborn or live birth with greater than or equal to 20 weeks, 0 days gestation completed
Inpatient hospitalizations for patients with confirmed diagnosis of COVID with COVID-related respiratory condition or patients with confirmed diagnosis of COVID with COVID-related respiratory procedure
Inpatient hospitalizations for patients with severe obstetric complications (not present on admission that occur during the current delivery encounter) including the following: - Severe maternal morbidity diagnoses (see list below) - Severe maternal morbidity procedures (see list below) - Discharge disposition of expired Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. Severe Maternal Morbidity Diagnoses: - Cardiac Acute heart failure Acute myocardial infarction Aortic aneurysm Cardiac arrest/ventricular fibrillation Heart failure/arrest during procedure or surgery - Hemorrhage Disseminated intravascular coagulation Shock - Renal Acute renal failure - Respiratory Adult respiratory distress syndrome Pulmonary edema - Sepsis - Other OB Air and thrombotic embolism Amniotic fluid embolism Eclampsia Severe anesthesia complications - Other Medical Puerperal cerebrovascular disorder Sickle cell disease with crisis Severe Maternal Morbidity Procedures: - Blood transfusion - Conversion of cardiac rhythm - Hysterectomy - Temporary tracheostomy - Ventilation
Stratum1: Delivery hospitalizations with severe obstetric complications excluding hospitalizations where transfusion was the only severe obstetric complication. Additionally, this measure will be stratified by race and ethnicity after measure submission.
Risk Variable Lab and Physical Exam Results