eCQM QICore Content Implementation Guide
2023.0.0 - CI Build
eCQM QICore Content Implementation Guide
2023.0.0 - CI Build
eCQM QICore Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2023.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/ecqm-content-qicore-2023/ and changes regularly. See the Directory of published versions
| Draft as of 2023-10-27 |
<Measure xmlns="http://hl7.org/fhir">
<id value="UseofHighRiskMedicationsintheElderlyFHIR"/>
<meta>
<profile
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<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<table class="grid dict">
<tr>
<th scope="row"><b>Title: </b></th>
<td style="padding-left: 4px;">Use of High-Risk Medications in Older AdultsFHIR</td>
</tr>
<tr>
<th scope="row"><b>Id: </b></th>
<td style="padding-left: 4px;">UseofHighRiskMedicationsintheElderlyFHIR</td>
</tr>
<tr>
<th scope="row"><b>Download cql: </b></th>
<td style="padding-left: 4px;"><a href="Library-UseofHighRiskMedicationsintheElderlyFHIR.cql">UseofHighRiskMedicationsintheElderlyFHIR.cql</a></td>
</tr>
<tr>
<th scope="row"><b>Version: </b></th>
<td style="padding-left: 4px;">0.0.001</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="Measure-UseofHighRiskMedicationsintheElderlyFHIR.html">Use of High-Risk Medications in Older AdultsFHIR</a></td>
</tr>
<tr>
<th scope="row">
<b>
short-name identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>CMS156FHIR</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
version-independent identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>urn:uuid:fa08c5d7-5345-4e0b-aa2d-d937099db108</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
version-specific identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>urn:uuid:2c928084808a958901809a8b347f0755</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
publisher (CMS) identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>156FHIR</span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Effective Period: </b></th>
<td style="padding-left: 4px;">2024-01-01
..2024-12-31</td>
</tr>
<tr>
<th scope="row"><b>Status: </b></th>
<td style="padding-left: 4px;">draft</td>
</tr>
<tr>
<th scope="row"><b>Date: </b></th>
<td style="padding-left: 4px;">2023-10-27 08:12:32+0000</td>
</tr>
<tr>
<th scope="row"><b>Approval Date: </b></th>
<td style="padding-left: 4px;">2023-08-28</td>
</tr>
<tr>
<th scope="row"><b>Last Review Date: </b></th>
<td style="padding-left: 4px;">2023-08-28</td>
</tr>
<tr>
<th scope="row"><b>Name: </b></th>
<td style="padding-left: 4px;">UseofHighRiskMedicationsintheElderlyFHIR</td>
</tr>
<tr>
<th scope="row"><b>Publisher: </b></th>
<td style="padding-left: 4px;">National Committee for Quality Assurance</td>
</tr>
<tr>
<th scope="row"><b>Author: </b></th>
<td style="padding-left: 4px;">National Committee for Quality Assurance: <a href="https://www.ncqa.org/">https://www.ncqa.org/</a></td>
</tr>
<tr>
<th scope="row"><b>Description: </b></th>
<td style="padding-left: 4px;"><div><p>Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported.</p>
<ol>
<li>Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class.</li>
<li>Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses.</li>
<li>Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators).</li>
</ol>
</div></td>
</tr>
<tr>
<th scope="row"><b>Use Context: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>code</b></th>
<th><b>value</b></th>
</tr>
<tr>
<td>program</td>
<td/>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Purpose: </b></th>
<td style="padding-left: 4px;"><div><p>UNKNOWN</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Copyright: </b></th>
<td style="padding-left: 4px;"><div><p>This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract HHSM-500-2011-00079C) with the National Committee for Quality Assurance (NCQA) to develop this electronic measure. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications.</p>
<p>Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications.</p>
<p>CPT(R) codes, descriptions and other data are copyright 2022. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.</p>
<p>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.</p>
<p>ICD-10 copyright 2022 World Health Organization. All Rights Reserved.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Disclaimer: </b></th>
<td style="padding-left: 4px;"><div><p>The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.</p>
<p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Rationale: </b></th>
<td style="padding-left: 4px;"><div><p>Certain medications (MacKinnon & Hepler, 2003) are associated with increased risk of harm from drug side-effects and drug toxicity and pose a concern for patient safety. There is clinical consensus that these drugs pose increased risks in older adults (Kaufman, Brodin, & Sarafian, 2005). Potentially inappropriate medication use in older adults has been connected to significantly longer hospital stay lengths and increased hospitalization costs (Hagstrom et al., 2015) as well as increased risk of death (Lau et al., 2004). Use of specific high-risk medications such as hypnotics, including benzodiazepine receptor agonists, and nonsteroidal anti-inflammatory drugs (NSAIDS) can result in increased risk of delirium, falls, fractures, gastrointestinal bleeding and acute kidney injury (Merel et al., 2017). Long-term use of benzodiazepines in older adults has been associated with increased risk of dementia (Zhong et al., 2015; Takada et al., 2016). Additionally, the use of antipsychotics can lead to increased risk of stroke and greater cognitive decline in older adults with dementia (Tampi et al., 2016).</p>
<p>Older adults receiving inappropriate medications are more likely to report poorer health status at follow-up, compared to those who receive appropriate medications (Fu, Liu, & Christensen, 2004). A study of the prevalence of potentially inappropriate medication use in older adults found that 40 percent of individuals 65 and older filled at least one prescription for a potentially inappropriate medication and 13 percent filled two or more (Fick et al., 2008). While some adverse drug events (ADEs) are unavoidable, studies estimate that between 30 and 80 percent of ADEs in older adults are preventable (MacKinnon & Hepler, 2003). More recently with the onset of the COVID-19 pandemic, several studies have shown an increase in anxiety, insomnia and depression rates, which could result in an increase in the use of high-risk medications in order to treat these conditions (Agrawal, 2020).</p>
<p>Reducing the number of inappropriate prescriptions can lead to improved patient safety and significant cost savings. Conservative estimates of extra costs due to potentially inappropriate medications in older adults average $7.2 billion a year (Fu et al., 2007). Medication use by older adults will likely increase further as the U.S. population ages, new drugs are developed, and new therapeutic and preventive uses for medications are discovered (Rothberg et al., 2008). The annual direct costs of preventable ADEs in the Medicare population have been estimated to exceed $800 million (Institute of Medicine, 2007). By the year 2030, nearly one in five U.S. residents is expected to be aged 65 years or older; this age group is projected to more than double from 38.7 million in 2008 to more than 88.5 million in 2050. Likewise, the population aged 85 years or older is expected to increase almost four-fold, from 5.4 million to 19 million between 2008 and 2050. As the older adult population continues to grow, the number of older adults who present with multiple medical conditions for which several medications are prescribed will likely continue to increase, resulting in polypharmacy concerns (Gray & Gardner, 2009).</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Clinical recommendation statement: </b></th>
<td style="padding-left: 4px;"><div><p>The measure is based on recommendations from the American Geriatrics Society Beers Criteria[R] for Potentially Inappropriate Medication Use in Older Adults (2019 Update). The criteria were developed through key clinical expert consensus processes by Beers in 1997, Zhan in 2001, and an updated process by Fick et al. in 2003, 2012, 2015, and 2019. The Beers Criteria identifies lists of drugs that are potentially inappropriate for all older adults, except for those with certain conditions for which some high-risk medications may be warranted, and drugs that are potentially inappropriate in older adults based on various high-risk factors such as dosage, days supply and underlying diseases or conditions.
NCQA's Geriatric Measurement Advisory Panel recommended a subset of drugs that should be used with caution in older adults for inclusion in the measure based upon the recommendations in the Beers Criteria.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Guidance (Usage): </b></th>
<td style="padding-left: 4px;">The intent of the measure is to assess if the patient has been ordered at least two high-risk medication prescriptions from the same drug class on different days.
The intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication from the same drug class for them.
Calculate average daily dose for each prescription event. To calculate average daily dose, multiply the quantity of pills prescribed by the dose of each pill and divide by the days supply. For example, a prescription for the 30-days supply of digoxin containing 15 pills, 0.25 mg each pill, has an average daily dose of 0.125 mg. To calculate average daily dose for elixirs and concentrates, multiply the volume prescribed by daily dose and divide by the days supply. Do not round when calculating average daily dose.
This eCQM is a patient-based measure.
This FHIR-based measure has been derived from the QDM-based measure: CMS156v12.
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).</td>
</tr>
<tr>
<th scope="row"><b>Population Criteria: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>649c8b4a4c79454c026f7495</b></th>
</tr>
<tr>
<td>Initial Population:</td>
<td>Patients 65 years and older at the end of the measurement period who had a visit during the measurement period</td>
</tr>
<tr>
<td>Denominator:</td>
<td>Equals Initial Population</td>
</tr>
<tr>
<td>Denominator Exclusion:</td>
<td>Exclude patients who are in hospice care for any part of the measurement period.
Exclude patients receiving palliative care for any part of the measurement period.</td>
</tr>
<tr>
<td>Numerator:</td>
<td>Rate 1: Patients with at least two orders of high-risk medications from the same drug class on different days.
a. At least two orders of high-risk medications from the same drug class.
b. At least two orders of high-risk medications from the same drug class with summed days supply greater than 90 days.
c. At least two orders of high-risk medications from the same drug class each exceeding average daily dose criteria.</td>
</tr>
<tr>
<td>Numerator Exclusion:</td>
<td>None</td>
</tr>
<tr>
<td>Denominator Exception:</td>
<td>None</td>
</tr>
</table>
<table class="grid-dict">
<tr>
<th><b>649c8b4a4c79454c026f7496</b></th>
</tr>
<tr>
<td>Initial Population:</td>
<td>Patients 65 years and older at the end of the measurement period who had a visit during the measurement period</td>
</tr>
<tr>
<td>Denominator:</td>
<td>Equals Initial Population</td>
</tr>
<tr>
<td>Denominator Exclusion:</td>
<td>Exclude patients who are in hospice care for any part of the measurement period.
Exclude patients receiving palliative care for any part of the measurement period.</td>
</tr>
<tr>
<td>Numerator:</td>
<td>Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines) on different days except for appropriate diagnoses.
a. Patients with two or more antipsychotic prescriptions ordered on different days, and who did not have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the IPSD for antipsychotics.
b. Patients with two or more benzodiazepine prescriptions ordered on different days, and who did not have a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between January 1 of the year prior to the measurement period and the IPSD for benzodiazepines.
</td>
</tr>
<tr>
<td>Numerator Exclusion:</td>
<td>None</td>
</tr>
<tr>
<td>Denominator Exception:</td>
<td>None</td>
</tr>
</table>
<table class="grid-dict">
<tr>
<th><b>649c8b4a4c79454c026f7497</b></th>
</tr>
<tr>
<td>Initial Population:</td>
<td>Patients 65 years and older at the end of the measurement period who had a visit during the measurement period</td>
</tr>
<tr>
<td>Denominator:</td>
<td>Equals Initial Population</td>
</tr>
<tr>
<td>Denominator Exclusion:</td>
<td>Exclude patients who are in hospice care for any part of the measurement period.
Exclude patients receiving palliative care for any part of the measurement period.</td>
</tr>
<tr>
<td>Numerator:</td>
<td>Total rate (the sum of the two previous numerators, deduplicated).</td>
</tr>
<tr>
<td>Numerator Exclusion:</td>
<td>None</td>
</tr>
<tr>
<td>Denominator Exception:</td>
<td>None</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Libraries: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td><a href="Library-UseofHighRiskMedicationsintheElderlyFHIR.html">UseofHighRiskMedicationsintheElderlyFHIR</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Related Artifact Dependencies: </b></th>
<td style="padding-left: 4px;">
<li><a href="Library-Status.html">Status</a> version: 1.6.000</li>
<li><a href="Library-CumulativeMedicationDuration.html">CumulativeMedicationDuration</a> version: 3.3.000</li>
<li><a href="Library-FHIRHelpers.html">FHIRHelpers</a> version: 4.3.000</li>
<li><a href="Library-QICoreCommon.html">QICoreCommon</a> version: 1.5.000</li>
<li><a href="Library-CQMCommon.html">CQMCommon</a> version: 1.4.000</li>
<li><a href="Library-Hospice.html">Hospice</a> version: 6.7.000</li>
<li><a href="Library-PalliativeCare.html">PalliativeCare</a> version: 1.7.000</li>
<li><a href="http://tx.fhir.org/r4/ValueSet/x-RxNorm-03022026">RxNorm</a></li>
<li><a href="http://tx.fhir.org/r4/ValueSet/x-cpt2023">CPT</a></li>
<li><a href="http://hl7.org/fhir/R4/codesystem-snomedct.html">SNOMED CT (all versions)</a></li>
<li><a href="http://terminology.hl7.org/7.1.0/CodeSystem-observation-category.html">Observation Category Codes</a></li>
<li><a href="http://tx.fhir.org/r4/ValueSet/x-loinc2.82">LOINC</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1523-20220213">Potentially Harmful Antipsychotics for Older Adults</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1205-20210224">Schizophrenia</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1157/expansion">Bipolar Disorder</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1522-20220212">Potentially Harmful Benzodiazepines for Older Adults</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1206-20210224">Seizure Disorder</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1207-20210224">REM Sleep Behavior Disorder</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1208-20210224">Benzodiazepine Withdrawal</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1209-20210224">Alcohol Withdrawal</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1210-20210224">Generalized Anxiety Disorder</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1043-20240120">Potentially Harmful Antihistamines for Older Adults</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1049-20240123">Potentially Harmful Antiparkinsonian Agents for Older Adults</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1050-20240123">Potentially Harmful Gastrointestinal Antispasmodics for Older Adults</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1051-20210909">Dipyridamole Medications</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1052-20240117">Cardiovascular, alpha agonists, central</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1053-20240117">Nifedipine Medications</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1054-20240120">Potentially Harmful Antidepressants for Older Adults</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1055-20240123">Potentially Harmful Barbiturates for Older Adults</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1056-20240117">Ergoloid Mesylates Medications</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1057-20210909">Meprobamate Medications</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1058-20240123">Potentially Harmful Estrogens for Older Adults</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1059-20240123">Potentially Harmful Sulfonylureas for Older Adults</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1060-20240117">Desiccated Thyroid Medications</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1480/expansion">Nonbenzodiazepine hypnotics</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1062-20240123">Potentially Harmful Skeletal Muscle Relaxants for Older Adults</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1063-20240123">Potentially Harmful Pain Medications for Older Adults</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1481/expansion">Anti Infectives, other</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1044-20210903">Reserpine</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1065-20210910">Digoxin Medications</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1067-20210910">Doxepin Medications</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion">Office Visit</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.11.1206/expansion">Ophthalmologic Services</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion">Preventive Care Services - Established Office Visit, 18 and Up</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1013/expansion">Discharge Services - Nursing Facility</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1012/expansion">Nursing Facility Visit</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1014/expansion">Care Services in Long-Term Residential Facility</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion">Preventive Care Services-Initial Office Visit, 18 and Up</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion">Annual Wellness Visit</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion">Home Healthcare Services</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion">Telephone Visits</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089-20210224">Virtual Encounter</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1003-20210820">Hospice Encounter</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion">Hospice Care Ambulatory</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1165-20220818">Hospice Diagnosis</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1167-20220820">Palliative Care Diagnosis</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090-20210224">Palliative Care Encounter</a></li>
<li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135-20210224">Palliative Care Intervention</a></li>
</td>
</tr>
<tr>
<th scope="row"><b>Parameters:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>name</b></th>
<th><b>use</b></th>
<th><b>min</b></th>
<th><b>max</b></th>
<th><b>type</b></th>
</tr>
<tr>
<td>Measurement Period</td>
<td>In</td>
<td>0</td>
<td>1</td>
<td>Period</td>
</tr>
<tr>
<td>ErrorLevel</td>
<td>In</td>
<td>0</td>
<td>1</td>
<td>string</td>
</tr>
<tr>
<td>Numerator 3</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>boolean</td>
</tr>
<tr>
<td>Denominator</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>boolean</td>
</tr>
<tr>
<td>Numerator 1</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>boolean</td>
</tr>
<tr>
<td>Numerator 2</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>boolean</td>
</tr>
<tr>
<td>Initial Population</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>boolean</td>
</tr>
<tr>
<td>Denominator Exclusions</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>boolean</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>DataRequirements:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>Type</b></th>
<th><b>Elements</b></th>
<th><b>Valueset Name</b></th>
<th><b>Valueset</b></th>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Antipsychotic
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1523-20220213">Potentially Harmful Antipsychotics for Older Adults</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Benzodiazepine
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1522-20220212">Potentially Harmful Benzodiazepines for Older Adults</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Anticholinergics, first generation antihistamines
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1043-20240120">Potentially Harmful Antihistamines for Older Adults</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Anticholinergics, anti Parkinson agents
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1049-20240123">Potentially Harmful Antiparkinsonian Agents for Older Adults</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Antispasmodics
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1050-20240123">Potentially Harmful Gastrointestinal Antispasmodics for Older Adults</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Antithrombotic
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1051-20210909">Dipyridamole Medications</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Cardiovascular, alpha agonists, central
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1052-20240117">Cardiovascular, alpha agonists, central</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Cardiovascular, other
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1053-20240117">Nifedipine Medications</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Central nervous system, antidepressants
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1054-20240120">Potentially Harmful Antidepressants for Older Adults</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Central nervous system, barbiturates
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1055-20240123">Potentially Harmful Barbiturates for Older Adults</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Central nervous system, vasodilators
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1056-20240117">Ergoloid Mesylates Medications</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Central nervous system, other
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1057-20210909">Meprobamate Medications</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Endocrine system, estrogens with or without progestins
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1058-20240123">Potentially Harmful Estrogens for Older Adults</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Endocrine system, sulfonylureas, long duration
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1059-20240123">Potentially Harmful Sulfonylureas for Older Adults</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Endocrine system, other
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1060-20240117">Desiccated Thyroid Medications</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Nonbenzodiazepine hypnotics
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1480/expansion">Nonbenzodiazepine hypnotics</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Pain medications, skeletal muscle relaxants
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1062-20240123">Potentially Harmful Skeletal Muscle Relaxants for Older Adults</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Pain medications, other
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1063-20240123">Potentially Harmful Pain Medications for Older Adults</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Anti Infectives, other
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1481/expansion">Anti Infectives, other</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Reserpine
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1044-20210903">Reserpine</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Digoxin
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1065-20210910">Digoxin Medications</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication.reference
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Doxepin
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1067-20210910">Doxepin Medications</a></td>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Schizophrenia
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1205-20210224">Schizophrenia</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Bipolar Disorder
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1157/expansion">Bipolar Disorder</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Seizure Disorder
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1206-20210224">Seizure Disorder</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
REM Sleep Behavior Disorder
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1207-20210224">REM Sleep Behavior Disorder</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Benzodiazepine Withdrawal
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1208-20210224">Benzodiazepine Withdrawal</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Alcohol Withdrawal
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1209-20210224">Alcohol Withdrawal</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Generalized Anxiety Disorder
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1210-20210224">Generalized Anxiety Disorder</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Hospice Diagnosis
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1165-20220818">Hospice Diagnosis</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Palliative Care Diagnosis
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1167-20220820">Palliative Care Diagnosis</a></td>
</tr>
<tr>
<td>Patient(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html">QICorePatient</a>)</td>
<td>
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
</td>
<td>
Office Visit
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion">Office Visit</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
</td>
<td>
Ophthalmologic Services
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.11.1206/expansion">Ophthalmologic Services</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
</td>
<td>
Preventive Care Services Established Office Visit, 18 and Up
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion">Preventive Care Services - Established Office Visit, 18 and Up</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
</td>
<td>
Discharge Services Nursing Facility
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1013/expansion">Discharge Services - Nursing Facility</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
</td>
<td>
Nursing Facility Visit
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1012/expansion">Nursing Facility Visit</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
</td>
<td>
Care Services in Long Term Residential Facility
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1014/expansion">Care Services in Long-Term Residential Facility</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
</td>
<td>
Preventive Care Services Initial Office Visit, 18 and Up
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion">Preventive Care Services-Initial Office Visit, 18 and Up</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
</td>
<td>
Annual Wellness Visit
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion">Annual Wellness Visit</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
</td>
<td>
Home Healthcare Services
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion">Home Healthcare Services</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
</td>
<td>
Telephone Visits
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion">Telephone Visits</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
</td>
<td>
Online Assessments
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089-20210224">Virtual Encounter</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
hospitalization
hospitalization.dischargeDisposition
period
status
status.value
</td>
<td>
Encounter Inpatient
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
</td>
<td>
Hospice Encounter
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.1003-20210820">Hospice Encounter</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
</td>
<td>
Palliative Care Encounter
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090-20210224">Palliative Care Encounter</a></td>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
<td>
code
value
effective
status
status.value
category
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
<td>
code
effective
status
status.value
category
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>ServiceRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html">QICoreServiceRequest</a>)</td>
<td>
code
authoredOn
authoredOn.value
status
status.value
intent
intent.value
</td>
<td>
Hospice Care Ambulatory
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion">Hospice Care Ambulatory</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
performed
status
status.value
</td>
<td>
Hospice Care Ambulatory
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion">Hospice Care Ambulatory</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
performed
status
status.value
</td>
<td>
Palliative Care Intervention
</td>
<td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135-20210224">Palliative Care Intervention</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Direct Reference Codes:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>display</b></th>
<th><b>code</b></th>
<th><b>system</b></th>
</tr>
<tr>
<td>reserpine 0.1 MG Oral Tablet</td>
<td>198196</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>reserpine 0.25 MG Oral Tablet</td>
<td>198197</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>digoxin 0.05 MG/ML Oral Solution</td>
<td>393245</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>digoxin 0.0625 MG Oral Tablet</td>
<td>245273</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>1 ML digoxin 0.1 MG/ML Injection</td>
<td>204504</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>digoxin 0.125 MG Oral Tablet</td>
<td>197604</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>digoxin 0.1875 MG Oral Tablet</td>
<td>1441565</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>digoxin 0.25 MG Oral Tablet</td>
<td>197606</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>2 ML digoxin 0.25 MG/ML Injection</td>
<td>104208</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>doxepin 3 MG Oral Tablet</td>
<td>966787</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>doxepin 6 MG Oral Tablet</td>
<td>966793</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>doxepin hydrochloride 10 MG Oral Capsule</td>
<td>1000048</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>doxepin hydrochloride 10 MG/ML Oral Solution</td>
<td>1000054</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>doxepin hydrochloride 25 MG Oral Capsule</td>
<td>1000070</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>doxepin hydrochloride 50 MG Oral Capsule</td>
<td>1000076</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>doxepin hydrochloride 75 MG Oral Capsule</td>
<td>1000097</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>doxepin hydrochloride 100 MG Oral Capsule</td>
<td>1000058</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>doxepin hydrochloride 150 MG Oral Capsule</td>
<td>1000064</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.</td>
<td>99211</td>
<td><a href="http://tx.fhir.org/r4/ValueSet/x-cpt2023">http://www.ama-assn.org/go/cpt</a></td>
</tr>
<tr>
<td>Discharge to home for hospice care (procedure)</td>
<td>428361000124107</td>
<td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
</tr>
<tr>
<td>Discharge to healthcare facility for hospice care (procedure)</td>
<td>428371000124100</td>
<td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
</tr>
<tr>
<td>survey</td>
<td>survey</td>
<td><a href="http://terminology.hl7.org/7.1.0/CodeSystem-observation-category.html">http://terminology.hl7.org/CodeSystem/observation-category</a></td>
</tr>
<tr>
<td>Hospice care [Minimum Data Set]</td>
<td>45755-6</td>
<td><a href="https://loinc.org/">http://loinc.org</a></td>
</tr>
<tr>
<td>Yes (qualifier value)</td>
<td>373066001</td>
<td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
</tr>
<tr>
<td>Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)</td>
<td>71007-9</td>
<td><a href="https://loinc.org/">http://loinc.org</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Logic Definitions:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>Group</b></th>
<th><b>Scoring</b></th>
<th><b>Population Criteria</b></th>
<th><b>Expression</b></th>
</tr>
<tr>
<td> 649c8b4a4c79454c026f7495 </td>
<td>
<b>Group scoring:</b>
<span> proportion </span>
</td>
<tr>
<td/>
<td/>
<td>Initial Population</td>
<td>
<pre><code class="language-cql">define "Initial Population":
AgeInYearsAt(date from
end of "Measurement Period"
) >= 65
and exists ( "Qualifying Encounters" )</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator</td>
<td>
<pre><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exclusion</td>
<td>
<pre><code class="language-cql">define "Denominator Exclusions":
Hospice."Has Hospice Services"
or PalliativeCare."Has Palliative Care in the Measurement Period"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Numerator</td>
<td>
<pre><code class="language-cql">define "Numerator 1":
exists ( "Same High Risk Medications Ordered on Different Days" )
or ( "Two High Risk Medications with Prolonged Duration" )
or ( "High Risk Medications with Average Daily Dose Criteria" )</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Numerator Exclusion</td>
<td>
None
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exception</td>
<td>
None
</td>
</tr>
<td> 649c8b4a4c79454c026f7496 </td>
<td>
<b>Group scoring:</b>
<span> proportion </span>
</td>
<tr>
<td/>
<td/>
<td>Initial Population</td>
<td>
<pre><code class="language-cql">define "Initial Population":
AgeInYearsAt(date from
end of "Measurement Period"
) >= 65
and exists ( "Qualifying Encounters" )</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator</td>
<td>
<pre><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exclusion</td>
<td>
<pre><code class="language-cql">define "Denominator Exclusions":
Hospice."Has Hospice Services"
or PalliativeCare."Has Palliative Care in the Measurement Period"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Numerator</td>
<td>
<pre><code class="language-cql">define "Numerator 2":
( "More than One Antipsychotic Order"
and ( not exists ( ( [Condition: "Schizophrenia"]
union [Condition: "Bipolar Disorder"] ) AntipsychoticTreatedDiagnoses
where QICoreCommon."ToPrevalenceInterval" ( AntipsychoticTreatedDiagnoses ) overlaps Interval[start of "Measurement Period" - 1 year, "Antipsychotic Index Prescription Start Date"]
)
)
)
or ( "More than One Benzodiazepine Order"
and ( not exists ( ( [Condition: "Seizure Disorder"]
union [Condition: "REM Sleep Behavior Disorder"]
union [Condition: "Benzodiazepine Withdrawal"]
union [Condition: "Alcohol Withdrawal"]
union [Condition: "Generalized Anxiety Disorder"] ) BenzodiazepineTreatedDiagnoses
where QICoreCommon."ToPrevalenceInterval" ( BenzodiazepineTreatedDiagnoses ) overlaps Interval[start of "Measurement Period" - 1 year, "Benzodiazepine Index Prescription Start Date"]
)
)
)</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Numerator Exclusion</td>
<td>
None
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exception</td>
<td>
None
</td>
</tr>
<td> 649c8b4a4c79454c026f7497 </td>
<td>
<b>Group scoring:</b>
<span> proportion </span>
</td>
<tr>
<td/>
<td/>
<td>Initial Population</td>
<td>
<pre><code class="language-cql">define "Initial Population":
AgeInYearsAt(date from
end of "Measurement Period"
) >= 65
and exists ( "Qualifying Encounters" )</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator</td>
<td>
<pre><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exclusion</td>
<td>
<pre><code class="language-cql">define "Denominator Exclusions":
Hospice."Has Hospice Services"
or PalliativeCare."Has Palliative Care in the Measurement Period"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Numerator</td>
<td>
<pre><code class="language-cql">define "Numerator 3":
"Numerator 2"
or ( "Numerator 1"
and not "Numerator 2"
)</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Numerator Exclusion</td>
<td>
None
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exception</td>
<td>
None
</td>
</tr>
</tr>
</table>
<table class="grid-dict">
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>More than One Antipsychotic Order</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "More than One Antipsychotic Order":
exists ( "More Than One Order"([MedicationRequest: "Antipsychotic"]) )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Antipsychotic Index Prescription Start Date</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Antipsychotic Index Prescription Start Date":
First((Status."Active or Completed Medication Request"([MedicationRequest: "Antipsychotic"])) AntipsychoticMedication
where AntipsychoticMedication.authoredOn during "Measurement Period"
return AntipsychoticMedication.authoredOn
sort asc
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>More than One Benzodiazepine Order</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "More than One Benzodiazepine Order":
exists ( "More Than One Order"([MedicationRequest: "Benzodiazepine"]) )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Benzodiazepine Index Prescription Start Date</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Benzodiazepine Index Prescription Start Date":
First((Status."Active or Completed Medication Request"([MedicationRequest: "Benzodiazepine"])) BenzodiazepineMedication
where BenzodiazepineMedication.authoredOn during "Measurement Period"
return BenzodiazepineMedication.authoredOn
sort asc
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Numerator 2</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Numerator 2":
( "More than One Antipsychotic Order"
and ( not exists ( ( [Condition: "Schizophrenia"]
union [Condition: "Bipolar Disorder"] ) AntipsychoticTreatedDiagnoses
where QICoreCommon."ToPrevalenceInterval" ( AntipsychoticTreatedDiagnoses ) overlaps Interval[start of "Measurement Period" - 1 year, "Antipsychotic Index Prescription Start Date"]
)
)
)
or ( "More than One Benzodiazepine Order"
and ( not exists ( ( [Condition: "Seizure Disorder"]
union [Condition: "REM Sleep Behavior Disorder"]
union [Condition: "Benzodiazepine Withdrawal"]
union [Condition: "Alcohol Withdrawal"]
union [Condition: "Generalized Anxiety Disorder"] ) BenzodiazepineTreatedDiagnoses
where QICoreCommon."ToPrevalenceInterval" ( BenzodiazepineTreatedDiagnoses ) overlaps Interval[start of "Measurement Period" - 1 year, "Benzodiazepine Index Prescription Start Date"]
)
)
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Same High Risk Medications Ordered on Different Days</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Same High Risk Medications Ordered on Different Days":
"More Than One Order"(["MedicationRequest": "Anticholinergics, first generation antihistamines"])
union "More Than One Order"(["MedicationRequest": "Anticholinergics, anti Parkinson agents"])
union "More Than One Order"(["MedicationRequest": "Antispasmodics"])
union "More Than One Order"(["MedicationRequest": "Antithrombotic"])
union "More Than One Order"(["MedicationRequest": "Cardiovascular, alpha agonists, central"])
union "More Than One Order"(["MedicationRequest": "Cardiovascular, other"])
union "More Than One Order"(["MedicationRequest": "Central nervous system, antidepressants"])
union "More Than One Order"(["MedicationRequest": "Central nervous system, barbiturates"])
union "More Than One Order"(["MedicationRequest": "Central nervous system, vasodilators"])
union "More Than One Order"(["MedicationRequest": "Central nervous system, other"])
union "More Than One Order"(["MedicationRequest": "Endocrine system, estrogens with or without progestins"])
union "More Than One Order"(["MedicationRequest": "Endocrine system, sulfonylureas, long duration"])
union "More Than One Order"(["MedicationRequest": "Endocrine system, other"])
union "More Than One Order"(["MedicationRequest": "Nonbenzodiazepine hypnotics"])
union "More Than One Order"(["MedicationRequest": "Pain medications, skeletal muscle relaxants"])
union "More Than One Order"(["MedicationRequest": "Pain medications, other"])</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Two High Risk Medications with Prolonged Duration</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Two High Risk Medications with Prolonged Duration":
Sum(("More Than One Order"([MedicationRequest: "Anti Infectives, other"])) AntiInfectives
let DaysSupply: AntiInfectives.MedicationRequestPeriodInDays()
return all DaysSupply
) > 90</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>High Risk Medications with Average Daily Dose Criteria</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "High Risk Medications with Average Daily Dose Criteria":
exists ( "More Than One Order"([MedicationRequest: "Reserpine"] ReserpineOrdered
where "Average Daily Dose"(ReserpineOrdered) > 0.1 'mg/d'
)
)
or exists ( "More Than One Order"([MedicationRequest: "Digoxin"] DigoxinOrdered
where "Average Daily Dose"(DigoxinOrdered) > 0.125 'mg/d'
)
)
or exists ( "More Than One Order"([MedicationRequest: "Doxepin"] DoxepinOrdered
where "Average Daily Dose"(DoxepinOrdered) > 6 'mg/d'
)
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Numerator 1</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Numerator 1":
exists ( "Same High Risk Medications Ordered on Different Days" )
or ( "Two High Risk Medications with Prolonged Duration" )
or ( "High Risk Medications with Average Daily Dose Criteria" )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Numerator 3</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Numerator 3":
"Numerator 2"
or ( "Numerator 1"
and not "Numerator 2"
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Qualifying Encounters</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Qualifying Encounters":
( ["Encounter": "Office Visit"]
union ["Encounter": "Ophthalmologic Services"]
union ["Encounter": "Preventive Care Services Established Office Visit, 18 and Up"]
union ["Encounter": "Discharge Services Nursing Facility"]
union ["Encounter": "Nursing Facility Visit"]
union ["Encounter": "Care Services in Long Term Residential Facility"]
union ["Encounter": "Preventive Care Services Initial Office Visit, 18 and Up"]
union ["Encounter": "Annual Wellness Visit"]
union ["Encounter": "Home Healthcare Services"]
union ["Encounter": "Telephone Visits"]
union ["Encounter": "Online Assessments"]
union ( [Encounter] E
where exists ( ( E.type ) T
where T ~ "Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal."
)
) ) ValidEncounters
where ValidEncounters.period during "Measurement Period"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Initial Population</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Initial Population":
AgeInYearsAt(date from
end of "Measurement Period"
) >= 65
and exists ( "Qualifying Encounters" )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Denominator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>Hospice</td>
<td>Has Hospice Services</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Hospice Services":
exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter
where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
)
and InpatientEncounter.period.toInterval() ends during day of "Measurement Period"
)
or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter
where HospiceEncounter.period.toInterval() overlaps day of "Measurement Period"
)
or exists ((([Observation: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment
where HospiceAssessment.value ~ "Yes (qualifier value)"
and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period"
)
or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder
where HospiceOrder.authoredOn.toInterval() during day of "Measurement Period"
)
or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed
where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period"
)
or exists (([Condition: "Hospice Diagnosis"]) HospiceCareDiagnosis
where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>PalliativeCare</td>
<td>Has Palliative Care in the Measurement Period</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Palliative Care in the Measurement Period":
exists ((([Observation: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"]).isAssessmentPerformed()) PalliativeAssessment
where PalliativeAssessment.effective.toInterval() overlaps day of "Measurement Period"
)
or exists ([Condition: "Palliative Care Diagnosis"] PalliativeDiagnosis
where PalliativeDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
)
or exists ((([Encounter: "Palliative Care Encounter"]).isEncounterPerformed()) PalliativeEncounter
where PalliativeEncounter.period.toInterval() overlaps day of "Measurement Period"
)
or exists ((([Procedure: "Palliative Care Intervention"]).isInterventionPerformed()) PalliativeIntervention
where PalliativeIntervention.performed.toInterval() overlaps day of "Measurement Period"
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Denominator Exclusions</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator Exclusions":
Hospice."Has Hospice Services"
or PalliativeCare."Has Palliative Care in the Measurement Period"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>More Than One Order</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">//Functions
define function "More Than One Order"(Medication List<"MedicationRequest">):
( Status."Active or Completed Medication Request" ( "Medication" ) ) OrderMedication1
with ( Status."Active or Completed Medication Request" ( "Medication" ) ) OrderMedication2
such that ( OrderMedication1.authoredOn during "Measurement Period"
and OrderMedication1.dispenseRequest.numberOfRepeatsAllowed >= 1
)
or ( date from OrderMedication1.authoredOn !~ date from OrderMedication2.authoredOn
and OrderMedication1.authoredOn during "Measurement Period"
and OrderMedication2.authoredOn during "Measurement Period"
)
or ( date from OrderMedication1.authoredOn ~ date from OrderMedication2.authoredOn
and OrderMedication1.authoredOn during "Measurement Period"
and date from start of CMD."MedicationRequestPeriod" ( OrderMedication1 ) !~ date from start of CMD."MedicationRequestPeriod" ( OrderMedication2 )
and start of CMD."MedicationRequestPeriod" ( OrderMedication1 ) during "Measurement Period"
and start of CMD."MedicationRequestPeriod" ( OrderMedication2 ) during "Measurement Period"
)
return OrderMedication1</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>Status</td>
<td>Active or Completed Medication Request</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">//Medication, Order: active and completed only
define function "Active or Completed Medication Request"(MedicationRequest List<MedicationRequest>):
MedicationRequest M
where M.status in { 'active', 'completed' }
and M.intent = 'order'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CumulativeMedicationDuration</td>
<td>MedicationRequestPeriod</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
Now that we have a ToDaily function, we can approach calculation of the
duration of medication for an order. First, consider the definitions
for each element:
* 1 and only 1 dosageInstruction
* 1 and only 1 doseAndRate
* 1 timing with 1 repeat
* frequency, frequencyMax, defaulting to 1
* period, periodUnit, defaulting to 1 'd'
* doseQuantity or doseRange
* timeOfDay
* authoredOn: The date the prescription was written
* dispenseRequest.validityPeriod: Time period supply is authorized for
* dispenseRequest.quantity: amount of medication supplied per dispense
* dispenseRequest.numberOfRepeatsAllowed: number of refills authorized
* dispenseRequest.expectedSupplyDuration: number of days supply per dispense
* dosageInstruction.timing.repeat.boundsDuration: total duration of the repeat
* dosageInstruction.timing.repeat.boundsRange: range of durations of the repeat
* dosageInstruction.timing.repeat.boundsPeriod: period bounds of the repeat
* dosageInstruction.timing.repeat.count: number of times to repeat
* dosageInstruction.timing.repeat.countMax: maximum number of times to repeat
* dosageInstruction.timing.repeat.frequency: event occurs frequency times per period
* dosageInstruction.timing.repeat.frequencyMax: event occurs up to frequencyMax times per period
* dosageInstruction.timing.repeat.period: event occurs frequency times per period
* dosageInstruction.timing.repeat.periodMax: upper limit of period
* dosageInstruction.timing.repeat.periodUnit: period duration (s | min | h | d | wk | mo | a)
* dosageInstruction.timing.repeat.timeOfDay: time of day for the event (0..*)
* dosageInstruction.timing.repeat.when: event timing (HS | WAKE | C | CM | CD | CV | AC | ACM...)
* dosageInstruction.timing.code: BID | TID | QID | AM | PM | QD | QOD...
* dosageInstruction.asNeeded
* dosageInstruction.doseAndRate.doseQuantity
* dosageInstruction.doseAndRate.doseRange
If expectedSupplyDuration is present, then the duration is
expectedSupplyDuration * (1 + numberOfRepeatsAllowed)
If expectedSupplyDuration is not present, then it must be calculated based on the quantity, dosage, and frequency:
(quantity / (dosage * frequency)) * (1 + numberOfRepeatsAllowed)
dosage: Coalesce(end of doseAndRate.doseRange, doseAndRate.doseQuantity)
frequency: Coalesce(frequencyMax, frequency)
period: Quantity(period, periodUnit)
If expectedSupplyDuration is not present and cannot be calculated, and the boundsPeriod is present (and completely specified), we can use that directly
dosage.timing.repeat.boundsPeriod
This calculation results in a number of days, which can then be turned into a period by anchoring that to the
start of the validityPeriod or the authoredOn:
Interval[earliestDispensable, earliestDispensable + expectedSupplyDuration - 1]
earliestDispensable: Coalesce(start of validityPeriod, authoredOn)
The following function illustrates this completely:
*/
/*
Calculates the Medication Period for a single MedicationRequest.
MedicationRequest instances provided to this function are expected
to conform to the [MMEMedicationRequest](http://build.fhir.org/ig/cqframework/opioid-mme-r4/StructureDefinition-mmemedicationrequest.html)
profile, which expects:
* 1 and only 1 dosageInstruction, multiple dosageInstruction elements will result in an error
* 1 and only 1 doseAndRate, multiple doseAndRate elements will result in an error
* 1 timing with 1 repeat, missing timing or repeat elements will result in a null
* frequency, frequencyMax, defaulting to 1
* period, periodUnit, defaulting to 1 'd'
* timeOfDay
* doseQuantity or doseRange, missing doseQuantity and doseRange will result in a null
Note that MedicationRequest status is not considered by this calculation, as the
list of MedicationRequest instances provided to this function should already have
considered appropriate statuses, depending on the use case, typically `completed`.
*/
define function MedicationRequestPeriod(Request "MedicationRequest"):
Request R
let
dosage: singleton from R.dosageInstruction,
doseAndRate: singleton from dosage.doseAndRate,
timing: dosage.timing,
frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),
period: Quantity(timing.repeat.period, timing.repeat.periodUnit),
doseRange: doseAndRate.dose,
doseQuantity: doseAndRate.dose,
dose: Coalesce(end of doseRange, doseQuantity),
dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0),
boundsPeriod: timing.repeat.bounds as Interval<DateTime>,
daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).value,
quantity: R.dispenseRequest.quantity,
refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),
startDate:
Coalesce(
date from start of boundsPeriod,
date from R.authoredOn,
date from start of R.dispenseRequest.validityPeriod
),
totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills)
return
if startDate is not null and totalDaysSupplied is not null then
Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ]
else if startDate is not null and boundsPeriod."high" is not null then
Interval[startDate, date from end of boundsPeriod]
else
null</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CumulativeMedicationDuration</td>
<td>Quantity</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/**********************************************************************/
/* Functions in this region are copied from opioid-mme-r4 */
/**********************************************************************/
define function Quantity(value Decimal, unit String):
if value is not null then
System.Quantity { value: value, unit: unit }
else
null</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CumulativeMedicationDuration</td>
<td>ToDaily</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
Goal is to get to number of days
Two broad approaches to the calculation:
1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered
2) Based on relevant period, determine a covered interval and calculate the length of that interval in days
This topic covers several use cases and illustrates how to calculate Cumulative
Medication Duration for each type of medication resource using the supply and
frequency approach.
*/
/*
For the first approach, we need to get from frequency to a frequency/day
So we define ToDaily
*/
/*
Calculates daily frequency given frequency within a period
*/
define function ToDaily(frequency System.Integer, period System.Quantity):
case period.unit
when 'h' then frequency * (24.0 / period.value)
when 'min' then frequency * (24.0 / period.value) * 60
when 's' then frequency * (24.0 / period.value) * 60 * 60
when 'd' then frequency * (24.0 / period.value) / 24
when 'wk' then frequency * (24.0 / period.value) / (24 * 7)
when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
when 'hour' then frequency * (24.0 / period.value)
when 'minute' then frequency * (24.0 / period.value) * 60
when 'second' then frequency * (24.0 / period.value) * 60 * 60
when 'day' then frequency * (24.0 / period.value) / 24
when 'week' then frequency * (24.0 / period.value) / (24 * 7)
when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
when 'hours' then frequency * (24.0 / period.value)
when 'minutes' then frequency * (24.0 / period.value) * 60
when 'seconds' then frequency * (24.0 / period.value) * 60 * 60
when 'days' then frequency * (24.0 / period.value) / 24
when 'weeks' then frequency * (24.0 / period.value) / (24 * 7)
when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit)
end</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>QICoreCommon</td>
<td>ToPrevalenceInterval</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, the resulting interval will have
a closed ending boundary. If the condition is not active, the resulting interval will have an open ending boundary.
@deprecated: This function is deprecated. Use the `prevalenceInterval()` fluent function instead
*/
define function ToPrevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
or condition.clinicalStatus ~ "recurrence"
or condition.clinicalStatus ~ "relapse" then
Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition)]
else
Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition))</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>MedicationRequestPeriodInDays</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function MedicationRequestPeriodInDays(Request "MedicationRequest"):
Request R
let dosage: singleton from R.dosageInstruction,
doseAndRate: singleton from dosage.doseAndRate,
timing: dosage.timing,
frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),
period: CMD."Quantity" ( timing.repeat.period, timing.repeat.periodUnit ),
doseRange: doseAndRate.dose,
doseQuantity: doseAndRate.dose,
dose: Coalesce(
end of doseRange, doseQuantity
),
dosesPerDay: Coalesce((CMD."ToDaily"(frequency, period)), Count(timing.repeat.timeOfDay), 1.0),
boundsPeriod: timing.repeat.bounds as Interval<DateTime>,
daysSupply: ( convert R.dispenseRequest.expectedSupplyDuration to days ).value,
quantity: R.dispenseRequest.quantity,
refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),
startDate: Coalesce(date from start of boundsPeriod, date from R.authoredOn, date from start of R.dispenseRequest.validityPeriod),
totalDaysSupplied: Coalesce(daysSupply, quantity.value /(dose.value * dosesPerDay)) * ( 1 + refills )
return totalDaysSupplied</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Average Daily Dose</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define function "Average Daily Dose"(MedicationRequest "MedicationRequest"):
MedicationRequest Order
let MedicationStrength: Order.getMedicationCode ( ).MedicationStrengthPerUnit ( ),
DaysSupplied: Order.MedicationRequestPeriodInDays ( )
return if DaysSupplied is not null
and ( MedicationStrength.unit = 'mg'
or ( MedicationStrength.unit = 'mg/mL'
and Order.dispenseRequest.quantity.unit = 'mL'
)
) then ( ( Order.dispenseRequest.quantity * MedicationStrength ) / Quantity { value: DaysSupplied, unit: 'd' } )
else null</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>MedicationStrengthPerUnit</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function MedicationStrengthPerUnit(Strength Concept):
case
when Strength ~ "reserpine 0.1 MG Oral Tablet" then 0.1 'mg'
when Strength ~ "reserpine 0.25 MG Oral Tablet" then 0.25 'mg'
when Strength ~ "digoxin 0.05 MG/ML Oral Solution" then 0.05 'mg/mL'
when Strength ~ "digoxin 0.0625 MG Oral Tablet" then 0.0625 'mg'
when Strength ~ "1 ML digoxin 0.1 MG/ML Injection" then 0.1 'mg/mL'
when Strength ~ "digoxin 0.125 MG Oral Tablet" then 0.125 'mg'
when Strength ~ "digoxin 0.1875 MG Oral Tablet" then 0.1875 'mg'
when Strength ~ "digoxin 0.25 MG Oral Tablet" then 0.25 'mg'
when Strength ~ "2 ML digoxin 0.25 MG/ML Injection" then 0.25 'mg/mL'
when Strength ~ "doxepin 3 MG Oral Tablet" then 3 'mg'
when Strength ~ "doxepin 6 MG Oral Tablet" then 6 'mg'
when Strength ~ "doxepin hydrochloride 10 MG Oral Capsule" then 10 'mg'
when Strength ~ "doxepin hydrochloride 10 MG/ML Oral Solution" then 10 'mg/mL'
when Strength ~ "doxepin hydrochloride 25 MG Oral Capsule" then 25 'mg'
when Strength ~ "doxepin hydrochloride 50 MG Oral Capsule" then 50 'mg'
when Strength ~ "doxepin hydrochloride 75 MG Oral Capsule" then 75 'mg'
when Strength ~ "doxepin hydrochloride 100 MG Oral Capsule" then 100 'mg'
when Strength ~ "doxepin hydrochloride 150 MG Oral Capsule" then 150 'mg'
else null end</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CQMCommon</td>
<td>getMedicationCode</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns the medication code for the given MedicationRequest
*/
define fluent function getMedicationCode(request MedicationRequest ):
if request.medication is Concept then
request.medication as Concept
else
(singleton from ([Medication] M where M.id = (request.medication as Reference).reference.getId())).code</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>FHIRHelpers</td>
<td>ToConcept</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
if concept is null then
null
else
System.Concept {
codes: concept.coding C return ToCode(C),
display: concept.text.value
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>Status</td>
<td>isEncounterPerformed</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function isEncounterPerformed(Enc List<Encounter>):
Enc E
where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>QICoreCommon</td>
<td>toInterval</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>>):
case
when choice is DateTime then
Interval[choice as DateTime, choice as DateTime]
when choice is Interval<DateTime> then
choice as Interval<DateTime>
when choice is Quantity then
Interval[Patient.birthDate + (choice as Quantity),
Patient.birthDate + (choice as Quantity) + 1 year)
when choice is Interval<Quantity> then
Interval[Patient.birthDate + (choice.low as Quantity),
Patient.birthDate + (choice.high as Quantity) + 1 year)
else
null as Interval<DateTime>
end</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>Status</td>
<td>isAssessmentPerformed</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">//Similar but different from QICoreCommon.isSurvey, which does not have status constraints
define fluent function isAssessmentPerformed(Obs List<Observation>):
Obs O
where O.status in { 'final', 'amended', 'corrected' }
and exists ( O.category ObservationCategory
where ( ObservationCategory ) ~ "survey"
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>Status</td>
<td>isInterventionOrder</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):
ServiceRequest S
where S.status in { 'active', 'completed' }
and S.intent = 'order'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>Status</td>
<td>isInterventionPerformed</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function isInterventionPerformed(Proc List<Procedure>):
Proc P
where P.status ~ 'completed'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>QICoreCommon</td>
<td>prevalenceInterval</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, the resulting interval will have
a closed ending boundary. If the condition is not active, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
or condition.clinicalStatus ~ "recurrence"
or condition.clinicalStatus ~ "relapse" then
Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
Interval[start of condition.onset.toInterval(), end of condition.abatementInterval())</code></pre>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</text>
<contained>
<Library>
<id value="effective-data-requirements"/>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="198196"/>
<display value="reserpine 0.1 MG Oral Tablet"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="198197"/>
<display value="reserpine 0.25 MG Oral Tablet"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="393245"/>
<display value="digoxin 0.05 MG/ML Oral Solution"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="245273"/>
<display value="digoxin 0.0625 MG Oral Tablet"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="204504"/>
<display value="1 ML digoxin 0.1 MG/ML Injection"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="197604"/>
<display value="digoxin 0.125 MG Oral Tablet"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="1441565"/>
<display value="digoxin 0.1875 MG Oral Tablet"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="197606"/>
<display value="digoxin 0.25 MG Oral Tablet"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="104208"/>
<display value="2 ML digoxin 0.25 MG/ML Injection"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="966787"/>
<display value="doxepin 3 MG Oral Tablet"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="966793"/>
<display value="doxepin 6 MG Oral Tablet"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="1000048"/>
<display value="doxepin hydrochloride 10 MG Oral Capsule"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="1000054"/>
<display value="doxepin hydrochloride 10 MG/ML Oral Solution"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="1000070"/>
<display value="doxepin hydrochloride 25 MG Oral Capsule"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="1000076"/>
<display value="doxepin hydrochloride 50 MG Oral Capsule"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="1000097"/>
<display value="doxepin hydrochloride 75 MG Oral Capsule"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="1000058"/>
<display value="doxepin hydrochloride 100 MG Oral Capsule"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="1000064"/>
<display value="doxepin hydrochloride 150 MG Oral Capsule"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.ama-assn.org/go/cpt"/>
<code value="99211"/>
<display
value="Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal."/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="428361000124107"/>
<display value="Discharge to home for hospice care (procedure)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="428371000124100"/>
<display
value="Discharge to healthcare facility for hospice care (procedure)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/observation-category"/>
<code value="survey"/>
<display value="survey"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://loinc.org"/>
<code value="45755-6"/>
<display value="Hospice care [Minimum Data Set]"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="373066001"/>
<display value="Yes (qualifier value)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://loinc.org"/>
<code value="71007-9"/>
<display
value="Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="More than One Antipsychotic Order"/>
</extension>
<extension url="statement">
<valueString
value="define "More than One Antipsychotic Order":
exists ( "More Than One Order"([MedicationRequest: "Antipsychotic"]) )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="0"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="Antipsychotic Index Prescription Start Date"/>
</extension>
<extension url="statement">
<valueString
value="define "Antipsychotic Index Prescription Start Date":
First((Status."Active or Completed Medication Request"([MedicationRequest: "Antipsychotic"])) AntipsychoticMedication
where AntipsychoticMedication.authoredOn during "Measurement Period"
return AntipsychoticMedication.authoredOn
sort asc
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="1"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="More than One Benzodiazepine Order"/>
</extension>
<extension url="statement">
<valueString
value="define "More than One Benzodiazepine Order":
exists ( "More Than One Order"([MedicationRequest: "Benzodiazepine"]) )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="Benzodiazepine Index Prescription Start Date"/>
</extension>
<extension url="statement">
<valueString
value="define "Benzodiazepine Index Prescription Start Date":
First((Status."Active or Completed Medication Request"([MedicationRequest: "Benzodiazepine"])) BenzodiazepineMedication
where BenzodiazepineMedication.authoredOn during "Measurement Period"
return BenzodiazepineMedication.authoredOn
sort asc
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="3"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="Numerator 2"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator 2":
( "More than One Antipsychotic Order"
and ( not exists ( ( [Condition: "Schizophrenia"]
union [Condition: "Bipolar Disorder"] ) AntipsychoticTreatedDiagnoses
where QICoreCommon."ToPrevalenceInterval" ( AntipsychoticTreatedDiagnoses ) overlaps Interval[start of "Measurement Period" - 1 year, "Antipsychotic Index Prescription Start Date"]
)
)
)
or ( "More than One Benzodiazepine Order"
and ( not exists ( ( [Condition: "Seizure Disorder"]
union [Condition: "REM Sleep Behavior Disorder"]
union [Condition: "Benzodiazepine Withdrawal"]
union [Condition: "Alcohol Withdrawal"]
union [Condition: "Generalized Anxiety Disorder"] ) BenzodiazepineTreatedDiagnoses
where QICoreCommon."ToPrevalenceInterval" ( BenzodiazepineTreatedDiagnoses ) overlaps Interval[start of "Measurement Period" - 1 year, "Benzodiazepine Index Prescription Start Date"]
)
)
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString
value="Same High Risk Medications Ordered on Different Days"/>
</extension>
<extension url="statement">
<valueString
value="define "Same High Risk Medications Ordered on Different Days":
"More Than One Order"(["MedicationRequest": "Anticholinergics, first generation antihistamines"])
union "More Than One Order"(["MedicationRequest": "Anticholinergics, anti Parkinson agents"])
union "More Than One Order"(["MedicationRequest": "Antispasmodics"])
union "More Than One Order"(["MedicationRequest": "Antithrombotic"])
union "More Than One Order"(["MedicationRequest": "Cardiovascular, alpha agonists, central"])
union "More Than One Order"(["MedicationRequest": "Cardiovascular, other"])
union "More Than One Order"(["MedicationRequest": "Central nervous system, antidepressants"])
union "More Than One Order"(["MedicationRequest": "Central nervous system, barbiturates"])
union "More Than One Order"(["MedicationRequest": "Central nervous system, vasodilators"])
union "More Than One Order"(["MedicationRequest": "Central nervous system, other"])
union "More Than One Order"(["MedicationRequest": "Endocrine system, estrogens with or without progestins"])
union "More Than One Order"(["MedicationRequest": "Endocrine system, sulfonylureas, long duration"])
union "More Than One Order"(["MedicationRequest": "Endocrine system, other"])
union "More Than One Order"(["MedicationRequest": "Nonbenzodiazepine hypnotics"])
union "More Than One Order"(["MedicationRequest": "Pain medications, skeletal muscle relaxants"])
union "More Than One Order"(["MedicationRequest": "Pain medications, other"])"/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString
value="Two High Risk Medications with Prolonged Duration"/>
</extension>
<extension url="statement">
<valueString
value="define "Two High Risk Medications with Prolonged Duration":
Sum(("More Than One Order"([MedicationRequest: "Anti Infectives, other"])) AntiInfectives
let DaysSupply: AntiInfectives.MedicationRequestPeriodInDays()
return all DaysSupply
) > 90"/>
</extension>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString
value="High Risk Medications with Average Daily Dose Criteria"/>
</extension>
<extension url="statement">
<valueString
value="define "High Risk Medications with Average Daily Dose Criteria":
exists ( "More Than One Order"([MedicationRequest: "Reserpine"] ReserpineOrdered
where "Average Daily Dose"(ReserpineOrdered) > 0.1 'mg/d'
)
)
or exists ( "More Than One Order"([MedicationRequest: "Digoxin"] DigoxinOrdered
where "Average Daily Dose"(DigoxinOrdered) > 0.125 'mg/d'
)
)
or exists ( "More Than One Order"([MedicationRequest: "Doxepin"] DoxepinOrdered
where "Average Daily Dose"(DoxepinOrdered) > 6 'mg/d'
)
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="7"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="Numerator 1"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator 1":
exists ( "Same High Risk Medications Ordered on Different Days" )
or ( "Two High Risk Medications with Prolonged Duration" )
or ( "High Risk Medications with Average Daily Dose Criteria" )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="8"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="Numerator 3"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator 3":
"Numerator 2"
or ( "Numerator 1"
and not "Numerator 2"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="Qualifying Encounters"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualifying Encounters":
( ["Encounter": "Office Visit"]
union ["Encounter": "Ophthalmologic Services"]
union ["Encounter": "Preventive Care Services Established Office Visit, 18 and Up"]
union ["Encounter": "Discharge Services Nursing Facility"]
union ["Encounter": "Nursing Facility Visit"]
union ["Encounter": "Care Services in Long Term Residential Facility"]
union ["Encounter": "Preventive Care Services Initial Office Visit, 18 and Up"]
union ["Encounter": "Annual Wellness Visit"]
union ["Encounter": "Home Healthcare Services"]
union ["Encounter": "Telephone Visits"]
union ["Encounter": "Online Assessments"]
union ( [Encounter] E
where exists ( ( E.type ) T
where T ~ "Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal."
)
) ) ValidEncounters
where ValidEncounters.period during "Measurement Period""/>
</extension>
<extension url="displaySequence">
<valueInteger value="10"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="Initial Population"/>
</extension>
<extension url="statement">
<valueString
value="define "Initial Population":
AgeInYearsAt(date from
end of "Measurement Period"
) >= 65
and exists ( "Qualifying Encounters" )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="11"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator":
"Initial Population""/>
</extension>
<extension url="displaySequence">
<valueInteger value="12"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="Hospice"/>
</extension>
<extension url="name">
<valueString value="Has Hospice Services"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Hospice Services":
exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter
where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
)
and InpatientEncounter.period.toInterval() ends during day of "Measurement Period"
)
or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter
where HospiceEncounter.period.toInterval() overlaps day of "Measurement Period"
)
or exists ((([Observation: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment
where HospiceAssessment.value ~ "Yes (qualifier value)"
and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period"
)
or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder
where HospiceOrder.authoredOn.toInterval() during day of "Measurement Period"
)
or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed
where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period"
)
or exists (([Condition: "Hospice Diagnosis"]) HospiceCareDiagnosis
where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="13"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="PalliativeCare"/>
</extension>
<extension url="name">
<valueString value="Has Palliative Care in the Measurement Period"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Palliative Care in the Measurement Period":
exists ((([Observation: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"]).isAssessmentPerformed()) PalliativeAssessment
where PalliativeAssessment.effective.toInterval() overlaps day of "Measurement Period"
)
or exists ([Condition: "Palliative Care Diagnosis"] PalliativeDiagnosis
where PalliativeDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
)
or exists ((([Encounter: "Palliative Care Encounter"]).isEncounterPerformed()) PalliativeEncounter
where PalliativeEncounter.period.toInterval() overlaps day of "Measurement Period"
)
or exists ((([Procedure: "Palliative Care Intervention"]).isInterventionPerformed()) PalliativeIntervention
where PalliativeIntervention.performed.toInterval() overlaps day of "Measurement Period"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="14"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator Exclusions"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator Exclusions":
Hospice."Has Hospice Services"
or PalliativeCare."Has Palliative Care in the Measurement Period""/>
</extension>
<extension url="displaySequence">
<valueInteger value="15"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="More Than One Order"/>
</extension>
<extension url="statement">
<valueString
value="//Functions
define function "More Than One Order"(Medication List<"MedicationRequest">):
( Status."Active or Completed Medication Request" ( "Medication" ) ) OrderMedication1
with ( Status."Active or Completed Medication Request" ( "Medication" ) ) OrderMedication2
such that ( OrderMedication1.authoredOn during "Measurement Period"
and OrderMedication1.dispenseRequest.numberOfRepeatsAllowed >= 1
)
or ( date from OrderMedication1.authoredOn !~ date from OrderMedication2.authoredOn
and OrderMedication1.authoredOn during "Measurement Period"
and OrderMedication2.authoredOn during "Measurement Period"
)
or ( date from OrderMedication1.authoredOn ~ date from OrderMedication2.authoredOn
and OrderMedication1.authoredOn during "Measurement Period"
and date from start of CMD."MedicationRequestPeriod" ( OrderMedication1 ) !~ date from start of CMD."MedicationRequestPeriod" ( OrderMedication2 )
and start of CMD."MedicationRequestPeriod" ( OrderMedication1 ) during "Measurement Period"
and start of CMD."MedicationRequestPeriod" ( OrderMedication2 ) during "Measurement Period"
)
return OrderMedication1"/>
</extension>
<extension url="displaySequence">
<valueInteger value="16"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="Status"/>
</extension>
<extension url="name">
<valueString value="Active or Completed Medication Request"/>
</extension>
<extension url="statement">
<valueString
value="//Medication, Order: active and completed only
define function "Active or Completed Medication Request"(MedicationRequest List<MedicationRequest>):
MedicationRequest M
where M.status in { 'active', 'completed' }
and M.intent = 'order'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="17"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CumulativeMedicationDuration"/>
</extension>
<extension url="name">
<valueString value="MedicationRequestPeriod"/>
</extension>
<extension url="statement">
<valueString
value="/*
Now that we have a ToDaily function, we can approach calculation of the
duration of medication for an order. First, consider the definitions
for each element:
* 1 and only 1 dosageInstruction
* 1 and only 1 doseAndRate
* 1 timing with 1 repeat
* frequency, frequencyMax, defaulting to 1
* period, periodUnit, defaulting to 1 'd'
* doseQuantity or doseRange
* timeOfDay
* authoredOn: The date the prescription was written
* dispenseRequest.validityPeriod: Time period supply is authorized for
* dispenseRequest.quantity: amount of medication supplied per dispense
* dispenseRequest.numberOfRepeatsAllowed: number of refills authorized
* dispenseRequest.expectedSupplyDuration: number of days supply per dispense
* dosageInstruction.timing.repeat.boundsDuration: total duration of the repeat
* dosageInstruction.timing.repeat.boundsRange: range of durations of the repeat
* dosageInstruction.timing.repeat.boundsPeriod: period bounds of the repeat
* dosageInstruction.timing.repeat.count: number of times to repeat
* dosageInstruction.timing.repeat.countMax: maximum number of times to repeat
* dosageInstruction.timing.repeat.frequency: event occurs frequency times per period
* dosageInstruction.timing.repeat.frequencyMax: event occurs up to frequencyMax times per period
* dosageInstruction.timing.repeat.period: event occurs frequency times per period
* dosageInstruction.timing.repeat.periodMax: upper limit of period
* dosageInstruction.timing.repeat.periodUnit: period duration (s | min | h | d | wk | mo | a)
* dosageInstruction.timing.repeat.timeOfDay: time of day for the event (0..*)
* dosageInstruction.timing.repeat.when: event timing (HS | WAKE | C | CM | CD | CV | AC | ACM...)
* dosageInstruction.timing.code: BID | TID | QID | AM | PM | QD | QOD...
* dosageInstruction.asNeeded
* dosageInstruction.doseAndRate.doseQuantity
* dosageInstruction.doseAndRate.doseRange
If expectedSupplyDuration is present, then the duration is
expectedSupplyDuration * (1 + numberOfRepeatsAllowed)
If expectedSupplyDuration is not present, then it must be calculated based on the quantity, dosage, and frequency:
(quantity / (dosage * frequency)) * (1 + numberOfRepeatsAllowed)
dosage: Coalesce(end of doseAndRate.doseRange, doseAndRate.doseQuantity)
frequency: Coalesce(frequencyMax, frequency)
period: Quantity(period, periodUnit)
If expectedSupplyDuration is not present and cannot be calculated, and the boundsPeriod is present (and completely specified), we can use that directly
dosage.timing.repeat.boundsPeriod
This calculation results in a number of days, which can then be turned into a period by anchoring that to the
start of the validityPeriod or the authoredOn:
Interval[earliestDispensable, earliestDispensable + expectedSupplyDuration - 1]
earliestDispensable: Coalesce(start of validityPeriod, authoredOn)
The following function illustrates this completely:
*/
/*
Calculates the Medication Period for a single MedicationRequest.
MedicationRequest instances provided to this function are expected
to conform to the [MMEMedicationRequest](http://build.fhir.org/ig/cqframework/opioid-mme-r4/StructureDefinition-mmemedicationrequest.html)
profile, which expects:
* 1 and only 1 dosageInstruction, multiple dosageInstruction elements will result in an error
* 1 and only 1 doseAndRate, multiple doseAndRate elements will result in an error
* 1 timing with 1 repeat, missing timing or repeat elements will result in a null
* frequency, frequencyMax, defaulting to 1
* period, periodUnit, defaulting to 1 'd'
* timeOfDay
* doseQuantity or doseRange, missing doseQuantity and doseRange will result in a null
Note that MedicationRequest status is not considered by this calculation, as the
list of MedicationRequest instances provided to this function should already have
considered appropriate statuses, depending on the use case, typically `completed`.
*/
define function MedicationRequestPeriod(Request "MedicationRequest"):
Request R
let
dosage: singleton from R.dosageInstruction,
doseAndRate: singleton from dosage.doseAndRate,
timing: dosage.timing,
frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),
period: Quantity(timing.repeat.period, timing.repeat.periodUnit),
doseRange: doseAndRate.dose,
doseQuantity: doseAndRate.dose,
dose: Coalesce(end of doseRange, doseQuantity),
dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0),
boundsPeriod: timing.repeat.bounds as Interval<DateTime>,
daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).value,
quantity: R.dispenseRequest.quantity,
refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),
startDate:
Coalesce(
date from start of boundsPeriod,
date from R.authoredOn,
date from start of R.dispenseRequest.validityPeriod
),
totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills)
return
if startDate is not null and totalDaysSupplied is not null then
Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ]
else if startDate is not null and boundsPeriod."high" is not null then
Interval[startDate, date from end of boundsPeriod]
else
null"/>
</extension>
<extension url="displaySequence">
<valueInteger value="18"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CumulativeMedicationDuration"/>
</extension>
<extension url="name">
<valueString value="Quantity"/>
</extension>
<extension url="statement">
<valueString
value="/**********************************************************************/
/* Functions in this region are copied from opioid-mme-r4 */
/**********************************************************************/
define function Quantity(value Decimal, unit String):
if value is not null then
System.Quantity { value: value, unit: unit }
else
null"/>
</extension>
<extension url="displaySequence">
<valueInteger value="19"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CumulativeMedicationDuration"/>
</extension>
<extension url="name">
<valueString value="ToDaily"/>
</extension>
<extension url="statement">
<valueString
value="/*
Goal is to get to number of days
Two broad approaches to the calculation:
1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered
2) Based on relevant period, determine a covered interval and calculate the length of that interval in days
This topic covers several use cases and illustrates how to calculate Cumulative
Medication Duration for each type of medication resource using the supply and
frequency approach.
*/
/*
For the first approach, we need to get from frequency to a frequency/day
So we define ToDaily
*/
/*
Calculates daily frequency given frequency within a period
*/
define function ToDaily(frequency System.Integer, period System.Quantity):
case period.unit
when 'h' then frequency * (24.0 / period.value)
when 'min' then frequency * (24.0 / period.value) * 60
when 's' then frequency * (24.0 / period.value) * 60 * 60
when 'd' then frequency * (24.0 / period.value) / 24
when 'wk' then frequency * (24.0 / period.value) / (24 * 7)
when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
when 'hour' then frequency * (24.0 / period.value)
when 'minute' then frequency * (24.0 / period.value) * 60
when 'second' then frequency * (24.0 / period.value) * 60 * 60
when 'day' then frequency * (24.0 / period.value) / 24
when 'week' then frequency * (24.0 / period.value) / (24 * 7)
when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
when 'hours' then frequency * (24.0 / period.value)
when 'minutes' then frequency * (24.0 / period.value) * 60
when 'seconds' then frequency * (24.0 / period.value) * 60 * 60
when 'days' then frequency * (24.0 / period.value) / 24
when 'weeks' then frequency * (24.0 / period.value) / (24 * 7)
when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit)
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="20"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="ToPrevalenceInterval"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, the resulting interval will have
a closed ending boundary. If the condition is not active, the resulting interval will have an open ending boundary.
@deprecated: This function is deprecated. Use the `prevalenceInterval()` fluent function instead
*/
define function ToPrevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
or condition.clinicalStatus ~ "recurrence"
or condition.clinicalStatus ~ "relapse" then
Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition)]
else
Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition))"/>
</extension>
<extension url="displaySequence">
<valueInteger value="21"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="MedicationRequestPeriodInDays"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function MedicationRequestPeriodInDays(Request "MedicationRequest"):
Request R
let dosage: singleton from R.dosageInstruction,
doseAndRate: singleton from dosage.doseAndRate,
timing: dosage.timing,
frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),
period: CMD."Quantity" ( timing.repeat.period, timing.repeat.periodUnit ),
doseRange: doseAndRate.dose,
doseQuantity: doseAndRate.dose,
dose: Coalesce(
end of doseRange, doseQuantity
),
dosesPerDay: Coalesce((CMD."ToDaily"(frequency, period)), Count(timing.repeat.timeOfDay), 1.0),
boundsPeriod: timing.repeat.bounds as Interval<DateTime>,
daysSupply: ( convert R.dispenseRequest.expectedSupplyDuration to days ).value,
quantity: R.dispenseRequest.quantity,
refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),
startDate: Coalesce(date from start of boundsPeriod, date from R.authoredOn, date from start of R.dispenseRequest.validityPeriod),
totalDaysSupplied: Coalesce(daysSupply, quantity.value /(dose.value * dosesPerDay)) * ( 1 + refills )
return totalDaysSupplied"/>
</extension>
<extension url="displaySequence">
<valueInteger value="22"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="Average Daily Dose"/>
</extension>
<extension url="statement">
<valueString
value="define function "Average Daily Dose"(MedicationRequest "MedicationRequest"):
MedicationRequest Order
let MedicationStrength: Order.getMedicationCode ( ).MedicationStrengthPerUnit ( ),
DaysSupplied: Order.MedicationRequestPeriodInDays ( )
return if DaysSupplied is not null
and ( MedicationStrength.unit = 'mg'
or ( MedicationStrength.unit = 'mg/mL'
and Order.dispenseRequest.quantity.unit = 'mL'
)
) then ( ( Order.dispenseRequest.quantity * MedicationStrength ) / Quantity { value: DaysSupplied, unit: 'd' } )
else null"/>
</extension>
<extension url="displaySequence">
<valueInteger value="23"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="MedicationStrengthPerUnit"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function MedicationStrengthPerUnit(Strength Concept):
case
when Strength ~ "reserpine 0.1 MG Oral Tablet" then 0.1 'mg'
when Strength ~ "reserpine 0.25 MG Oral Tablet" then 0.25 'mg'
when Strength ~ "digoxin 0.05 MG/ML Oral Solution" then 0.05 'mg/mL'
when Strength ~ "digoxin 0.0625 MG Oral Tablet" then 0.0625 'mg'
when Strength ~ "1 ML digoxin 0.1 MG/ML Injection" then 0.1 'mg/mL'
when Strength ~ "digoxin 0.125 MG Oral Tablet" then 0.125 'mg'
when Strength ~ "digoxin 0.1875 MG Oral Tablet" then 0.1875 'mg'
when Strength ~ "digoxin 0.25 MG Oral Tablet" then 0.25 'mg'
when Strength ~ "2 ML digoxin 0.25 MG/ML Injection" then 0.25 'mg/mL'
when Strength ~ "doxepin 3 MG Oral Tablet" then 3 'mg'
when Strength ~ "doxepin 6 MG Oral Tablet" then 6 'mg'
when Strength ~ "doxepin hydrochloride 10 MG Oral Capsule" then 10 'mg'
when Strength ~ "doxepin hydrochloride 10 MG/ML Oral Solution" then 10 'mg/mL'
when Strength ~ "doxepin hydrochloride 25 MG Oral Capsule" then 25 'mg'
when Strength ~ "doxepin hydrochloride 50 MG Oral Capsule" then 50 'mg'
when Strength ~ "doxepin hydrochloride 75 MG Oral Capsule" then 75 'mg'
when Strength ~ "doxepin hydrochloride 100 MG Oral Capsule" then 100 'mg'
when Strength ~ "doxepin hydrochloride 150 MG Oral Capsule" then 150 'mg'
else null end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="24"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CQMCommon"/>
</extension>
<extension url="name">
<valueString value="getMedicationCode"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns the medication code for the given MedicationRequest
*/
define fluent function getMedicationCode(request MedicationRequest ):
if request.medication is Concept then
request.medication as Concept
else
(singleton from ([Medication] M where M.id = (request.medication as Reference).reference.getId())).code"/>
</extension>
<extension url="displaySequence">
<valueInteger value="25"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToConcept"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
if concept is null then
null
else
System.Concept {
codes: concept.coding C return ToCode(C),
display: concept.text.value
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="26"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="Status"/>
</extension>
<extension url="name">
<valueString value="isEncounterPerformed"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function isEncounterPerformed(Enc List<Encounter>):
Enc E
where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="27"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="toInterval"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>>):
case
when choice is DateTime then
Interval[choice as DateTime, choice as DateTime]
when choice is Interval<DateTime> then
choice as Interval<DateTime>
when choice is Quantity then
Interval[Patient.birthDate + (choice as Quantity),
Patient.birthDate + (choice as Quantity) + 1 year)
when choice is Interval<Quantity> then
Interval[Patient.birthDate + (choice.low as Quantity),
Patient.birthDate + (choice.high as Quantity) + 1 year)
else
null as Interval<DateTime>
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="28"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="Status"/>
</extension>
<extension url="name">
<valueString value="isAssessmentPerformed"/>
</extension>
<extension url="statement">
<valueString
value="//Similar but different from QICoreCommon.isSurvey, which does not have status constraints
define fluent function isAssessmentPerformed(Obs List<Observation>):
Obs O
where O.status in { 'final', 'amended', 'corrected' }
and exists ( O.category ObservationCategory
where ( ObservationCategory ) ~ "survey"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="29"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="Status"/>
</extension>
<extension url="name">
<valueString value="isInterventionOrder"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):
ServiceRequest S
where S.status in { 'active', 'completed' }
and S.intent = 'order'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="30"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="Status"/>
</extension>
<extension url="name">
<valueString value="isInterventionPerformed"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function isInterventionPerformed(Proc List<Procedure>):
Proc P
where P.status ~ 'completed'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="31"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="prevalenceInterval"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, the resulting interval will have
a closed ending boundary. If the condition is not active, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
or condition.clinicalStatus ~ "recurrence"
or condition.clinicalStatus ~ "relapse" then
Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
Interval[start of condition.onset.toInterval(), end of condition.abatementInterval())"/>
</extension>
<extension url="displaySequence">
<valueInteger value="32"/>
</extension>
</extension>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/library-type"/>
<code value="module-definition"/>
</coding>
</type>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Status"/>
<resource
value="http://ecqi.healthit.gov/ecqms/Library/Status|1.6.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library CMD"/>
<resource
value="http://ecqi.healthit.gov/ecqms/Library/CumulativeMedicationDuration|3.3.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource
value="http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers|4.3.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library QICoreCommon"/>
<resource
value="http://ecqi.healthit.gov/ecqms/Library/QICoreCommon|1.5.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library CQMCommon"/>
<resource
value="http://ecqi.healthit.gov/ecqms/Library/CQMCommon|1.4.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Hospice"/>
<resource
value="http://ecqi.healthit.gov/ecqms/Library/Hospice|6.7.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library PalliativeCare"/>
<resource
value="http://ecqi.healthit.gov/ecqms/Library/PalliativeCare|1.7.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system RXNORM"/>
<resource value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system CPT"/>
<resource value="http://www.ama-assn.org/go/cpt"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system SNOMEDCT"/>
<resource value="http://snomed.info/sct"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ObservationCategoryCodes"/>
<resource
value="http://terminology.hl7.org/CodeSystem/observation-category"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system LOINC"/>
<resource value="http://loinc.org"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Antipsychotic"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1523"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Schizophrenia"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1205"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Bipolar Disorder"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1157"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Benzodiazepine"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1522"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Seizure Disorder"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1206"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set REM Sleep Behavior Disorder"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1207"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Benzodiazepine Withdrawal"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1208"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Alcohol Withdrawal"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1209"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Generalized Anxiety Disorder"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1210"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Anticholinergics, first generation antihistamines"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1043"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Anticholinergics, anti Parkinson agents"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1049"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Antispasmodics"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1050"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Antithrombotic"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1051"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Cardiovascular, alpha agonists, central"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1052"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Cardiovascular, other"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1053"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Central nervous system, antidepressants"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1054"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Central nervous system, barbiturates"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1055"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Central nervous system, vasodilators"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1056"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Central nervous system, other"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1057"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Endocrine system, estrogens with or without progestins"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1058"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Endocrine system, sulfonylureas, long duration"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1059"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Endocrine system, other"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1060"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Nonbenzodiazepine hypnotics"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1480"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Pain medications, skeletal muscle relaxants"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1062"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Pain medications, other"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1063"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Anti Infectives, other"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1481"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Reserpine"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1044"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Digoxin"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1065"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Doxepin"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1067"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Office Visit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Ophthalmologic Services"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.11.1206"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Preventive Care Services Established Office Visit, 18 and Up"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Discharge Services Nursing Facility"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1013"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Nursing Facility Visit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Care Services in Long Term Residential Facility"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Preventive Care Services Initial Office Visit, 18 and Up"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Annual Wellness Visit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Home Healthcare Services"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Telephone Visits"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Online Assessments"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Encounter Inpatient"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Hospice Encounter"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
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<profile
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<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
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<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
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<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
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<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
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<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
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<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
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<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
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<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
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<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
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<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
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<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
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<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
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<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
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<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
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<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
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<mustSupport value="id"/>
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<dataRequirement>
<type value="Medication"/>
<profile
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<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
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<profile
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<mustSupport value="id"/>
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<dataRequirement>
<type value="Medication"/>
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</codeFilter>
</dataRequirement>
<dataRequirement>
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<mustSupport value="type"/>
<mustSupport value="hospitalization"/>
<mustSupport value="hospitalization.dischargeDisposition"/>
<mustSupport value="period"/>
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<code>
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<code value="45755-6"/>
<display value="Hospice care [Minimum Data Set]"/>
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<code>
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<display
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</code>
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</extension>
<url
value="http://ecqi.healthit.gov/ecqms/Measure/UseofHighRiskMedicationsintheElderlyFHIR"/>
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<use value="usual"/>
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<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="short-name"/>
</coding>
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<value value="CMS156FHIR"/>
</identifier>
<identifier>
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<code value="version-independent"/>
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<system value="https://madie.cms.gov/measure/cmsId"/>
<value value="156FHIR"/>
<assigner>
<display value="CMS"/>
</assigner>
</identifier>
<version value="0.0.001"/>
<name value="UseofHighRiskMedicationsintheElderlyFHIR"/>
<title value="Use of High-Risk Medications in Older AdultsFHIR"/>
<status value="draft"/>
<experimental value="false"/>
<date value="2023-10-27T08:12:32+00:00"/>
<publisher value="National Committee for Quality Assurance"/>
<contact>
<telecom>
<system value="url"/>
<value value="https://www.ncqa.org/"/>
</telecom>
</contact>
<description
value="Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported.
1. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class.
2. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses.
3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators)."/>
<useContext>
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value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
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value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/quality-programs"/>
<code value="ep-ec"/>
<display value="EP/EC"/>
</coding>
</valueCodeableConcept>
</useContext>
<purpose value="UNKNOWN"/>
<usage
value="The intent of the measure is to assess if the patient has been ordered at least two high-risk medication prescriptions from the same drug class on different days.
The intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication from the same drug class for them.
Calculate average daily dose for each prescription event. To calculate average daily dose, multiply the quantity of pills prescribed by the dose of each pill and divide by the days supply. For example, a prescription for the 30-days supply of digoxin containing 15 pills, 0.25 mg each pill, has an average daily dose of 0.125 mg. To calculate average daily dose for elixirs and concentrates, multiply the volume prescribed by daily dose and divide by the days supply. Do not round when calculating average daily dose.
This eCQM is a patient-based measure.
This FHIR-based measure has been derived from the QDM-based measure: CMS156v12.
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)."/>
<copyright
value="This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract HHSM-500-2011-00079C) with the National Committee for Quality Assurance (NCQA) to develop this electronic measure. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications.
Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications.
CPT(R) codes, descriptions and other data are copyright 2022. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.
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."/>
<approvalDate value="2023-08-28"/>
<lastReviewDate value="2023-08-28"/>
<effectivePeriod>
<start value="2024-01-01"/>
<end value="2024-12-31"/>
</effectivePeriod>
<author>
<name value="National Committee for Quality Assurance"/>
<telecom>
<system value="url"/>
<value value="https://www.ncqa.org/"/>
</telecom>
</author>
<library
value="http://ecqi.healthit.gov/ecqms/Library/UseofHighRiskMedicationsintheElderlyFHIR"/>
<disclaimer
value="The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.
Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]."/>
<rationale
value="Certain medications (MacKinnon & Hepler, 2003) are associated with increased risk of harm from drug side-effects and drug toxicity and pose a concern for patient safety. There is clinical consensus that these drugs pose increased risks in older adults (Kaufman, Brodin, & Sarafian, 2005). Potentially inappropriate medication use in older adults has been connected to significantly longer hospital stay lengths and increased hospitalization costs (Hagstrom et al., 2015) as well as increased risk of death (Lau et al., 2004). Use of specific high-risk medications such as hypnotics, including benzodiazepine receptor agonists, and nonsteroidal anti-inflammatory drugs (NSAIDS) can result in increased risk of delirium, falls, fractures, gastrointestinal bleeding and acute kidney injury (Merel et al., 2017). Long-term use of benzodiazepines in older adults has been associated with increased risk of dementia (Zhong et al., 2015; Takada et al., 2016). Additionally, the use of antipsychotics can lead to increased risk of stroke and greater cognitive decline in older adults with dementia (Tampi et al., 2016).
Older adults receiving inappropriate medications are more likely to report poorer health status at follow-up, compared to those who receive appropriate medications (Fu, Liu, & Christensen, 2004). A study of the prevalence of potentially inappropriate medication use in older adults found that 40 percent of individuals 65 and older filled at least one prescription for a potentially inappropriate medication and 13 percent filled two or more (Fick et al., 2008). While some adverse drug events (ADEs) are unavoidable, studies estimate that between 30 and 80 percent of ADEs in older adults are preventable (MacKinnon & Hepler, 2003). More recently with the onset of the COVID-19 pandemic, several studies have shown an increase in anxiety, insomnia and depression rates, which could result in an increase in the use of high-risk medications in order to treat these conditions (Agrawal, 2020).
Reducing the number of inappropriate prescriptions can lead to improved patient safety and significant cost savings. Conservative estimates of extra costs due to potentially inappropriate medications in older adults average $7.2 billion a year (Fu et al., 2007). Medication use by older adults will likely increase further as the U.S. population ages, new drugs are developed, and new therapeutic and preventive uses for medications are discovered (Rothberg et al., 2008). The annual direct costs of preventable ADEs in the Medicare population have been estimated to exceed $800 million (Institute of Medicine, 2007). By the year 2030, nearly one in five U.S. residents is expected to be aged 65 years or older; this age group is projected to more than double from 38.7 million in 2008 to more than 88.5 million in 2050. Likewise, the population aged 85 years or older is expected to increase almost four-fold, from 5.4 million to 19 million between 2008 and 2050. As the older adult population continues to grow, the number of older adults who present with multiple medical conditions for which several medications are prescribed will likely continue to increase, resulting in polypharmacy concerns (Gray & Gardner, 2009)."/>
<clinicalRecommendationStatement
value="The measure is based on recommendations from the American Geriatrics Society Beers Criteria[R] for Potentially Inappropriate Medication Use in Older Adults (2019 Update). The criteria were developed through key clinical expert consensus processes by Beers in 1997, Zhan in 2001, and an updated process by Fick et al. in 2003, 2012, 2015, and 2019. The Beers Criteria identifies lists of drugs that are potentially inappropriate for all older adults, except for those with certain conditions for which some high-risk medications may be warranted, and drugs that are potentially inappropriate in older adults based on various high-risk factors such as dosage, days supply and underlying diseases or conditions.
NCQA's Geriatric Measurement Advisory Panel recommended a subset of drugs that should be used with caution in older adults for inclusion in the measure based upon the recommendations in the Beers Criteria."/>
<group id="649c8b4a4c79454c026f7495">
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
<valueCode value="boolean"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
<code value="process"/>
<display value="Process"/>
</coding>
</valueCodeableConcept>
</extension>
<population id="0A19E9FB-0BAA-4105-8BCA-EC0647E679FB">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="initial-population"/>
<display value="Initial Population"/>
</coding>
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<description
value="Patients 65 years and older at the end of the measurement period who had a visit during the measurement period"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Initial Population"/>
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</population>
<population id="604B904A-A7D3-452F-BFC1-78E825247DAD">
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<coding>
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<code value="denominator"/>
<display value="Denominator"/>
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<description value="Equals Initial Population"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator"/>
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<population id="D6782756-5656-47E5-991B-8AC5F4F0E7A7">
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<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exclusion"/>
<display value="Denominator Exclusion"/>
</coding>
</code>
<description
value="Exclude patients who are in hospice care for any part of the measurement period.
Exclude patients receiving palliative care for any part of the measurement period."/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exclusions"/>
</criteria>
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<code value="numerator"/>
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<description
value="Rate 1: Patients with at least two orders of high-risk medications from the same drug class on different days.
a. At least two orders of high-risk medications from the same drug class.
b. At least two orders of high-risk medications from the same drug class with summed days supply greater than 90 days.
c. At least two orders of high-risk medications from the same drug class each exceeding average daily dose criteria."/>
<criteria>
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<code value="numerator-exclusion"/>
<display value="Numerator Exclusion"/>
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<criteria>
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<system
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<code value="denominator-exception"/>
<display value="Denominator Exception"/>
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<criteria>
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<group id="649c8b4a4c79454c026f7496">
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url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
<valueCode value="boolean"/>
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<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
<code value="process"/>
<display value="Process"/>
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</extension>
<population id="D09246EA-9FBF-4C80-ABD9-3051DC7CE8FA">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="initial-population"/>
<display value="Initial Population"/>
</coding>
</code>
<description
value="Patients 65 years and older at the end of the measurement period who had a visit during the measurement period"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Initial Population"/>
</criteria>
</population>
<population id="D76C3A1E-4767-415E-8CEF-C9D54C8D3904">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator"/>
<display value="Denominator"/>
</coding>
</code>
<description value="Equals Initial Population"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator"/>
</criteria>
</population>
<population id="920ADB82-C127-473E-834C-191682317146">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exclusion"/>
<display value="Denominator Exclusion"/>
</coding>
</code>
<description
value="Exclude patients who are in hospice care for any part of the measurement period.
Exclude patients receiving palliative care for any part of the measurement period."/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exclusions"/>
</criteria>
</population>
<population id="EDEE8DED-11C6-492B-B371-BF1D5ECB34CB">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="numerator"/>
<display value="Numerator"/>
</coding>
</code>
<description
value="Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines) on different days except for appropriate diagnoses.
a. Patients with two or more antipsychotic prescriptions ordered on different days, and who did not have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the IPSD for antipsychotics.
b. Patients with two or more benzodiazepine prescriptions ordered on different days, and who did not have a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between January 1 of the year prior to the measurement period and the IPSD for benzodiazepines.
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Numerator 2"/>
</criteria>
</population>
<population id="3a3bad39-103f-43d5-8427-ab9297832f5e">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="numerator-exclusion"/>
<display value="Numerator Exclusion"/>
</coding>
</code>
<criteria>
<language value="text/cql-identifier"/>
</criteria>
</population>
<population id="7dbe07f8-c46d-4457-a9bc-7b40c6bb0d0f">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exception"/>
<display value="Denominator Exception"/>
</coding>
</code>
<criteria>
<language value="text/cql-identifier"/>
</criteria>
</population>
</group>
<group id="649c8b4a4c79454c026f7497">
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
<valueCode value="boolean"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
<code value="process"/>
<display value="Process"/>
</coding>
</valueCodeableConcept>
</extension>
<population id="B6C3E029-C345-4BB5-96C9-9E5D1C2B63BD">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="initial-population"/>
<display value="Initial Population"/>
</coding>
</code>
<description
value="Patients 65 years and older at the end of the measurement period who had a visit during the measurement period"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Initial Population"/>
</criteria>
</population>
<population id="DF3CBBB3-1FA3-497D-8287-2FE6AE9745F6">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator"/>
<display value="Denominator"/>
</coding>
</code>
<description value="Equals Initial Population"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator"/>
</criteria>
</population>
<population id="D4EA7568-D2C8-4B9D-818B-FBC488913633">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exclusion"/>
<display value="Denominator Exclusion"/>
</coding>
</code>
<description
value="Exclude patients who are in hospice care for any part of the measurement period.
Exclude patients receiving palliative care for any part of the measurement period."/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exclusions"/>
</criteria>
</population>
<population id="36304EB4-9F6F-4657-9457-1E4295106EA8">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="numerator"/>
<display value="Numerator"/>
</coding>
</code>
<description
value="Total rate (the sum of the two previous numerators, deduplicated)."/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Numerator 3"/>
</criteria>
</population>
<population id="b590d000-f50e-4f01-b4fe-70b4e59cd271">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="numerator-exclusion"/>
<display value="Numerator Exclusion"/>
</coding>
</code>
<criteria>
<language value="text/cql-identifier"/>
</criteria>
</population>
<population id="caae9cb4-3bd5-4cca-9520-11fa44ca70a1">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exception"/>
<display value="Denominator Exception"/>
</coding>
</code>
<criteria>
<language value="text/cql-identifier"/>
</criteria>
</population>
</group>
</Measure>
IG © 2023+ cqframework. Package gov.healthit.ecqi.ecqms#2023.0.0 based on FHIR 4.0.1. Generated 2026-05-13
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