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

## : Controlling High Blood PressureFHIR - XML Representation

Draft as of 2023-09-07

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    <Measure xmlns="http://hl7.org/fhir">
      <id value="ControllingHighBloodPressureFHIR"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"/>
        <profile
                 value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm"/>
        <profile
                 value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"/>
      </meta>
      <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;">Controlling High Blood PressureFHIR</td>
                </tr>

                <tr>
                    <th scope="row"><b>Id: </b></th>
                    <td style="padding-left: 4px;">ControllingHighBloodPressureFHIR</td>
                </tr>

                    <tr>
                        <th scope="row"><b>Download cql: </b></th>
                        <td style="padding-left: 4px;"><a href="Library-ControllingHighBloodPressureFHIR.cql">ControllingHighBloodPressureFHIR.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-ControllingHighBloodPressureFHIR.html">Controlling High Blood PressureFHIR</a></td>
                </tr>

                <tr>
                    <th scope="row">
                        <b>

                                    short-name identifier:

                        </b>
                    </th>

                    <td style="padding-left: 4px;">

                            <p style="margin-bottom: 5px;">
                                <span>CMS165FHIR</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:9017d914-6748-45a9-bff1-8392ed644a7b</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:e254a6be-bec3-4304-87bc-d85ad3d8fa39</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>165FHIR</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;">2023-09-07 19:36:39+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;">ControllingHighBloodPressureFHIR</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 18-85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period, and whose most recent blood pressure was adequately controlled (&lt;140/90 mmHg) during the measurement period</p>
    </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 were developed by the National Committee for Quality Assurance (NCQA). 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. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2022 National Committee for Quality Assurance. All Rights Reserved.</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.</p>
    <p>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 &quot;AS IS&quot; 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>High blood pressure (HBP), also known as hypertension, is when the pressure in blood vessels is higher than normal (Centers for Disease Control and Prevention [CDC], 2021). The causes of hypertension are multiple and multifaceted and can be based on genetic predisposition, environmental risk factors, being overweight and obese, sodium intake, potassium intake, physical activity, and alcohol use. High blood pressure is common; according to the American Heart Association, between 2013-2016, approximately 121.5 million US adults &gt;= 20 years of age had HBP and the prevalence of hypertension among US adults 65 and older was 77.0 percent (Virani et al., 2021). In an analysis of adults with hypertension in NHANES, the estimated age-adjusted proportion with controlled BP increased from 31.8 percent in 1999 to 53.8 percent in 2014. However, that proportion declined to 43.7 percent in 2017 to 2018 (Tsao et al., 2022).</p>
    <p>HBP, known as the “silent killer,” increases risks of heart disease and stroke which are two of the leading causes of death in the US; a person who has HBP is four times more likely to die from a stroke and three times more likely to die from heart disease (CDC, 2012). The National Center for Health Statistics reported that in 2020 there were over 670,000 deaths with HBP as a primary or contributing cause (CDC, 2022). Between 2009 and 2019 the number of deaths due to HBP rose by 65.3 percent (Tsao et al., 2022). Managing and treating HBP would reduce cardiovascular disease mortality for males and females by 30.4 percent and 38.0 percent, respectively (Patel et al., 2015). Age-adjusted death rates attributable to HBP in 2019 were more than twice as high in non-Hispanic Black males (56.7 percent) when compared to rates for non-Hispanic White males (25.7 percent) (Tsao et al., 2022).</p>
    <p>HBP costs the U.S. approximately 131 billion dollars each year, averaged over 12 years from 2003 to 2014 (Kirkland et al., 2018). A study on cost-effectiveness on treating hypertension found that controlling HBP in patients with cardiovascular disease and systolic blood pressures (SBP) of &gt;= 160 mmHg could be effective and cost-saving (Moran, 2015).</p>
    <p>Many studies have shown that controlling high blood pressure reduces cardiovascular events and mortality. The Systolic Blood Pressure Intervention Trial (SPRINT) investigated the impact of obtaining a SBP goal of &lt;120 mmHg compared to a SBP goal of &lt;140 mmHg among patients 50 and older with established cardiovascular disease and found that the patients with the former goal had reduced cardiovascular events and mortality (SPRINT Research Group et al., 2015).</p>
    <p>Controlling HBP will significantly reduce the risks of cardiovascular disease mortality and lead to better health outcomes like reduction of heart attacks, stroke, and kidney disease (James et al., 2014). Thus, the relationship between the measure (control of hypertension) and the long-term clinical outcomes listed is well established.</p>
    </div></td>
            </tr>

            <tr>
                <th scope="row"><b>Clinical recommendation statement: </b></th>
                <td style="padding-left: 4px;"><div><p>U.S. Preventive Services Task Force (USPSTF) (2021):</p>
    <ul>
    <li>The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement (OBPM). The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. This is a grade A recommendation.</li>
    </ul>
    <p>American College of Cardiology/American Heart Association (2017):</p>
    <ul>
    <li>
    <p>For adults with confirmed hypertension and known CVD or 10-year ASCVD event risk of 10 percent or higher, a blood pressure target of less than 130/80 mmHg is recommended (Level of evidence: B-R (for systolic blood pressures), Level of evidence: C-EO (for diastolic blood pressure))</p>
    </li>
    <li>
    <p>For adults with confirmed hypertension, without additional markers of increased CVD risk, a blood pressure target of less than 130/80 mmHg may be reasonable (Note: clinical trial evidence is strongest for a target blood pressure of 140/90 mmHg in this population. However, observational studies suggest that these individuals often have a high lifetime risk and would benefit from blood pressure control earlier in life) (Level of evidence: B-NR (for systolic blood pressure), Level of evidence: C-EO (for diastolic blood pressure)).</p>
    </li>
    </ul>
    <p>American College of Physicians and the American Academy of Family Physicians (2017):</p>
    <ul>
    <li>
    <p>Initiate or intensify pharmacologic treatment in some adults aged 60 years or older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mmHg (Grade: weak recommendation, Quality of evidence: low)</p>
    </li>
    <li>
    <p>Initiate or intensify pharmacologic treatment in adults aged 60 years or older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mmHg to reduce the risk of recurrent stroke (Grade: weak recommendation, Quality of evidence: moderate)</p>
    </li>
    </ul>
    <p>American Diabetes Association (2021):</p>
    <ul>
    <li>
    <p>For individuals with diabetes and hypertension at higher cardiovascular risk (existing atherosclerotic cardiovascular disease or 10-year atherosclerotic cardiovascular disease risk &gt;=15 percent), a blood pressure target of &lt;130/80 mmHg may be appropriate, if it can be safely attained (Level of evidence: C)</p>
    </li>
    <li>
    <p>For individuals with diabetes and hypertension at lower risk for cardiovascular disease (10-year atherosclerotic cardiovascular disease risk &lt;15 percent), treat to a blood pressure target of &lt;140/90 mmHg (Level of evidence: A)</p>
    </li>
    </ul>
    </div></td>
            </tr>

                <tr>
                    <th scope="row"><b>Guidance (Usage): </b></th>
                    <td style="padding-left: 4px;">In reference to the numerator element, only blood pressure readings performed by a clinician or an automated blood pressure monitor or device are acceptable for numerator compliance with this measure. This includes blood pressures taken in person by a clinician and blood pressures measured remotely by electronic monitoring devices capable of transmitting the blood pressure data to the clinician. Blood pressure readings taken by an automated blood pressure monitor or device and conveyed by the patient to the clinician are also acceptable. It is the clinician’s responsibility and discretion to confirm the automated blood pressure monitor or device used to obtain the blood pressure is considered acceptable and reliable and whether the blood pressure reading is considered accurate before documenting it in the patient’s medical record.

    Do not include BP readings taken during an acute inpatient stay or an ED visit.

    If no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed &quot;not controlled&quot;.

    If there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading. Ranges and thresholds do not meet criteria for this measure. A distinct numeric result for both the systolic and diastolic BP reading is required for numerator compliance.

    This eCQM is a patient-based measure.

    This FHIR-based measure has been derived from the QDM-based measure: CMS165v12.

    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>643716e4d4d7050edabb0444</b></th>
                                        </tr>

                                        <tr>
                                            <td>Initial Population:</td>

                                                <td>Patients 18-85 years of age by the end of the measurement period who had a visit during the meaurement period and diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period</td>

                                        </tr>

                                        <tr>
                                            <td>Denominator:</td>

                                                <td>Equals Initial Population</td>

                                        </tr>

                                        <tr>
                                            <td>Denominator Exclusion:</td>

                                                <td>Patients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period. Also exclude patients with a diagnosis of pregnancy during the measurement period.

    Exclude patients who are in hospice care for any part of the measurement period.

    Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period.

    Exclude patients 66-80 by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria:
    - Advanced illness with two outpatient encounters during the measurement period or the year prior
    - OR advanced illness with one inpatient encounter during the measurement period or the year prior
    - OR taking dementia medications during the measurement period or the year prior

    Exclude patients 81 and older by the end of the measurement period with an indication of frailty for any part of the measurement period.

    Exclude patients receiving palliative care for any part of the measurement period.</td>

                                        </tr>

                                        <tr>
                                            <td>Denominator Exception:</td>

                                                <td>None</td>

                                        </tr>

                                        <tr>
                                            <td>Numerator:</td>

                                                <td>Patients whose most recent blood pressure is adequately controlled (systolic blood pressure &lt; 140 mmHg and diastolic blood pressure &lt; 90 mmHg) during the measurement period</td>

                                        </tr>

                                        <tr>
                                            <td>Numerator Exclusion:</td>

                                                <td>None</td>

                                        </tr>

                                </table>

                        </td>
                    </tr>

                <tr>
                    <th scope="row">
                        <b> Supplemental Data Guidance
                            : </b></th>
                    <td style="padding-left: 4px;">  </td>
                </tr>

                <tr>
                    <th scope="row"><b> Supplemental Data Elements: </b></th>
                    <td style="padding-left: 4px;">

                                    SDE Ethnicity

                                    SDE Payer

                                    SDE Race

                                    SDE Sex

                    </td>
                </tr>

                <tr>
                    <th scope="row"><b>Libraries: </b></th>
                    <td style="padding-left: 4px;">
                        <table class="grid-dict">

                                <tr>
                                    <td><a href="Library-ControllingHighBloodPressureFHIR.html">ControllingHighBloodPressureFHIR</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-SupplementalDataElements.html">SupplementalDataElements</a> version: 3.4.000</li>

                                <li><a href="Library-Status.html">Status</a> version: 1.6.000</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-AdultOutpatientEncounters.html">AdultOutpatientEncounters</a> version: 4.6.000</li>

                                <li><a href="Library-Hospice.html">Hospice</a> version: 6.7.000</li>

                                <li><a href="Library-AdvancedIllnessandFrailty.html">AdvancedIllnessandFrailty</a> version: 1.6.000</li>

                                <li><a href="Library-CQMCommon.html">CQMCommon</a> version: 1.4.000</li>

                                <li><a href="Library-CumulativeMedicationDuration.html">CumulativeMedicationDuration</a> version: 3.3.000</li>

                                <li><a href="Library-PalliativeCare.html">PalliativeCare</a> version: 1.7.000</li>

                                <li><a href="http://tx.fhir.org/r4/ValueSet/x-loinc2.82">LOINC</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="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.104.12.1011/expansion">Essential Hypertension</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/2.16.840.1.113883.3.526.3.1240/expansion">Annual Wellness Visit</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion">Preventive Care Services - Established Office Visit, 18 and Up</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion">Preventive Care Services-Initial Office Visit, 18 and Up</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion">Home Healthcare Services</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/2.16.840.1.113883.3.464.1003.101.12.1080/expansion">Telephone Visits</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</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://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.378/expansion">Pregnancy</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.353/expansion">End Stage Renal Disease</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.109.12.1029/expansion">Kidney Transplant Recipient</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1002/expansion">Chronic Kidney Disease, Stage 5</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.109.12.1012/expansion">Kidney Transplant</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.109.12.1013/expansion">Dialysis Services</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.109.12.1014/expansion">ESRD Monthly Outpatient Services</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.118.12.1300/expansion">Frailty Device</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.113.12.1074/expansion">Frailty Diagnosis</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1088/expansion">Frailty Encounter</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.113.12.1075/expansion">Frailty Symptom</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1087/expansion">Outpatient</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1086/expansion">Observation</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion">Emergency Department Visit</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1084/expansion">Nonacute Inpatient</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.110.12.1082/expansion">Advanced Illness</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1083/expansion">Acute Inpatient</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1510/expansion">Dementia Medications</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>SDE Sex</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>1</td>
                                        <td>Coding</td>
                                    </tr>

                                    <tr>
                                        <td>Numerator</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>SDE Payer</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>*</td>
                                        <td>Resource</td>
                                    </tr>

                                    <tr>
                                        <td>Initial Population</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>1</td>
                                        <td>boolean</td>
                                    </tr>

                                    <tr>
                                        <td>SDE Ethnicity</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>1</td>
                                        <td>Resource</td>
                                    </tr>

                                    <tr>
                                        <td>Denominator Exclusions</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>1</td>
                                        <td>boolean</td>
                                    </tr>

                                    <tr>
                                        <td>SDE Race</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>1</td>
                                        <td>Resource</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>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>Patient(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html">QICorePatient</a>)</td>
                                        <td>

                                                url

                                                extension

                                        </td>
                                        <td>

                                        </td>
                                        <td/>
                                    </tr>

                                    <tr>
                                        <td>Patient(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html">QICorePatient</a>)</td>
                                        <td>

                                                url

                                                extension

                                        </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>

                                                id

                                                id.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

                                                hospitalization

                                                hospitalization.dischargeDisposition

                                                period

                                        </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

                                        </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

                                        </td>
                                        <td>

                                                     ESRD Monthly Outpatient Services

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.109.12.1014/expansion">ESRD Monthly Outpatient 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

                                        </td>
                                        <td>

                                                     Frailty Encounter

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1088/expansion">Frailty 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

                                        </td>
                                        <td>

                                                     Acute Inpatient

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1083/expansion">Acute 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

                                        </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/R4/bp.html">Observation Blood Pressure Profile</a>)</td>
                                        <td>

                                                encounter

                                                encounter.class

                                                encounter.class.code

                                                effective

                                                component

                                        </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>

                                                     Essential Hypertension

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.104.12.1011/expansion">Essential Hypertension</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>

                                                     Frailty Diagnosis

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.113.12.1074/expansion">Frailty 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>

                                                id

                                                id.value

                                        </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>

                                                     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>Coverage(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html">QICoreCoverage</a>)</td>
                                        <td>

                                                type

                                                period

                                        </td>
                                        <td>

                                                     Payer Type

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</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

                                        </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

                                                value

                                                effective

                                        </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

                                        </td>
                                        <td>

                                                     Frailty Symptom

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.113.12.1075/expansion">Frailty Symptom</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

                                                effective

                                                value

                                        </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

                                                value

                                        </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

                                        </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

                                        </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

                                        </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

                                        </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>Systolic blood pressure</td>
                                            <td>8480-6</td>
                                            <td><a href="https://loinc.org/">http://loinc.org</a></td>
                                        </tr>

                                        <tr>
                                            <td>Diastolic blood pressure</td>
                                            <td>8462-4</td>
                                            <td><a href="https://loinc.org/">http://loinc.org</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>Medical equipment used</td>
                                            <td>98181-1</td>
                                            <td><a href="https://loinc.org/">http://loinc.org</a></td>
                                        </tr>

                                        <tr>
                                            <td>Housing status</td>
                                            <td>71802-3</td>
                                            <td><a href="https://loinc.org/">http://loinc.org</a></td>
                                        </tr>

                                        <tr>
                                            <td>Lives in a nursing home (finding)</td>
                                            <td>160734000</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> 643716e4d4d7050edabb0444 </td>
                                    <td>

                                            <b>Group scoring:</b>

                                                <span>  proportion </span>

                                    </td>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Initial Population</td>
                                        <td>

                                                <pre><code class="language-cql">define &quot;Initial Population&quot;:
      AgeInYearsAt(date from
        end of &quot;Measurement Period&quot;
      ) in Interval[18, 85]
        and exists &quot;Essential Hypertension Diagnosis&quot;
        and exists AdultOutpatientEncounters.&quot;Qualifying Encounters&quot;</code></pre>

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Denominator</td>
                                        <td>

                                                <pre><code class="language-cql">define &quot;Denominator&quot;:
      &quot;Initial Population&quot;</code></pre>

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Denominator Exclusion</td>
                                        <td>

                                                <pre><code class="language-cql">define &quot;Denominator Exclusions&quot;:
      Hospice.&quot;Has Hospice Services&quot;
        or exists ( &quot;Pregnancy or Renal Diagnosis&quot; )
        or exists ( &quot;End Stage Renal Disease Procedures&quot; )
        or exists ( &quot;End Stage Renal Disease Encounter&quot; )
        or AIFrailLTCF.&quot;Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty&quot;
        or AIFrailLTCF.&quot;Is Age 66 or Older Living Long Term in a Nursing Home&quot;
        or PalliativeCare.&quot;Has Palliative Care in the Measurement Period&quot;</code></pre>

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Denominator Exception</td>
                                        <td>

                                                None

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Numerator</td>
                                        <td>

                                                <pre><code class="language-cql">define &quot;Numerator&quot;:
      &quot;Has Systolic Blood Pressure Less Than 140&quot;
        and &quot;Has Diastolic Blood Pressure Less Than 90&quot;</code></pre>

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Numerator Exclusion</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>SupplementalDataElements</td>

                                    <td>SDE Sex</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Sex&quot;:
      case
          when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }
          when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }
          else null
        end</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>SDE Sex</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Sex&quot;:
      SDE.&quot;SDE Sex&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>Qualifying Systolic Blood Pressure Reading</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Qualifying Systolic Blood Pressure Reading&quot;:
      ( ( [&quot;observation-bp&quot;] ).isObservationBP ( ) ) BloodPressure
        where ( not ( ( BloodPressure.encounter.getEncounter ( ) ).class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS' } ) )
          and BloodPressure.effective.latest ( ) during day of &quot;Measurement Period&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>Qualifying Diastolic Blood Pressure Reading</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Qualifying Diastolic Blood Pressure Reading&quot;:
      ( ( [&quot;observation-bp&quot;] ).isObservationBP ( ) ) BloodPressure
        where ( not ( ( BloodPressure.encounter.getEncounter ( ) ).class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS' } ) )
          and BloodPressure.effective.latest ( ) during day of &quot;Measurement Period&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>Blood Pressure Days</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Blood Pressure Days&quot;:
      ( &quot;Qualifying Diastolic Blood Pressure Reading&quot; DBPExam
          return date from DBPExam.effective.latest ( )
      )
        intersect ( &quot;Qualifying Systolic Blood Pressure Reading&quot; SBPExam
            return date from SBPExam.effective.latest ( )
        )</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>Most Recent Blood Pressure Day</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Most Recent Blood Pressure Day&quot;:
      Last(&quot;Blood Pressure Days&quot; BPDays
          sort asc
      )</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>Lowest Systolic Reading on Most Recent Blood Pressure Day</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Lowest Systolic Reading on Most Recent Blood Pressure Day&quot;:
      First(&quot;Qualifying Systolic Blood Pressure Reading&quot; SBPReading
          where SBPReading.effective.latest() same day as &quot;Most Recent Blood Pressure Day&quot;
          return singleton from(SBPReading.component SBPComponent
              where SBPComponent.code ~ &quot;Systolic blood pressure&quot;
              return SBPComponent.value as Quantity
          )
          sort asc
      )</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>Has Systolic Blood Pressure Less Than 140</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Systolic Blood Pressure Less Than 140&quot;:
      &quot;Lowest Systolic Reading on Most Recent Blood Pressure Day&quot; &lt; 140 'mm[Hg]'</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>Lowest Diastolic Reading on Most Recent Blood Pressure Day</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Lowest Diastolic Reading on Most Recent Blood Pressure Day&quot;:
      First(&quot;Qualifying Diastolic Blood Pressure Reading&quot; DBPReading
          where DBPReading.effective.latest() same day as &quot;Most Recent Blood Pressure Day&quot;
          return singleton from(DBPReading.component DBPComponent
              where DBPComponent.code ~ &quot;Diastolic blood pressure&quot;
              return DBPComponent.value as Quantity
          )
          sort asc
      )</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>Has Diastolic Blood Pressure Less Than 90</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Diastolic Blood Pressure Less Than 90&quot;:
      &quot;Lowest Diastolic Reading on Most Recent Blood Pressure Day&quot; &lt; 90 'mm[Hg]'</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>Numerator</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Numerator&quot;:
      &quot;Has Systolic Blood Pressure Less Than 140&quot;
        and &quot;Has Diastolic Blood Pressure Less Than 90&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>Essential Hypertension Diagnosis</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Essential Hypertension Diagnosis&quot;:
      ( [Condition: &quot;Essential Hypertension&quot;] ) Hypertension
        where Hypertension.prevalenceInterval ( ) overlaps Interval[start of &quot;Measurement Period&quot;, start of &quot;Measurement Period&quot; + 6 months )</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>AdultOutpatientEncounters</td>

                                    <td>Qualifying Encounters</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Qualifying Encounters&quot;:
      ( ( [Encounter: &quot;Office Visit&quot;]
        union [Encounter: &quot;Annual Wellness Visit&quot;]
        union [Encounter: &quot;Preventive Care Services Established Office Visit, 18 and Up&quot;]
        union [Encounter: &quot;Preventive Care Services Initial Office Visit, 18 and Up&quot;]
        union [Encounter: &quot;Home Healthcare Services&quot;]
        union [Encounter: &quot;Online Assessments&quot;]
        union [Encounter: &quot;Telephone Visits&quot;] ).isEncounterPerformed() ) ValidEncounter
        where ValidEncounter.period.toInterval() during day of &quot;Measurement Period&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>Initial Population</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Initial Population&quot;:
      AgeInYearsAt(date from
        end of &quot;Measurement Period&quot;
      ) in Interval[18, 85]
        and exists &quot;Essential Hypertension Diagnosis&quot;
        and exists AdultOutpatientEncounters.&quot;Qualifying Encounters&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>Denominator</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Denominator&quot;:
      &quot;Initial Population&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>SupplementalDataElements</td>

                                    <td>SDE Payer</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Payer&quot;:
      [Coverage: type in &quot;Payer Type&quot;] Payer
        return {
          code: Payer.type,
          period: Payer.period
        }</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>SDE Payer</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Payer&quot;:
      SDE.&quot;SDE Payer&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>SupplementalDataElements</td>

                                    <td>SDE Ethnicity</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Ethnicity&quot;:
      Patient.ethnicity E
        return Tuple {
          codes: { E.ombCategory } union E.detailed,
          display: E.text
        }</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>SDE Ethnicity</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Ethnicity&quot;:
      SDE.&quot;SDE Ethnicity&quot;</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 &quot;Has Hospice Services&quot;:
      exists ((([Encounter: &quot;Encounter Inpatient&quot;]).isEncounterPerformed()) InpatientEncounter
          where (InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to home for hospice care (procedure)&quot;
              or InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to healthcare facility for hospice care (procedure)&quot;
          )
            and InpatientEncounter.period.toInterval() ends during day of &quot;Measurement Period&quot;
      )
        or exists ((([Encounter: &quot;Hospice Encounter&quot;]).isEncounterPerformed()) HospiceEncounter
            where HospiceEncounter.period.toInterval() overlaps day of &quot;Measurement Period&quot;
        )
        or exists ((([Observation: &quot;Hospice care [Minimum Data Set]&quot;]).isAssessmentPerformed()) HospiceAssessment
            where HospiceAssessment.value ~ &quot;Yes (qualifier value)&quot;
              and HospiceAssessment.effective.toInterval() overlaps day of &quot;Measurement Period&quot;
        )
        or exists ((([ServiceRequest: &quot;Hospice Care Ambulatory&quot;]).isInterventionOrder()) HospiceOrder
            where HospiceOrder.authoredOn.toInterval() during day of &quot;Measurement Period&quot;
        )
        or exists ((([Procedure: &quot;Hospice Care Ambulatory&quot;]).isInterventionPerformed()) HospicePerformed
            where HospicePerformed.performed.toInterval() overlaps day of &quot;Measurement Period&quot;
        )
        or exists (([Condition: &quot;Hospice Diagnosis&quot;]) HospiceCareDiagnosis
            where HospiceCareDiagnosis.prevalenceInterval() overlaps day of &quot;Measurement Period&quot;
        )</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>Pregnancy or Renal Diagnosis</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Pregnancy or Renal Diagnosis&quot;:
      ( [Condition: &quot;Pregnancy&quot;]
        union [Condition: &quot;End Stage Renal Disease&quot;]
        union [Condition: &quot;Kidney Transplant Recipient&quot;]
        union [Condition: &quot;Chronic Kidney Disease, Stage 5&quot;] ) PregnancyESRDDiagnosis
        where PregnancyESRDDiagnosis.prevalenceInterval ( ) overlaps &quot;Measurement Period&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>End Stage Renal Disease Procedures</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;End Stage Renal Disease Procedures&quot;:
      ( ( [Procedure: &quot;Kidney Transplant&quot;]
          union [Procedure: &quot;Dialysis Services&quot;]
      ).isProcedurePerformed ( ) ) ESRDProcedure
        where ESRDProcedure.performed.toInterval ( ) ends on or before end of &quot;Measurement Period&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>End Stage Renal Disease Encounter</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;End Stage Renal Disease Encounter&quot;:
      ( ( [Encounter: &quot;ESRD Monthly Outpatient Services&quot;] ).isEncounterPerformed ( ) ) ESRDEncounter
        where ESRDEncounter.period.toInterval ( ) starts on or before end of &quot;Measurement Period&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>AdvancedIllnessandFrailty</td>

                                    <td>Has Criteria Indicating Frailty</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Criteria Indicating Frailty&quot;:
      exists ( (([DeviceRequest: &quot;Frailty Device&quot;]).isDeviceOrder()) FrailtyDeviceOrder
          where FrailtyDeviceOrder.doNotPerform() is not true
          and FrailtyDeviceOrder.authoredOn.toInterval() during day of &quot;Measurement Period&quot;
      )
        or exists ( (([Observation: &quot;Medical equipment used&quot;]).isAssessmentPerformed()) EquipmentUsed
            where EquipmentUsed.value as Concept in &quot;Frailty Device&quot;
            and EquipmentUsed.effective.toInterval() ends during day of &quot;Measurement Period&quot;
        )
        or exists ( ([Condition: &quot;Frailty Diagnosis&quot;]) FrailtyDiagnosis
            where FrailtyDiagnosis.prevalenceInterval() overlaps &quot;Measurement Period&quot;
        )
        or exists ( (([Encounter: &quot;Frailty Encounter&quot;]).isEncounterPerformed()) FrailtyEncounter
            where FrailtyEncounter.period.toInterval() overlaps &quot;Measurement Period&quot;
        )
        or exists ( (([Observation: &quot;Frailty Symptom&quot;]).isSymptom()) FrailtySymptom
            where FrailtySymptom.effective.toInterval() overlaps &quot;Measurement Period&quot;
        )</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>AdvancedIllnessandFrailty</td>

                                    <td>Outpatient Encounters with Advanced Illness</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Outpatient Encounters with Advanced Illness&quot;:
       (( [Encounter: &quot;Outpatient&quot;]
        union [Encounter: &quot;Observation&quot;]
        union [Encounter: &quot;Emergency Department Evaluation and Management Visit&quot;]
        union [Encounter: &quot;Nonacute Inpatient&quot;] ).isEncounterPerformed()) OutpatientEncounter
          where exists ((OutpatientEncounter.encounterDiagnosis()) Diagnosis where Diagnosis.code in &quot;Advanced Illness&quot;)
            and OutpatientEncounter.period.toInterval() starts during day of Interval[start of &quot;Measurement Period&quot; - 1 year,
            end of &quot;Measurement Period&quot;]</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>AdvancedIllnessandFrailty</td>

                                    <td>Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service&quot;:
      exists ( from
          &quot;Outpatient Encounters with Advanced Illness&quot; OutpatientEncounter1,
          &quot;Outpatient Encounters with Advanced Illness&quot; OutpatientEncounter2
          where OutpatientEncounter2.period ends 1 day or more after day of
          end of OutpatientEncounter1.period
          return OutpatientEncounter1
      )</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>AdvancedIllnessandFrailty</td>

                                    <td>Has Inpatient Encounter with Advanced Illness</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Inpatient Encounter with Advanced Illness&quot;:
      exists ( ( ([Encounter: &quot;Acute Inpatient&quot;]).isEncounterPerformed()) InpatientEncounter
          where exists ((InpatientEncounter.encounterDiagnosis()) Diagnosis where Diagnosis.code in &quot;Advanced Illness&quot;)
            and InpatientEncounter.period.toInterval() starts during day of Interval[start of &quot;Measurement Period&quot; - 1 year,
              end of &quot;Measurement Period&quot;]
      )</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>AdvancedIllnessandFrailty</td>

                                    <td>Has Dementia Medications in Year Before or During Measurement Period</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Dementia Medications in Year Before or During Measurement Period&quot;:
      exists (( ([MedicationRequest: &quot;Dementia Medications&quot;]).isMedicationActive()) DementiaMedication
          where DementiaMedication.doNotPerform is not true and
          CMD.&quot;MedicationRequestPeriod&quot; ( DementiaMedication ) overlaps Interval[start of &quot;Measurement Period&quot; - 1 year,
            end of &quot;Measurement Period&quot;]
      )</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>AdvancedIllnessandFrailty</td>

                                    <td>Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty&quot;:
      ( AgeInYearsAt(date from end of &quot;Measurement Period&quot;)in Interval[66, 80]
          and &quot;Has Criteria Indicating Frailty&quot;
          and ( &quot;Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service&quot;
              or &quot;Has Inpatient Encounter with Advanced Illness&quot;
              or &quot;Has Dementia Medications in Year Before or During Measurement Period&quot;
          )
      )
        or ( AgeInYearsAt(date from end of &quot;Measurement Period&quot;)&gt;= 81
            and &quot;Has Criteria Indicating Frailty&quot;
        )</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>AdvancedIllnessandFrailty</td>

                                    <td>Is Age 66 or Older Living Long Term in a Nursing Home</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Is Age 66 or Older Living Long Term in a Nursing Home&quot;:
      AgeInYearsAt(date from
         end of &quot;Measurement Period&quot;
      )&gt;= 66
        and ( ( Last( (([Observation: &quot;Housing status&quot;]).isAssessmentPerformed()) HousingStatus
              where HousingStatus.effective.toInterval() ends on or before
              end of &quot;Measurement Period&quot;
              sort by
              end of effective.toInterval() asc
          )) LastHousingStatus
            where LastHousingStatus.value ~ &quot;Lives in a nursing home (finding)&quot;
        ) is not null</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 &quot;Has Palliative Care in the Measurement Period&quot;:
      exists ((([Observation: &quot;Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)&quot;]).isAssessmentPerformed()) PalliativeAssessment
          where PalliativeAssessment.effective.toInterval() overlaps day of &quot;Measurement Period&quot;
      )
        or exists ([Condition: &quot;Palliative Care Diagnosis&quot;] PalliativeDiagnosis
            where PalliativeDiagnosis.prevalenceInterval() overlaps day of &quot;Measurement Period&quot;
        )
        or exists ((([Encounter: &quot;Palliative Care Encounter&quot;]).isEncounterPerformed()) PalliativeEncounter
            where PalliativeEncounter.period.toInterval() overlaps day of &quot;Measurement Period&quot;
        )
        or exists ((([Procedure: &quot;Palliative Care Intervention&quot;]).isInterventionPerformed()) PalliativeIntervention
            where PalliativeIntervention.performed.toInterval() overlaps day of &quot;Measurement Period&quot;
        )</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>Denominator Exclusions</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Denominator Exclusions&quot;:
      Hospice.&quot;Has Hospice Services&quot;
        or exists ( &quot;Pregnancy or Renal Diagnosis&quot; )
        or exists ( &quot;End Stage Renal Disease Procedures&quot; )
        or exists ( &quot;End Stage Renal Disease Encounter&quot; )
        or AIFrailLTCF.&quot;Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty&quot;
        or AIFrailLTCF.&quot;Is Age 66 or Older Living Long Term in a Nursing Home&quot;
        or PalliativeCare.&quot;Has Palliative Care in the Measurement Period&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>SupplementalDataElements</td>

                                    <td>SDE Race</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Race&quot;:
      Patient.race R
        return Tuple {
          codes: R.ombCategory union R.detailed,
          display: R.text
        }</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>ControllingHighBloodPressureFHIR</td>

                                    <td>SDE Race</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Race&quot;:
      SDE.&quot;SDE Race&quot;</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://loinc.org"/>
              <code value="8480-6"/>
              <display value="Systolic blood pressure"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="8462-4"/>
              <display value="Diastolic blood pressure"/>
            </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="98181-1"/>
              <display value="Medical equipment used"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="71802-3"/>
              <display value="Housing status"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system value="http://snomed.info/sct"/>
              <code value="160734000"/>
              <display value="Lives in a nursing home (finding)"/>
            </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="SupplementalDataElements"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Sex"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Sex&quot;:
      case
          when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }
          when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }
          else null
        end"/>
            </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="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Sex"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Sex&quot;:
      SDE.&quot;SDE Sex&quot;"/>
            </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="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Qualifying Systolic Blood Pressure Reading"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Qualifying Systolic Blood Pressure Reading&quot;:
      ( ( [&quot;observation-bp&quot;] ).isObservationBP ( ) ) BloodPressure
        where ( not ( ( BloodPressure.encounter.getEncounter ( ) ).class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS' } ) )
          and BloodPressure.effective.latest ( ) during day of &quot;Measurement Period&quot;"/>
            </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="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Qualifying Diastolic Blood Pressure Reading"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Qualifying Diastolic Blood Pressure Reading&quot;:
      ( ( [&quot;observation-bp&quot;] ).isObservationBP ( ) ) BloodPressure
        where ( not ( ( BloodPressure.encounter.getEncounter ( ) ).class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS' } ) )
          and BloodPressure.effective.latest ( ) during day of &quot;Measurement Period&quot;"/>
            </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="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Blood Pressure Days"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Blood Pressure Days&quot;:
      ( &quot;Qualifying Diastolic Blood Pressure Reading&quot; DBPExam
          return date from DBPExam.effective.latest ( )
      )
        intersect ( &quot;Qualifying Systolic Blood Pressure Reading&quot; SBPExam
            return date from SBPExam.effective.latest ( )
        )"/>
            </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="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Most Recent Blood Pressure Day"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Most Recent Blood Pressure Day&quot;:
      Last(&quot;Blood Pressure Days&quot; BPDays
          sort asc
      )"/>
            </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="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString
                           value="Lowest Systolic Reading on Most Recent Blood Pressure Day"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Lowest Systolic Reading on Most Recent Blood Pressure Day&quot;:
      First(&quot;Qualifying Systolic Blood Pressure Reading&quot; SBPReading
          where SBPReading.effective.latest() same day as &quot;Most Recent Blood Pressure Day&quot;
          return singleton from(SBPReading.component SBPComponent
              where SBPComponent.code ~ &quot;Systolic blood pressure&quot;
              return SBPComponent.value as Quantity
          )
          sort asc
      )"/>
            </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="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Has Systolic Blood Pressure Less Than 140"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Has Systolic Blood Pressure Less Than 140&quot;:
      &quot;Lowest Systolic Reading on Most Recent Blood Pressure Day&quot; &lt; 140 'mm[Hg]'"/>
            </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="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString
                           value="Lowest Diastolic Reading on Most Recent Blood Pressure Day"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Lowest Diastolic Reading on Most Recent Blood Pressure Day&quot;:
      First(&quot;Qualifying Diastolic Blood Pressure Reading&quot; DBPReading
          where DBPReading.effective.latest() same day as &quot;Most Recent Blood Pressure Day&quot;
          return singleton from(DBPReading.component DBPComponent
              where DBPComponent.code ~ &quot;Diastolic blood pressure&quot;
              return DBPComponent.value as Quantity
          )
          sort asc
      )"/>
            </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="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Has Diastolic Blood Pressure Less Than 90"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Has Diastolic Blood Pressure Less Than 90&quot;:
      &quot;Lowest Diastolic Reading on Most Recent Blood Pressure Day&quot; &lt; 90 'mm[Hg]'"/>
            </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="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Numerator"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Numerator&quot;:
      &quot;Has Systolic Blood Pressure Less Than 140&quot;
        and &quot;Has Diastolic Blood Pressure Less Than 90&quot;"/>
            </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="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Essential Hypertension Diagnosis"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Essential Hypertension Diagnosis&quot;:
      ( [Condition: &quot;Essential Hypertension&quot;] ) Hypertension
        where Hypertension.prevalenceInterval ( ) overlaps Interval[start of &quot;Measurement Period&quot;, start of &quot;Measurement Period&quot; + 6 months )"/>
            </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="AdultOutpatientEncounters"/>
            </extension>
            <extension url="name">
              <valueString value="Qualifying Encounters"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Qualifying Encounters&quot;:
      ( ( [Encounter: &quot;Office Visit&quot;]
        union [Encounter: &quot;Annual Wellness Visit&quot;]
        union [Encounter: &quot;Preventive Care Services Established Office Visit, 18 and Up&quot;]
        union [Encounter: &quot;Preventive Care Services Initial Office Visit, 18 and Up&quot;]
        union [Encounter: &quot;Home Healthcare Services&quot;]
        union [Encounter: &quot;Online Assessments&quot;]
        union [Encounter: &quot;Telephone Visits&quot;] ).isEncounterPerformed() ) ValidEncounter
        where ValidEncounter.period.toInterval() during day of &quot;Measurement Period&quot;"/>
            </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="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Initial Population"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Initial Population&quot;:
      AgeInYearsAt(date from
        end of &quot;Measurement Period&quot;
      ) in Interval[18, 85]
        and exists &quot;Essential Hypertension Diagnosis&quot;
        and exists AdultOutpatientEncounters.&quot;Qualifying Encounters&quot;"/>
            </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="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Denominator"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Denominator&quot;:
      &quot;Initial Population&quot;"/>
            </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="SupplementalDataElements"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Payer"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Payer&quot;:
      [Coverage: type in &quot;Payer Type&quot;] Payer
        return {
          code: Payer.type,
          period: Payer.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="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Payer"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Payer&quot;:
      SDE.&quot;SDE Payer&quot;"/>
            </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="SupplementalDataElements"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Ethnicity"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Ethnicity&quot;:
      Patient.ethnicity E
        return Tuple {
          codes: { E.ombCategory } union E.detailed,
          display: E.text
        }"/>
            </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="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Ethnicity"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Ethnicity&quot;:
      SDE.&quot;SDE Ethnicity&quot;"/>
            </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="Hospice"/>
            </extension>
            <extension url="name">
              <valueString value="Has Hospice Services"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Has Hospice Services&quot;:
      exists ((([Encounter: &quot;Encounter Inpatient&quot;]).isEncounterPerformed()) InpatientEncounter
          where (InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to home for hospice care (procedure)&quot;
              or InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to healthcare facility for hospice care (procedure)&quot;
          )
            and InpatientEncounter.period.toInterval() ends during day of &quot;Measurement Period&quot;
      )
        or exists ((([Encounter: &quot;Hospice Encounter&quot;]).isEncounterPerformed()) HospiceEncounter
            where HospiceEncounter.period.toInterval() overlaps day of &quot;Measurement Period&quot;
        )
        or exists ((([Observation: &quot;Hospice care [Minimum Data Set]&quot;]).isAssessmentPerformed()) HospiceAssessment
            where HospiceAssessment.value ~ &quot;Yes (qualifier value)&quot;
              and HospiceAssessment.effective.toInterval() overlaps day of &quot;Measurement Period&quot;
        )
        or exists ((([ServiceRequest: &quot;Hospice Care Ambulatory&quot;]).isInterventionOrder()) HospiceOrder
            where HospiceOrder.authoredOn.toInterval() during day of &quot;Measurement Period&quot;
        )
        or exists ((([Procedure: &quot;Hospice Care Ambulatory&quot;]).isInterventionPerformed()) HospicePerformed
            where HospicePerformed.performed.toInterval() overlaps day of &quot;Measurement Period&quot;
        )
        or exists (([Condition: &quot;Hospice Diagnosis&quot;]) HospiceCareDiagnosis
            where HospiceCareDiagnosis.prevalenceInterval() overlaps day of &quot;Measurement Period&quot;
        )"/>
            </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="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Pregnancy or Renal Diagnosis"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Pregnancy or Renal Diagnosis&quot;:
      ( [Condition: &quot;Pregnancy&quot;]
        union [Condition: &quot;End Stage Renal Disease&quot;]
        union [Condition: &quot;Kidney Transplant Recipient&quot;]
        union [Condition: &quot;Chronic Kidney Disease, Stage 5&quot;] ) PregnancyESRDDiagnosis
        where PregnancyESRDDiagnosis.prevalenceInterval ( ) overlaps &quot;Measurement Period&quot;"/>
            </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="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="End Stage Renal Disease Procedures"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;End Stage Renal Disease Procedures&quot;:
      ( ( [Procedure: &quot;Kidney Transplant&quot;]
          union [Procedure: &quot;Dialysis Services&quot;]
      ).isProcedurePerformed ( ) ) ESRDProcedure
        where ESRDProcedure.performed.toInterval ( ) ends on or before end of &quot;Measurement Period&quot;"/>
            </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="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="End Stage Renal Disease Encounter"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;End Stage Renal Disease Encounter&quot;:
      ( ( [Encounter: &quot;ESRD Monthly Outpatient Services&quot;] ).isEncounterPerformed ( ) ) ESRDEncounter
        where ESRDEncounter.period.toInterval ( ) starts on or before end of &quot;Measurement Period&quot;"/>
            </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="AdvancedIllnessandFrailty"/>
            </extension>
            <extension url="name">
              <valueString value="Has Criteria Indicating Frailty"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Has Criteria Indicating Frailty&quot;:
      exists ( (([DeviceRequest: &quot;Frailty Device&quot;]).isDeviceOrder()) FrailtyDeviceOrder
          where FrailtyDeviceOrder.doNotPerform() is not true
          and FrailtyDeviceOrder.authoredOn.toInterval() during day of &quot;Measurement Period&quot;
      )
        or exists ( (([Observation: &quot;Medical equipment used&quot;]).isAssessmentPerformed()) EquipmentUsed
            where EquipmentUsed.value as Concept in &quot;Frailty Device&quot;
            and EquipmentUsed.effective.toInterval() ends during day of &quot;Measurement Period&quot;
        )
        or exists ( ([Condition: &quot;Frailty Diagnosis&quot;]) FrailtyDiagnosis
            where FrailtyDiagnosis.prevalenceInterval() overlaps &quot;Measurement Period&quot;
        )
        or exists ( (([Encounter: &quot;Frailty Encounter&quot;]).isEncounterPerformed()) FrailtyEncounter
            where FrailtyEncounter.period.toInterval() overlaps &quot;Measurement Period&quot;
        )
        or exists ( (([Observation: &quot;Frailty Symptom&quot;]).isSymptom()) FrailtySymptom
            where FrailtySymptom.effective.toInterval() overlaps &quot;Measurement Period&quot;
        )"/>
            </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="AdvancedIllnessandFrailty"/>
            </extension>
            <extension url="name">
              <valueString value="Outpatient Encounters with Advanced Illness"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Outpatient Encounters with Advanced Illness&quot;:
       (( [Encounter: &quot;Outpatient&quot;]
        union [Encounter: &quot;Observation&quot;]
        union [Encounter: &quot;Emergency Department Evaluation and Management Visit&quot;]
        union [Encounter: &quot;Nonacute Inpatient&quot;] ).isEncounterPerformed()) OutpatientEncounter
          where exists ((OutpatientEncounter.encounterDiagnosis()) Diagnosis where Diagnosis.code in &quot;Advanced Illness&quot;)
            and OutpatientEncounter.period.toInterval() starts during day of Interval[start of &quot;Measurement Period&quot; - 1 year,
            end of &quot;Measurement Period&quot;]"/>
            </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="AdvancedIllnessandFrailty"/>
            </extension>
            <extension url="name">
              <valueString
                           value="Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service&quot;:
      exists ( from
          &quot;Outpatient Encounters with Advanced Illness&quot; OutpatientEncounter1,
          &quot;Outpatient Encounters with Advanced Illness&quot; OutpatientEncounter2
          where OutpatientEncounter2.period ends 1 day or more after day of
          end of OutpatientEncounter1.period
          return OutpatientEncounter1
      )"/>
            </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="AdvancedIllnessandFrailty"/>
            </extension>
            <extension url="name">
              <valueString value="Has Inpatient Encounter with Advanced Illness"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Has Inpatient Encounter with Advanced Illness&quot;:
      exists ( ( ([Encounter: &quot;Acute Inpatient&quot;]).isEncounterPerformed()) InpatientEncounter
          where exists ((InpatientEncounter.encounterDiagnosis()) Diagnosis where Diagnosis.code in &quot;Advanced Illness&quot;)
            and InpatientEncounter.period.toInterval() starts during day of Interval[start of &quot;Measurement Period&quot; - 1 year,
              end of &quot;Measurement Period&quot;]
      )"/>
            </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="AdvancedIllnessandFrailty"/>
            </extension>
            <extension url="name">
              <valueString
                           value="Has Dementia Medications in Year Before or During Measurement Period"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Has Dementia Medications in Year Before or During Measurement Period&quot;:
      exists (( ([MedicationRequest: &quot;Dementia Medications&quot;]).isMedicationActive()) DementiaMedication
          where DementiaMedication.doNotPerform is not true and
          CMD.&quot;MedicationRequestPeriod&quot; ( DementiaMedication ) overlaps Interval[start of &quot;Measurement Period&quot; - 1 year,
            end of &quot;Measurement Period&quot;]
      )"/>
            </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="AdvancedIllnessandFrailty"/>
            </extension>
            <extension url="name">
              <valueString
                           value="Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty&quot;:
      ( AgeInYearsAt(date from end of &quot;Measurement Period&quot;)in Interval[66, 80]
          and &quot;Has Criteria Indicating Frailty&quot;
          and ( &quot;Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service&quot;
              or &quot;Has Inpatient Encounter with Advanced Illness&quot;
              or &quot;Has Dementia Medications in Year Before or During Measurement Period&quot;
          )
      )
        or ( AgeInYearsAt(date from end of &quot;Measurement Period&quot;)&gt;= 81
            and &quot;Has Criteria Indicating Frailty&quot;
        )"/>
            </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="AdvancedIllnessandFrailty"/>
            </extension>
            <extension url="name">
              <valueString
                           value="Is Age 66 or Older Living Long Term in a Nursing Home"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Is Age 66 or Older Living Long Term in a Nursing Home&quot;:
      AgeInYearsAt(date from
         end of &quot;Measurement Period&quot;
      )&gt;= 66
        and ( ( Last( (([Observation: &quot;Housing status&quot;]).isAssessmentPerformed()) HousingStatus
              where HousingStatus.effective.toInterval() ends on or before
              end of &quot;Measurement Period&quot;
              sort by
              end of effective.toInterval() asc
          )) LastHousingStatus
            where LastHousingStatus.value ~ &quot;Lives in a nursing home (finding)&quot;
        ) is not null"/>
            </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="PalliativeCare"/>
            </extension>
            <extension url="name">
              <valueString value="Has Palliative Care in the Measurement Period"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Has Palliative Care in the Measurement Period&quot;:
      exists ((([Observation: &quot;Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)&quot;]).isAssessmentPerformed()) PalliativeAssessment
          where PalliativeAssessment.effective.toInterval() overlaps day of &quot;Measurement Period&quot;
      )
        or exists ([Condition: &quot;Palliative Care Diagnosis&quot;] PalliativeDiagnosis
            where PalliativeDiagnosis.prevalenceInterval() overlaps day of &quot;Measurement Period&quot;
        )
        or exists ((([Encounter: &quot;Palliative Care Encounter&quot;]).isEncounterPerformed()) PalliativeEncounter
            where PalliativeEncounter.period.toInterval() overlaps day of &quot;Measurement Period&quot;
        )
        or exists ((([Procedure: &quot;Palliative Care Intervention&quot;]).isInterventionPerformed()) PalliativeIntervention
            where PalliativeIntervention.performed.toInterval() overlaps day of &quot;Measurement Period&quot;
        )"/>
            </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="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Denominator Exclusions"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Denominator Exclusions&quot;:
      Hospice.&quot;Has Hospice Services&quot;
        or exists ( &quot;Pregnancy or Renal Diagnosis&quot; )
        or exists ( &quot;End Stage Renal Disease Procedures&quot; )
        or exists ( &quot;End Stage Renal Disease Encounter&quot; )
        or AIFrailLTCF.&quot;Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty&quot;
        or AIFrailLTCF.&quot;Is Age 66 or Older Living Long Term in a Nursing Home&quot;
        or PalliativeCare.&quot;Has Palliative Care in the Measurement Period&quot;"/>
            </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="SupplementalDataElements"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Race"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Race&quot;:
      Patient.race R
        return Tuple {
          codes: R.ombCategory union R.detailed,
          display: R.text
        }"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="32"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="ControllingHighBloodPressureFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Race"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Race&quot;:
      SDE.&quot;SDE Race&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="33"/>
            </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 SDE"/>
            <resource
                      value="http://ecqi.healthit.gov/ecqms/Library/SupplementalDataElements|3.4.000"/>
          </relatedArtifact>
          <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 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 AdultOutpatientEncounters"/>
            <resource
                      value="http://ecqi.healthit.gov/ecqms/Library/AdultOutpatientEncounters|4.6.000"/>
          </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 AIFrailLTCF"/>
            <resource
                      value="http://ecqi.healthit.gov/ecqms/Library/AdvancedIllnessandFrailty|1.6.000"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Library Global"/>
            <resource
                      value="http://ecqi.healthit.gov/ecqms/Library/CQMCommon|1.4.000"/>
          </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 PalliativeCare"/>
            <resource
                      value="http://ecqi.healthit.gov/ecqms/Library/PalliativeCare|1.7.000"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Code system LOINC"/>
            <resource value="http://loinc.org"/>
          </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="Value set Essential Hypertension"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.104.12.1011"/>
          </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 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 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 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 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 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 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 Payer Type"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
          </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"/>
            <display value="Value set Hospice Care Ambulatory"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Hospice Diagnosis"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Pregnancy"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.378"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set End Stage Renal Disease"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.353"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Kidney Transplant Recipient"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1029"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Chronic Kidney Disease, Stage 5"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1002"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Kidney Transplant"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1012"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Dialysis Services"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1013"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set ESRD Monthly Outpatient Services"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1014"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Frailty Device"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.118.12.1300"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Frailty Diagnosis"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1074"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Frailty Encounter"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1088"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Frailty Symptom"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1075"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Outpatient"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1087"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Observation"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1086"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display
                     value="Value set Emergency Department Evaluation and Management Visit"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Nonacute Inpatient"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1084"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Advanced Illness"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1082"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Acute Inpatient"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1083"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Dementia Medications"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1510"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Palliative Care Diagnosis"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Palliative Care Encounter"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Palliative Care Intervention"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135"/>
          </relatedArtifact>
          <parameter>
            <name value="Measurement Period"/>
            <use value="in"/>
            <min value="0"/>
            <max value="1"/>
            <type value="Period"/>
          </parameter>
          <parameter>
            <name value="ErrorLevel"/>
            <use value="in"/>
            <min value="0"/>
            <max value="1"/>
            <type value="string"/>
          </parameter>
          <parameter>
            <name value="SDE Sex"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="Coding"/>
          </parameter>
          <parameter>
            <name value="Numerator"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="boolean"/>
          </parameter>
          <parameter>
            <name value="Denominator"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="boolean"/>
          </parameter>
          <parameter>
            <name value="SDE Payer"/>
            <use value="out"/>
            <min value="0"/>
            <max value="*"/>
            <type value="Resource"/>
          </parameter>
          <parameter>
            <name value="Initial Population"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="boolean"/>
          </parameter>
          <parameter>
            <name value="SDE Ethnicity"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="Resource"/>
          </parameter>
          <parameter>
            <name value="Denominator Exclusions"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="boolean"/>
          </parameter>
          <parameter>
            <name value="SDE Race"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="Resource"/>
          </parameter>
          <dataRequirement>
            <type value="Patient"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
          </dataRequirement>
          <dataRequirement>
            <type value="Patient"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
            <mustSupport value="url"/>
            <mustSupport value="extension"/>
            <codeFilter>
              <path value="url"/>
              <code>
                <code
                      value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity"/>
              </code>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Patient"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
            <mustSupport value="url"/>
            <mustSupport value="extension"/>
            <codeFilter>
              <path value="url"/>
              <code>
                <code
                      value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-race"/>
              </code>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
            <mustSupport value="id"/>
            <mustSupport value="id.value"/>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="hospitalization"/>
            <mustSupport value="hospitalization.dischargeDisposition"/>
            <mustSupport value="period"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <codeFilter>
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                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1014"/>
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            <dateFilter>
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            </dateFilter>
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            <profile
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            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1088"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1083"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile value="http://hl7.org/fhir/StructureDefinition/bp"/>
            <mustSupport value="encounter"/>
            <mustSupport value="encounter.class"/>
            <mustSupport value="encounter.class.code"/>
            <mustSupport value="effective"/>
            <mustSupport value="component"/>
            <dateFilter>
              <path value="effective"/>
              <valuePeriod>
                <extension
                           url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
                  <valueExpression>
                    <language value="text/cql-identifier"/>
                    <expression value="Measurement Period"/>
                  </valueExpression>
                </extension>
              </valuePeriod>
            </dateFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Condition"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
            <mustSupport value="code"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.104.12.1011"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Condition"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
            <mustSupport value="code"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Condition"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
            <mustSupport value="code"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1074"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Condition"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
            <mustSupport value="id"/>
            <mustSupport value="id.value"/>
          </dataRequirement>
          <dataRequirement>
            <type value="Condition"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
            <mustSupport value="code"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Coverage"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="value"/>
            <mustSupport value="effective"/>
            <codeFilter>
              <path value="code"/>
              <code>
                <system value="http://loinc.org"/>
                <code value="45755-6"/>
                <display value="Hospice care [Minimum Data Set]"/>
              </code>
            </codeFilter>
            <codeFilter>
              <path value="value"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="value"/>
            <mustSupport value="effective"/>
            <codeFilter>
              <path value="code"/>
              <code>
                <system value="http://loinc.org"/>
                <code value="98181-1"/>
                <display value="Medical equipment used"/>
              </code>
            </codeFilter>
            <codeFilter>
              <path value="value"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.118.12.1300"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="effective"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1075"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="effective"/>
            <mustSupport value="value"/>
            <codeFilter>
              <path value="code"/>
              <code>
                <system value="http://loinc.org"/>
                <code value="71802-3"/>
                <display value="Housing status"/>
              </code>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="effective"/>
            <mustSupport value="value"/>
            <codeFilter>
              <path value="code"/>
              <code>
                <system value="http://loinc.org"/>
                <code value="71802-3"/>
                <display value="Housing status"/>
              </code>
            </codeFilter>
            <codeFilter>
              <path value="value"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="effective"/>
            <codeFilter>
              <path value="code"/>
              <code>
                <system value="http://loinc.org"/>
                <code value="71007-9"/>
                <display
                         value="Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"/>
              </code>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="ServiceRequest"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"/>
            <mustSupport value="code"/>
            <mustSupport value="authoredOn"/>
            <mustSupport value="authoredOn.value"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Procedure"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"/>
            <mustSupport value="code"/>
            <mustSupport value="performed"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Procedure"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"/>
            <mustSupport value="code"/>
            <mustSupport value="performed"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135"/>
            </codeFilter>
          </dataRequirement>
        </Library>
      </contained>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance" id="supplementalDataGuidance">
        <extension url="guidance"/>
        <extension url="usage">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
              <code value="supplemental-data"/>
              <display value="Supplemental Data"/>
            </coding>
            <text value="Supplemental Data Guidance"/>
          </valueCodeableConcept>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem">
        <valueReference>
          <reference value="Device/cqf-tooling"/>
        </valueReference>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements" id="effective-data-requirements">
        <valueReference>
          <reference value="#effective-data-requirements"/>
        </valueReference>
      </extension>
      <url
           value="http://ecqi.healthit.gov/ecqms/Measure/ControllingHighBloodPressureFHIR"/>
      <identifier>
        <use value="usual"/>
        <type>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
            <code value="short-name"/>
          </coding>
        </type>
        <system value="https://madie.cms.gov/measure/shortName"/>
        <value value="CMS165FHIR"/>
      </identifier>
      <identifier>
        <use value="official"/>
        <type>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
            <code value="version-independent"/>
          </coding>
        </type>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:uuid:9017d914-6748-45a9-bff1-8392ed644a7b"/>
      </identifier>
      <identifier>
        <use value="official"/>
        <type>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
            <code value="version-specific"/>
          </coding>
        </type>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:uuid:e254a6be-bec3-4304-87bc-d85ad3d8fa39"/>
      </identifier>
      <identifier>
        <use value="official"/>
        <type>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
            <code value="publisher"/>
          </coding>
        </type>
        <system value="https://madie.cms.gov/measure/cmsId"/>
        <value value="165FHIR"/>
        <assigner>
          <display value="CMS"/>
        </assigner>
      </identifier>
      <version value="0.0.001"/>
      <name value="ControllingHighBloodPressureFHIR"/>
      <title value="Controlling High Blood PressureFHIR"/>
      <status value="draft"/>
      <experimental value="false"/>
      <date value="2023-09-07T19:36:39+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 18-85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period, and whose most recent blood pressure was adequately controlled (&lt;140/90 mmHg) during the measurement period"/>
      <useContext>
        <code>
          <system
                  value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
          <code value="program"/>
        </code>
        <valueCodeableConcept>
          <coding>
            <system
                    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="In reference to the numerator element, only blood pressure readings performed by a clinician or an automated blood pressure monitor or device are acceptable for numerator compliance with this measure. This includes blood pressures taken in person by a clinician and blood pressures measured remotely by electronic monitoring devices capable of transmitting the blood pressure data to the clinician. Blood pressure readings taken by an automated blood pressure monitor or device and conveyed by the patient to the clinician are also acceptable. It is the clinician’s responsibility and discretion to confirm the automated blood pressure monitor or device used to obtain the blood pressure is considered acceptable and reliable and whether the blood pressure reading is considered accurate before documenting it in the patient’s medical record.

    Do not include BP readings taken during an acute inpatient stay or an ED visit.

    If no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed &quot;not controlled&quot;.

    If there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading. Ranges and thresholds do not meet criteria for this measure. A distinct numeric result for both the systolic and diastolic BP reading is required for numerator compliance.

    This eCQM is a patient-based measure.

    This FHIR-based measure has been derived from the QDM-based measure: CMS165v12.

    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 were developed by the National Committee for Quality Assurance (NCQA). 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. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2022 National Committee for Quality Assurance. All Rights Reserved.

    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/ControllingHighBloodPressureFHIR"/>
      <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 &quot;AS IS&quot; 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="High blood pressure (HBP), also known as hypertension, is when the pressure in blood vessels is higher than normal (Centers for Disease Control and Prevention [CDC], 2021). The causes of hypertension are multiple and multifaceted and can be based on genetic predisposition, environmental risk factors, being overweight and obese, sodium intake, potassium intake, physical activity, and alcohol use. High blood pressure is common; according to the American Heart Association, between 2013-2016, approximately 121.5 million US adults &gt;= 20 years of age had HBP and the prevalence of hypertension among US adults 65 and older was 77.0 percent (Virani et al., 2021). In an analysis of adults with hypertension in NHANES, the estimated age-adjusted proportion with controlled BP increased from 31.8 percent in 1999 to 53.8 percent in 2014. However, that proportion declined to 43.7 percent in 2017 to 2018 (Tsao et al., 2022).

    HBP, known as the “silent killer,” increases risks of heart disease and stroke which are two of the leading causes of death in the US; a person who has HBP is four times more likely to die from a stroke and three times more likely to die from heart disease (CDC, 2012). The National Center for Health Statistics reported that in 2020 there were over 670,000 deaths with HBP as a primary or contributing cause (CDC, 2022). Between 2009 and 2019 the number of deaths due to HBP rose by 65.3 percent (Tsao et al., 2022). Managing and treating HBP would reduce cardiovascular disease mortality for males and females by 30.4 percent and 38.0 percent, respectively (Patel et al., 2015). Age-adjusted death rates attributable to HBP in 2019 were more than twice as high in non-Hispanic Black males (56.7 percent) when compared to rates for non-Hispanic White males (25.7 percent) (Tsao et al., 2022).

    HBP costs the U.S. approximately 131 billion dollars each year, averaged over 12 years from 2003 to 2014 (Kirkland et al., 2018). A study on cost-effectiveness on treating hypertension found that controlling HBP in patients with cardiovascular disease and systolic blood pressures (SBP) of &gt;= 160 mmHg could be effective and cost-saving (Moran, 2015).

    Many studies have shown that controlling high blood pressure reduces cardiovascular events and mortality. The Systolic Blood Pressure Intervention Trial (SPRINT) investigated the impact of obtaining a SBP goal of &lt;120 mmHg compared to a SBP goal of &lt;140 mmHg among patients 50 and older with established cardiovascular disease and found that the patients with the former goal had reduced cardiovascular events and mortality (SPRINT Research Group et al., 2015).

    Controlling HBP will significantly reduce the risks of cardiovascular disease mortality and lead to better health outcomes like reduction of heart attacks, stroke, and kidney disease (James et al., 2014). Thus, the relationship between the measure (control of hypertension) and the long-term clinical outcomes listed is well established."/>
      <clinicalRecommendationStatement
                                       value="U.S. Preventive Services Task Force (USPSTF) (2021):

    - The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement (OBPM). The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. This is a grade A recommendation.

    American College of Cardiology/American Heart Association (2017):

    - For adults with confirmed hypertension and known CVD or 10-year ASCVD event risk of 10 percent or higher, a blood pressure target of less than 130/80 mmHg is recommended (Level of evidence: B-R (for systolic blood pressures), Level of evidence: C-EO (for diastolic blood pressure))

    - For adults with confirmed hypertension, without additional markers of increased CVD risk, a blood pressure target of less than 130/80 mmHg may be reasonable (Note: clinical trial evidence is strongest for a target blood pressure of 140/90 mmHg in this population. However, observational studies suggest that these individuals often have a high lifetime risk and would benefit from blood pressure control earlier in life) (Level of evidence: B-NR (for systolic blood pressure), Level of evidence: C-EO (for diastolic blood pressure)).

    American College of Physicians and the American Academy of Family Physicians (2017):

    - Initiate or intensify pharmacologic treatment in some adults aged 60 years or older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mmHg (Grade: weak recommendation, Quality of evidence: low)

    - Initiate or intensify pharmacologic treatment in adults aged 60 years or older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mmHg to reduce the risk of recurrent stroke (Grade: weak recommendation, Quality of evidence: moderate)

    American Diabetes Association (2021):

    - For individuals with diabetes and hypertension at higher cardiovascular risk (existing atherosclerotic cardiovascular disease or 10-year atherosclerotic cardiovascular disease risk &gt;=15 percent), a blood pressure target of &lt;130/80 mmHg may be appropriate, if it can be safely attained (Level of evidence: C)

    - For individuals with diabetes and hypertension at lower risk for cardiovascular disease (10-year atherosclerotic cardiovascular disease risk &lt;15 percent), treat to a blood pressure target of &lt;140/90 mmHg (Level of evidence: A)"/>
      <group id="643716e4d4d7050edabb0444">
        <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="outcome"/>
              <display value="Outcome"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <population id="DB8494F3-F2F2-4493-A9F6-8793D5F77F41">
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="initial-population"/>
              <display value="Initial Population"/>
            </coding>
          </code>
          <description
                       value="Patients 18-85 years of age by the end of the measurement period who had a visit during the meaurement period and diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period"/>
          <criteria>
            <language value="text/cql-identifier"/>
            <expression value="Initial Population"/>
          </criteria>
        </population>
        <population id="47151B22-36FA-413F-8F3A-665071CB2E83">
          <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="cc61a60b-d556-4368-9651-a1577003ae68">
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="denominator-exclusion"/>
              <display value="Denominator Exclusion"/>
            </coding>
          </code>
          <description
                       value="Patients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period. Also exclude patients with a diagnosis of pregnancy during the measurement period.

    Exclude patients who are in hospice care for any part of the measurement period.

    Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period.

    Exclude patients 66-80 by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria:
    - Advanced illness with two outpatient encounters during the measurement period or the year prior
    - OR advanced illness with one inpatient encounter during the measurement period or the year prior
    - OR taking dementia medications during the measurement period or the year prior

    Exclude patients 81 and older by the end of the measurement period with an indication of frailty 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="5e313386-443f-4eab-a29f-2d70c0a39e5e">
          <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>
        <population id="D4F113F9-F280-45AC-ACDA-88CD87C42EB6">
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="numerator"/>
              <display value="Numerator"/>
            </coding>
          </code>
          <description
                       value="Patients whose most recent blood pressure is adequately controlled (systolic blood pressure &lt; 140 mmHg and diastolic blood pressure &lt; 90 mmHg) during the measurement period"/>
          <criteria>
            <language value="text/cql-identifier"/>
            <expression value="Numerator"/>
          </criteria>
        </population>
        <population id="9a4ce9df-cfb7-4305-9b9f-6c61c21f1027">
          <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>
      </group>
      <supplementalData id="sde-ethnicity">
        <usage>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
            <code value="supplemental-data"/>
          </coding>
        </usage>
        <description value="SDE Ethnicity"/>
        <criteria>
          <language value="text/cql-identifier"/>
          <expression value="SDE Ethnicity"/>
        </criteria>
      </supplementalData>
      <supplementalData id="sde-payer">
        <usage>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
            <code value="supplemental-data"/>
          </coding>
        </usage>
        <description value="SDE Payer"/>
        <criteria>
          <language value="text/cql-identifier"/>
          <expression value="SDE Payer"/>
        </criteria>
      </supplementalData>
      <supplementalData id="sde-race">
        <usage>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
            <code value="supplemental-data"/>
          </coding>
        </usage>
        <description value="SDE Race"/>
        <criteria>
          <language value="text/cql-identifier"/>
          <expression value="SDE Race"/>
        </criteria>
      </supplementalData>
      <supplementalData id="sde-sex">
        <usage>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
            <code value="supplemental-data"/>
          </coding>
        </usage>
        <description value="SDE Sex"/>
        <criteria>
          <language value="text/cql-identifier"/>
          <expression value="SDE Sex"/>
        </criteria>
      </supplementalData>
    </Measure>