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

## : GMCSAU2024 - XML Representation

Active as of 2023-09-06

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    <Measure xmlns="http://hl7.org/fhir">
      <id value="GMCSAU2024FHIR"/>
      <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;">GMCSAU2024</td>
                </tr>

                <tr>
                    <th scope="row"><b>Id: </b></th>
                    <td style="padding-left: 4px;">GMCSAU2024FHIR</td>
                </tr>

                    <tr>
                        <th scope="row"><b>Download cql: </b></th>
                        <td style="padding-left: 4px;"><a href="Library-GMCSAU2024FHIR.cql">GMCSAU2024FHIR.cql</a></td>
                    </tr>

                <tr>
                    <th scope="row"><b>Version: </b></th>
                    <td style="padding-left: 4px;">0.1.000</td>
                </tr>

                <tr>
                    <th scope="row"><b>Url: </b></th>
                    <td style="padding-left: 4px;"><a href="Measure-GMCSAU2024FHIR.html">GMCSAU2024</a></td>
                </tr>

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

                                    short-name identifier:

                        </b>
                    </th>

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

                            <p style="margin-bottom: 5px;">
                                <span>GMCSAU2024FHIR</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:eed68e80-b466-4369-be87-166ada45f7c5</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:d234bfa0-a3a4-4cb4-86a0-3d8ca137c4ed</span>
                            </p>

                    </td>
                </tr>

                <tr>
                    <th scope="row"><b>Effective Period: </b></th>
                    <td style="padding-left: 4px;">2021-01-01
                        ..2021-12-31</td>
                </tr>

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

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

                <tr>
                    <th scope="row"><b>Date: </b></th>
                    <td style="padding-left: 4px;">2023-09-06 20:02:04+0000</td>
                </tr>

                <tr>
                    <th scope="row"><b>Approval Date: </b></th>
                    <td style="padding-left: 4px;">2023-09-06</td>
                </tr>

                <tr>
                    <th scope="row"><b>Last Review Date: </b></th>
                    <td style="padding-left: 4px;">2023-09-06</td>
                </tr>

                <tr>
                    <th scope="row"><b>Name: </b></th>
                    <td style="padding-left: 4px;">GMCSAU2024FHIR</td>
                </tr>

                <tr>
                    <th scope="row"><b>Publisher: </b></th>
                    <td style="padding-left: 4px;">Academy of Nutrition and Dietetics</td>
                </tr>

            <tr>
                <th scope="row"><b>Author: </b></th>
                <td style="padding-left: 4px;">Academy of Nutrition and Dietetics: <a href="www.eatrightpro.org">www.eatrightpro.org</a></td>
            </tr>

                <tr>
                    <th scope="row"><b>Description: </b></th>
                    <td style="padding-left: 4px;"><div><p>This measure assesses the percentage of hospitalizations of adults aged 65 years and older at the start of the inpatient encounter during the  measurement period, with a length of stay equal to or greater than 24 hours, who received optimal malnutrition care where care performed was appropriate to the patient's level of malnutrition risk and severity. Malnutrition care best practices recommend that for each hospitalization, adult inpatients are (1) screened for malnutrition risk or for a hospital dietitian referral order to be placed, (2) assessed by a registered dietitian (RD) or registered dietitian nutritionist (RDN) to confirm findings of malnutrition risk, and if identified with a &quot;moderate&quot; or &quot;severe&quot; malnutrition status in the current performed malnutrition assessment , (3) receive a current &quot;moderate&quot; or &quot;severe&quot; malnutrition diagnosis by a physician or eligible provider as defined by CMS, and (4) have a current nutrition care plan performed by an RD/RDN.</p>
    </div></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>(C) Academy of Nutrition and Dietetics 2023</p>
    <p>Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets.</p>
    <p>LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc.</p>
    <p>ICD-10 copyright 2022 World Health Organization.</p>
    <p>This material contains SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2022. International Health Terminology Standards Development Organization. All Rights Reserved.</p>
    </div></td>
                </tr>

                <tr>
                    <th scope="row"><b>Disclaimer: </b></th>
                    <td style="padding-left: 4px;"><div><p>This measure and the specifications are subject to further revisions.</p>
    <p>This performance measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.</p>
    <p>THE MEASURE AND SPECIFICATIONS ARE PROVIDED &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND.</p>
    <p>Due to technical limitations, copyright is indicated by (C) or [C], 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>The components of this measure are supported by clinical guidance that recommends the following  : (1) malnutrition screening for patients admitted into the acute inpatient care setting; (2)  nutrition assessment for patients identified at risk for malnutrition or with a hospital dietitian referral order to form the basis for appropriate nutrition interventions; (3) appropriate recognition, diagnosis, and documentation of the nutrition status of a patient in order to (4) address their condition with an appropriate plan of care and communicate patient needs to other care providers.</p>
    <p>The process for risk identification, assessment, diagnosis, and treatment of malnutrition necessitates a multi-disciplinary care team that begins with the identification of an initial risk population for a more thorough assessment by the RD/RDN. The RD/RDN, in turn, provides the necessary treatment recommendations to address nutritional status utilizing a nutrition diagnosis and care plan, along with the clinical indicators that inform a medical diagnosis of malnutrition completed by a physician or eligible provider as defined by CMS. The four measure observations individually will only provide a fraction of the necessary information on quality of care for patients at risk for or with malnutrition. For example, knowing which patients have been assessed out of those who were initially identified as at risk, but not knowing if the appropriate proportion of patients were screened upon admission, would be an insufficient assessment of quality of care.</p>
    <p>Implementation of this measure supports timely malnutrition risk screening and hand off to RDNs for appropriate nutrition assessment for identified patients during the current hospitalization. For patients identified with a moderate or severe malnutrition by the nutrition assessment, best practice also recommends a medical diagnosis by a physician or other eligible clinician and the execution of the nutrition care plan by an RD/RDN. Evidence demonstrates that implementing a standardized protocol for screening, assessment, diagnosis, and care planning results in better identification of malnourished patients and subsequent improvements in rates of associated nutrition interventions. Outcomes modeling, and those reported in other studies, also demonstrate the benefits to patient outcomes, including reduced risk of 30-day readmissions, length of hospital stays, and complications, as well as improved quality of life after hospitalization.</p>
    </div></td>
            </tr>

            <tr>
                <th scope="row"><b>Clinical recommendation statement: </b></th>
                <td style="padding-left: 4px;"><div><p>American  Society for Parenteral and Enteral Nutrition (ASPEN) clinical guidelines on nutrition screening, assessment, and intervention in adults, Screening for nutrition risk is suggested for hospitalized patients. (ASPEN, 2011).</p>
    <p>This guideline places nutrition assessment and screening in the context of intervention as part of nutrition care. Screening those individuals at risk for malnutrition is the first step in nutrition care as risk for malnutrition, identified by nutrition screening, is associated with longer length of hospital stay, complications, and mortality. Malnutrition screening is also a predictor of mortality risk.
    Malnourished patients, identified by nutrition assessment tools, have more complications and longer hospitalizations than do patients with optimal nutrition status. Such patients, identified by nutrition assessment tools, have more infectious and noninfectious complications, longer hospital length of stay, and greater mortality.
    Nutrition intervention is recommended for patients identified by assessment as at risk for malnutrition or malnourished. Nutrition intervention with associated monitoring and evaluation plants in patients identified as at risk for malnutrition or malnourished improves clinical outcomes. Nutrition interventions and their associated monitoring and evaluation plans in malnourished patients are associated with improved nutrition status, nutrient intake, physical function, and quality of life. Hospital readmissions, inpatient length of stay, and complications were reduced with increased nutrition support interventions.</p>
    </div></td>
            </tr>

                <tr>
                    <th scope="row"><b>Guidance (Usage): </b></th>
                    <td style="padding-left: 4px;">This measure is constructed of four clinically eligible components that are aggregated as an arithmetic average of eligible hospitalizations and expressed as a percentage. The four populations used to calculate the four components may differ and the measure observations for the four components do not need to be performed sequentially. The initial population are hospitalizations during the measurement period for patients aged 65 years and greater with a length of stay of 24 hours and greater.

    Component Measure  1: Inpatient hospitalizations for patients with a current &quot;Malnutrition Risk Screening&quot; performed by an eligible healthcare clinician (professional).

    Component Measure 2: Inpatient hospitalizations for patients with a current &quot;Nutrition Assessment&quot; performed by an RD/RDN, after a &quot;Malnutrition Screening At Risk Result&quot; during the current hospitalization or a &quot;Hospital Dietitian Referral&quot; order from a physician or eligible clinician during the current hospitalization.

    For Component Measure 1 and Component Measure 2, only report LOINC code '84291-4 Nutrition and dietetics Risk assessment and screening note' when the RD/RDN performs both the &quot;Malnutrition Risk Screening&quot; and &quot;Nutrition Assessment&quot;.

    Component Measure 3: Inpatient hospitalizations for patients with a current documented &quot;Malnutrition Diagnosis&quot; as a result of a current &quot;Nutrition Assessment Status Moderately Malnourished&quot; OR current &quot;Nutrition Assessment Status Severely Malnourished&quot;.

    Component Measure 4: Inpatient hospitalizations for patients with a current &quot;Nutrition Care Plan&quot; performed as a result of a current &quot;Nutrition Assessment Status Moderately Malnourished&quot; OR current “Nutrition Assessment Status Severely Malnourished”.

    &quot;Population 5  Measure Observation TotalMalnutritionComponentsScore&quot; Calculations
    -For each hospitalization, Population Criteria 5 represents the subtotal of Measure Observations performed for Population Criteria 1, 2, 3, and 4.
    -For the reporting facility, the Population Criteria 5 Aggregate Operator 'Count' counts the number of eligible hospitalizations during the measurement period.

    &quot;Population 6 Measure Observation TotalMalnutritionCompositeScore as Percentage&quot; Calculations:
    -For each hospitalization, Population Criteria 6 represents the sum of performed Measure Observations 1, 2, 3, and 4 divided by the number of clinically eligible denominators.
    -For the reporting facility, the Population Criteria 6 Aggregate Operator 'Average' averages the performance of each &quot;TotalMalnutritionCompositeScore as Percentage&quot; across all eligible hospitalizations during the measurement period.

    &quot;TotalMalnutritionCompositeScore Eligible Denominators&quot; is always 4 except in the following instances:
    -The &quot;TotalMalnutritionCompositeScore Eligible Denominators&quot; is 1 if
    ---A &quot;Malnutrition Risk Screening&quot; was performed and a &quot;Malnutrition Screening Not At Risk Result&quot; was identified AND &quot;Hospital Dietitian Referral&quot; was not ordered
    ---No “Malnutrition Risk Screening” was performed AND “Hospital Dietitian Referral” was not ordered
    - The &quot;TotalMalnutritionCompositeScore Eligible Denominators&quot; are 2
    ---If a &quot;Nutrition Assessment&quot; was performed and a &quot;Nutrition Status Not or Mildly Malnourished&quot; was identified
    --- A &quot;Malnutrition Risk Screening&quot; was performed and a &quot;Malnutrition Screening Not At Risk Result&quot; was identified AND &quot;Hospital Dietitian Referral&quot; was not ordered
    --A &quot;Malnutrition Risk Screening&quot; was performed and a &quot;Malnutrition Screening At Risk Result&quot; was identified was ordered but the “Nutrition Assessment” was not performed
    This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter with a length of stay of greater than or equal to 24 hours among individuals 65 years of age and older at the start of the inpatient encounter

    This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.</td>
                </tr>

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

                                <table class="grid-dict">

                                        <tr>
                                            <th><b>64e8b0d12ad653247b573b14</b></th>
                                        </tr>

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

                                                <td>Initial</td>

                                        </tr>

                                        <tr>
                                            <td>Measure Population:</td>

                                                <td>Measure</td>

                                        </tr>

                                        <tr>
                                            <td>Measure Population Exclusion:</td>

                                                <td>None</td>

                                        </tr>

                                        <tr>
                                            <td>Measure Observation:</td>

                                                <td>Screening</td>

                                        </tr>

                                </table>

                                <table class="grid-dict">

                                        <tr>
                                            <th><b>64ee08b80320a85d687669e5</b></th>
                                        </tr>

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

                                                <td>Initial</td>

                                        </tr>

                                        <tr>
                                            <td>Measure Population:</td>

                                                <td>Measure</td>

                                        </tr>

                                        <tr>
                                            <td>Measure Population Exclusion:</td>

                                                <td>None</td>

                                        </tr>

                                        <tr>
                                            <td>Measure Observation:</td>

                                                <td>Assessment</td>

                                        </tr>

                                </table>

                                <table class="grid-dict">

                                        <tr>
                                            <th><b>64ef459356d636294b157b01</b></th>
                                        </tr>

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

                                                <td>Initial</td>

                                        </tr>

                                        <tr>
                                            <td>Measure Population:</td>

                                                <td>Measure</td>

                                        </tr>

                                        <tr>
                                            <td>Measure Population Exclusion:</td>

                                                <td>None</td>

                                        </tr>

                                        <tr>
                                            <td>Measure Observation:</td>

                                                <td>Diagnosis</td>

                                        </tr>

                                </table>

                                <table class="grid-dict">

                                        <tr>
                                            <th><b>64ef45ad56d636294b157b02</b></th>
                                        </tr>

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

                                                <td>Initial</td>

                                        </tr>

                                        <tr>
                                            <td>Measure Population:</td>

                                                <td>Measure</td>

                                        </tr>

                                        <tr>
                                            <td>Measure Population Exclusion:</td>

                                                <td>None</td>

                                        </tr>

                                        <tr>
                                            <td>Measure Observation:</td>

                                                <td>Care Plan</td>

                                        </tr>

                                </table>

                                <table class="grid-dict">

                                        <tr>
                                            <th><b>64ef45c156d636294b157b03</b></th>
                                        </tr>

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

                                                <td>Initial</td>

                                        </tr>

                                        <tr>
                                            <td>Measure Population:</td>

                                                <td>Measure</td>

                                        </tr>

                                        <tr>
                                            <td>Measure Population Exclusion:</td>

                                                <td>None</td>

                                        </tr>

                                        <tr>
                                            <td>Measure Observation:</td>

                                                <td>Total Score</td>

                                        </tr>

                                </table>

                                <table class="grid-dict">

                                        <tr>
                                            <th><b>64ef45d356d636294b157b04</b></th>
                                        </tr>

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

                                                <td>Initial</td>

                                        </tr>

                                        <tr>
                                            <td>Measure Population:</td>

                                                <td>Measure</td>

                                        </tr>

                                        <tr>
                                            <td>Measure Population Exclusion:</td>

                                                <td>None</td>

                                        </tr>

                                        <tr>
                                            <td>Measure Observation:</td>

                                                <td>GMCS Percentage</td>

                                        </tr>

                                      <tr><b>Stratifier Criteria: </b></tr>

                                            <tr>
                                                <td>:</td>

                                                    <td>None</td>

                                            </tr>

                                            <tr>
                                                <td>:</td>

                                                    <td>None</td>

                                            </tr>

                                </table>

                        </td>
                    </tr>

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

                                <tr>
                                    <td><a href="Library-GMCSAU2024FHIR.html">GMCSAU2024FHIR</a></td>
                                </tr>

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

                    <tr>
                        <th scope="row"><b>Related Artifact Dependencies: </b></th>
                        <td style="padding-left: 4px;">

                                <li><code>Library/FHIRHelpers|4.3.000</code></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</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>Initial Population</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>*</td>
                                        <td>Resource</td>
                                    </tr>

                                    <tr>
                                        <td>Measure Population</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>*</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>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                        <td>

                                                type

                                                period

                                                status

                                                status.value

                                        </td>
                                        <td>

                                                     Encounter Inpatient

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a></td>
                                    </tr>

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

                                                type

                                                period

                                                status

                                                status.value

                                        </td>
                                        <td>

                                                     Encounter Inpatient

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a></td>
                                    </tr>

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

                                                type

                                                period

                                                status

                                                status.value

                                        </td>
                                        <td>

                                                     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>

                            </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> 64e8b0d12ad653247b573b14 </td>
                                    <td>

                                            <b>Group scoring:</b>

                                                <span>  continuous-variable </span>

                                    </td>

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

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

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Measure Population</td>
                                        <td>

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

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Measure Population Exclusion</td>
                                        <td>

                                                None

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Measure Observation</td>
                                        <td>

                                                <pre><code class="language-cql"/></pre>

                                        </td>
                                    </tr>

                                    <td> 64ee08b80320a85d687669e5 </td>
                                    <td>

                                            <b>Group scoring:</b>

                                                <span>  continuous-variable </span>

                                    </td>

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

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

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Measure Population</td>
                                        <td>

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

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Measure Population Exclusion</td>
                                        <td>

                                                None

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Measure Observation</td>
                                        <td>

                                                <pre><code class="language-cql"/></pre>

                                        </td>
                                    </tr>

                                    <td> 64ef459356d636294b157b01 </td>
                                    <td>

                                            <b>Group scoring:</b>

                                                <span>  continuous-variable </span>

                                    </td>

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

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

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Measure Population</td>
                                        <td>

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

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Measure Population Exclusion</td>
                                        <td>

                                                None

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Measure Observation</td>
                                        <td>

                                                <pre><code class="language-cql"/></pre>

                                        </td>
                                    </tr>

                                    <td> 64ef45ad56d636294b157b02 </td>
                                    <td>

                                            <b>Group scoring:</b>

                                                <span>  continuous-variable </span>

                                    </td>

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

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

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Measure Population</td>
                                        <td>

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

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Measure Population Exclusion</td>
                                        <td>

                                                None

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Measure Observation</td>
                                        <td>

                                                <pre><code class="language-cql"/></pre>

                                        </td>
                                    </tr>

                                    <td> 64ef45c156d636294b157b03 </td>
                                    <td>

                                            <b>Group scoring:</b>

                                                <span>  continuous-variable </span>

                                    </td>

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

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

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Measure Population</td>
                                        <td>

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

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Measure Population Exclusion</td>
                                        <td>

                                                None

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Measure Observation</td>
                                        <td>

                                                <pre><code class="language-cql"/></pre>

                                        </td>
                                    </tr>

                                    <td> 64ef45d356d636294b157b04 </td>
                                    <td>

                                            <b>Group scoring:</b>

                                                <span>  continuous-variable </span>

                                    </td>

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

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

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Measure Population</td>
                                        <td>

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

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Measure Population Exclusion</td>
                                        <td>

                                                None

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Measure Observation</td>
                                        <td>

                                                <pre><code class="language-cql"/></pre>

                                        </td>
                                    </tr>

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

                                                None

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <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>GMCSAU2024FHIR</td>

                                    <td>Qualifying Encounter</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &amp;quot;Qualifying Encounter&amp;quot;:
      [Encounter: &amp;quot;Encounter Inpatient&amp;quot;] EncounterInpatient
        where EncounterInpatient.period ends during day of &amp;quot;Measurement Period&amp;quot;
          and AgeInYearsAt(date from start of EncounterInpatient.period) &amp;gt;= 65
          and ( duration in hours of EncounterInpatient.period &amp;gt;= 24 )
          and EncounterInpatient.status = &amp;#39;finished&amp;#39;</code></pre>
                                    </td>

                            </tr>

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

                                    <td>GMCSAU2024FHIR</td>

                                    <td>Initial Population</td>

                            </tr>
                            <tr>

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

                            </tr>

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

                                    <td>GMCSAU2024FHIR</td>

                                    <td>Measure Population</td>

                            </tr>
                            <tr>

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

                            </tr>

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

        </table>
    </div>
      </text>
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            </extension>
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            <extension url="statement">
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          and AgeInYearsAt(date from start of EncounterInpatient.period) &amp;gt;= 65
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            </extension>
            <extension url="displaySequence">
              <valueString value="2"/>
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          </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 FHIRHelpers"/>
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          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
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            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
          </relatedArtifact>
          <parameter>
            <name value="Measurement Period"/>
            <use value="in"/>
            <min value="0"/>
            <max value="1"/>
            <type value="Period"/>
          </parameter>
          <parameter>
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            <use value="out"/>
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            <max value="*"/>
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          </parameter>
          <parameter>
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            <use value="out"/>
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            <max value="*"/>
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          </parameter>
          <dataRequirement>
            <type value="Patient"/>
            <profile
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          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile
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            <mustSupport value="period"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
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                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
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            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
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            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
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            <mustSupport value="period"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <codeFilter>
              <path value="type"/>
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            </codeFilter>
          </dataRequirement>
        </Library>
      </contained>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements">
        <valueReference>
          <reference value="#effective-data-requirements"/>
        </valueReference>
      </extension>
      <url value="http://ecqi.healthit.gov/ecqms/Measure/GMCSAU2024FHIR"/>
      <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="GMCSAU2024FHIR"/>
      </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:eed68e80-b466-4369-be87-166ada45f7c5"/>
      </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:d234bfa0-a3a4-4cb4-86a0-3d8ca137c4ed"/>
      </identifier>
      <version value="0.1.000"/>
      <name value="GMCSAU2024FHIR"/>
      <title value="GMCSAU2024"/>
      <status value="active"/>
      <experimental value="true"/>
      <date value="2023-09-06T20:02:04+00:00"/>
      <publisher value="Academy of Nutrition and Dietetics"/>
      <contact>
        <telecom>
          <system value="url"/>
          <value value="www.eatrightpro.org"/>
        </telecom>
      </contact>
      <description
                   value="This measure assesses the percentage of hospitalizations of adults aged 65 years and older at the start of the inpatient encounter during the  measurement period, with a length of stay equal to or greater than 24 hours, who received optimal malnutrition care where care performed was appropriate to the patient's level of malnutrition risk and severity. Malnutrition care best practices recommend that for each hospitalization, adult inpatients are (1) screened for malnutrition risk or for a hospital dietitian referral order to be placed, (2) assessed by a registered dietitian (RD) or registered dietitian nutritionist (RDN) to confirm findings of malnutrition risk, and if identified with a &quot;moderate&quot; or &quot;severe&quot; malnutrition status in the current performed malnutrition assessment , (3) receive a current &quot;moderate&quot; or &quot;severe&quot; malnutrition diagnosis by a physician or eligible provider as defined by CMS, and (4) have a current nutrition care plan performed by an RD/RDN."/>
      <purpose value="UNKNOWN"/>
      <usage
             value="This measure is constructed of four clinically eligible components that are aggregated as an arithmetic average of eligible hospitalizations and expressed as a percentage. The four populations used to calculate the four components may differ and the measure observations for the four components do not need to be performed sequentially. The initial population are hospitalizations during the measurement period for patients aged 65 years and greater with a length of stay of 24 hours and greater.

    Component Measure  1: Inpatient hospitalizations for patients with a current &quot;Malnutrition Risk Screening&quot; performed by an eligible healthcare clinician (professional).

    Component Measure 2: Inpatient hospitalizations for patients with a current &quot;Nutrition Assessment&quot; performed by an RD/RDN, after a &quot;Malnutrition Screening At Risk Result&quot; during the current hospitalization or a &quot;Hospital Dietitian Referral&quot; order from a physician or eligible clinician during the current hospitalization.

    For Component Measure 1 and Component Measure 2, only report LOINC code '84291-4 Nutrition and dietetics Risk assessment and screening note' when the RD/RDN performs both the &quot;Malnutrition Risk Screening&quot; and &quot;Nutrition Assessment&quot;.

    Component Measure 3: Inpatient hospitalizations for patients with a current documented &quot;Malnutrition Diagnosis&quot; as a result of a current &quot;Nutrition Assessment Status Moderately Malnourished&quot; OR current &quot;Nutrition Assessment Status Severely Malnourished&quot;.

    Component Measure 4: Inpatient hospitalizations for patients with a current &quot;Nutrition Care Plan&quot; performed as a result of a current &quot;Nutrition Assessment Status Moderately Malnourished&quot; OR current “Nutrition Assessment Status Severely Malnourished”.

    &quot;Population 5  Measure Observation TotalMalnutritionComponentsScore&quot; Calculations
    -For each hospitalization, Population Criteria 5 represents the subtotal of Measure Observations performed for Population Criteria 1, 2, 3, and 4.
    -For the reporting facility, the Population Criteria 5 Aggregate Operator 'Count' counts the number of eligible hospitalizations during the measurement period.

    &quot;Population 6 Measure Observation TotalMalnutritionCompositeScore as Percentage&quot; Calculations:
    -For each hospitalization, Population Criteria 6 represents the sum of performed Measure Observations 1, 2, 3, and 4 divided by the number of clinically eligible denominators.
    -For the reporting facility, the Population Criteria 6 Aggregate Operator 'Average' averages the performance of each &quot;TotalMalnutritionCompositeScore as Percentage&quot; across all eligible hospitalizations during the measurement period.

    &quot;TotalMalnutritionCompositeScore Eligible Denominators&quot; is always 4 except in the following instances:
    -The &quot;TotalMalnutritionCompositeScore Eligible Denominators&quot; is 1 if
    ---A &quot;Malnutrition Risk Screening&quot; was performed and a &quot;Malnutrition Screening Not At Risk Result&quot; was identified AND &quot;Hospital Dietitian Referral&quot; was not ordered
    ---No “Malnutrition Risk Screening” was performed AND “Hospital Dietitian Referral” was not ordered
    - The &quot;TotalMalnutritionCompositeScore Eligible Denominators&quot; are 2
    ---If a &quot;Nutrition Assessment&quot; was performed and a &quot;Nutrition Status Not or Mildly Malnourished&quot; was identified
    --- A &quot;Malnutrition Risk Screening&quot; was performed and a &quot;Malnutrition Screening Not At Risk Result&quot; was identified AND &quot;Hospital Dietitian Referral&quot; was not ordered
    --A &quot;Malnutrition Risk Screening&quot; was performed and a &quot;Malnutrition Screening At Risk Result&quot; was identified was ordered but the “Nutrition Assessment” was not performed
    This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter with a length of stay of greater than or equal to 24 hours among individuals 65 years of age and older at the start of the inpatient encounter

    This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM."/>
      <copyright
                 value="(C) Academy of Nutrition and Dietetics 2023

    Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets.

    LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc.

    ICD-10 copyright 2022 World Health Organization.

    This material contains SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2022. International Health Terminology Standards Development Organization. All Rights Reserved."/>
      <approvalDate value="2023-09-06"/>
      <lastReviewDate value="2023-09-06"/>
      <effectivePeriod>
        <start value="2021-01-01"/>
        <end value="2021-12-31"/>
      </effectivePeriod>
      <author>
        <name value="Academy of Nutrition and Dietetics"/>
        <telecom>
          <system value="url"/>
          <value value="www.eatrightpro.org"/>
        </telecom>
      </author>
      <library value="http://ecqi.healthit.gov/ecqms/Library/GMCSAU2024FHIR"/>
      <disclaimer
                  value="This measure and the specifications are subject to further revisions.

    This performance measure is not a clinical guideline, 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, copyright is indicated by (C) or [C], registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]."/>
      <rationale
                 value="The components of this measure are supported by clinical guidance that recommends the following  : (1) malnutrition screening for patients admitted into the acute inpatient care setting; (2)  nutrition assessment for patients identified at risk for malnutrition or with a hospital dietitian referral order to form the basis for appropriate nutrition interventions; (3) appropriate recognition, diagnosis, and documentation of the nutrition status of a patient in order to (4) address their condition with an appropriate plan of care and communicate patient needs to other care providers.

    The process for risk identification, assessment, diagnosis, and treatment of malnutrition necessitates a multi-disciplinary care team that begins with the identification of an initial risk population for a more thorough assessment by the RD/RDN. The RD/RDN, in turn, provides the necessary treatment recommendations to address nutritional status utilizing a nutrition diagnosis and care plan, along with the clinical indicators that inform a medical diagnosis of malnutrition completed by a physician or eligible provider as defined by CMS. The four measure observations individually will only provide a fraction of the necessary information on quality of care for patients at risk for or with malnutrition. For example, knowing which patients have been assessed out of those who were initially identified as at risk, but not knowing if the appropriate proportion of patients were screened upon admission, would be an insufficient assessment of quality of care.

    Implementation of this measure supports timely malnutrition risk screening and hand off to RDNs for appropriate nutrition assessment for identified patients during the current hospitalization. For patients identified with a moderate or severe malnutrition by the nutrition assessment, best practice also recommends a medical diagnosis by a physician or other eligible clinician and the execution of the nutrition care plan by an RD/RDN. Evidence demonstrates that implementing a standardized protocol for screening, assessment, diagnosis, and care planning results in better identification of malnourished patients and subsequent improvements in rates of associated nutrition interventions. Outcomes modeling, and those reported in other studies, also demonstrate the benefits to patient outcomes, including reduced risk of 30-day readmissions, length of hospital stays, and complications, as well as improved quality of life after hospitalization."/>
      <clinicalRecommendationStatement
                                       value="American  Society for Parenteral and Enteral Nutrition (ASPEN) clinical guidelines on nutrition screening, assessment, and intervention in adults, Screening for nutrition risk is suggested for hospitalized patients. (ASPEN, 2011).

    This guideline places nutrition assessment and screening in the context of intervention as part of nutrition care. Screening those individuals at risk for malnutrition is the first step in nutrition care as risk for malnutrition, identified by nutrition screening, is associated with longer length of hospital stay, complications, and mortality. Malnutrition screening is also a predictor of mortality risk.
    Malnourished patients, identified by nutrition assessment tools, have more complications and longer hospitalizations than do patients with optimal nutrition status. Such patients, identified by nutrition assessment tools, have more infectious and noninfectious complications, longer hospital length of stay, and greater mortality.
    Nutrition intervention is recommended for patients identified by assessment as at risk for malnutrition or malnourished. Nutrition intervention with associated monitoring and evaluation plants in patients identified as at risk for malnutrition or malnourished improves clinical outcomes. Nutrition interventions and their associated monitoring and evaluation plans in malnourished patients are associated with improved nutrition status, nutrient intake, physical function, and quality of life. Hospital readmissions, inpatient length of stay, and complications were reduced with increased nutrition support interventions."/>
      <group id="64e8b0d12ad653247b573b14">
        <extension
                   url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
              <code value="continuous-variable"/>
              <display value="Continuous Variable"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
          <valueCode value="Encounter"/>
        </extension>
        <extension
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          <valueCodeableConcept>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
              <code value="process"/>
              <display value="Process"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <description value="Population Criteria 1 "/>
        <population id="a05fc6fb-1644-441f-b616-de21576a1813">
          <code>
            <coding>
              <system
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              <code value="initial-population"/>
              <display value="Initial Population"/>
            </coding>
          </code>
          <description value="Initial"/>
          <criteria>
            <language value="text/cql-identifier"/>
            <expression value="Initial Population"/>
          </criteria>
        </population>
        <population id="bc3d85e4-8f7d-4cc7-b260-9e8dc2d0848f">
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="measure-population"/>
              <display value="Measure Population"/>
            </coding>
          </code>
          <description value="Measure"/>
          <criteria>
            <language value="text/cql-identifier"/>
            <expression value="Measure Population"/>
          </criteria>
        </population>
        <population id="ca60181c-e0e1-4427-91a3-f00a2e0090b9">
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="measure-population-exclusion"/>
              <display value="Measure Population Exclusion"/>
            </coding>
          </code>
          <criteria>
            <language value="text/cql-identifier"/>
          </criteria>
        </population>
        <population id="087da320-e1ff-48ff-9b16-3990ff169148">
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod">
            <valueString value="Count"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference">
            <valueString value="bc3d85e4-8f7d-4cc7-b260-9e8dc2d0848f"/>
          </extension>
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="measure-observation"/>
              <display value="Measure Observation"/>
            </coding>
          </code>
          <description value="Screening"/>
          <criteria>
            <language value="text/cql-identifier"/>
            <expression value="Measure Observation 1"/>
          </criteria>
        </population>
      </group>
      <group id="64ee08b80320a85d687669e5">
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                   url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
          <valueCodeableConcept>
            <coding>
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