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

## Measure: GMCSAU2024 (Experimental)

Official URL: http://ecqi.healthit.gov/ecqms/Measure/GMCSAU2024FHIR | Version: 0.1.000
Active as of 2023-09-06 | ​ Responsible: Academy of Nutrition and Dietetics | Computable Name: GMCSAU2024FHIR
Other Identifiers: Short Name (use: usual, ), UUID:eed68e80-b466-4369-be87-166ada45f7c5 (use: official, ), UUID:d234bfa0-a3a4-4cb4-86a0-3d8ca137c4ed (use: official, )
Copyright/Legal: (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.

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 “moderate” or “severe” malnutrition status in the current performed malnutrition assessment , (3) receive a current “moderate” or “severe” 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.

UNKNOWN

Title: | GMCSAU2024
Id: | GMCSAU2024FHIR
Download cql: | GMCSAU2024FHIR.cql
Version: | 0.1.000
Url: | GMCSAU2024
short-name identifier: | GMCSAU2024FHIR
version-independent identifier: | urn:uuid:eed68e80-b466-4369-be87-166ada45f7c5
version-specific identifier: | urn:uuid:d234bfa0-a3a4-4cb4-86a0-3d8ca137c4ed
Effective Period: | 2021-01-01 ..2021-12-31
Status: | active
Experimental: | true
Date: | 2023-09-06 20:02:04+0000
Approval Date: | 2023-09-06
Last Review Date: | 2023-09-06
Name: | GMCSAU2024FHIR
Publisher: | Academy of Nutrition and Dietetics
Author: | ​Academy of Nutrition and Dietetics: www.eatrightpro.org
Description: | 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 "moderate" or "severe" malnutrition status in the current performed malnutrition assessment , (3) receive a current "moderate" or "severe" 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: | UNKNOWN
Copyright: | (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.
Disclaimer: | 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 "AS IS" 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: | 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.
Clinical recommendation statement: | 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.
Guidance (Usage): | 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 "Malnutrition Risk Screening" performed by an eligible healthcare clinician (professional). Component Measure 2: Inpatient hospitalizations for patients with a current "Nutrition Assessment" performed by an RD/RDN, after a "Malnutrition Screening At Risk Result" during the current hospitalization or a "Hospital Dietitian Referral" 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 "Malnutrition Risk Screening" and "Nutrition Assessment". Component Measure 3: Inpatient hospitalizations for patients with a current documented "Malnutrition Diagnosis" as a result of a current "Nutrition Assessment Status Moderately Malnourished" OR current "Nutrition Assessment Status Severely Malnourished". Component Measure 4: Inpatient hospitalizations for patients with a current "Nutrition Care Plan" performed as a result of a current "Nutrition Assessment Status Moderately Malnourished" OR current “Nutrition Assessment Status Severely Malnourished”. "Population 5 Measure Observation TotalMalnutritionComponentsScore" 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. "Population 6 Measure Observation TotalMalnutritionCompositeScore as Percentage" 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 "TotalMalnutritionCompositeScore as Percentage" across all eligible hospitalizations during the measurement period. "TotalMalnutritionCompositeScore Eligible Denominators" is always 4 except in the following instances: -The "TotalMalnutritionCompositeScore Eligible Denominators" is 1 if ---A "Malnutrition Risk Screening" was performed and a "Malnutrition Screening Not At Risk Result" was identified AND "Hospital Dietitian Referral" was not ordered ---No “Malnutrition Risk Screening” was performed AND “Hospital Dietitian Referral” was not ordered - The "TotalMalnutritionCompositeScore Eligible Denominators" are 2 ---If a "Nutrition Assessment" was performed and a "Nutrition Status Not or Mildly Malnourished" was identified --- A "Malnutrition Risk Screening" was performed and a "Malnutrition Screening Not At Risk Result" was identified AND "Hospital Dietitian Referral" was not ordered --A "Malnutrition Risk Screening" was performed and a "Malnutrition Screening At Risk Result" 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.
Population Criteria: |
64e8b0d12ad653247b573b14
Initial Population: | Initial
Measure Population: | Measure
Measure Population Exclusion: | None
Measure Observation: | Screening
64ee08b80320a85d687669e5
Initial Population: | Initial
Measure Population: | Measure
Measure Population Exclusion: | None
Measure Observation: | Assessment
64ef459356d636294b157b01
Initial Population: | Initial
Measure Population: | Measure
Measure Population Exclusion: | None
Measure Observation: | Diagnosis
64ef45ad56d636294b157b02
Initial Population: | Initial
Measure Population: | Measure
Measure Population Exclusion: | None
Measure Observation: | Care Plan
64ef45c156d636294b157b03
Initial Population: | Initial
Measure Population: | Measure
Measure Population Exclusion: | None
Measure Observation: | Total Score
64ef45d356d636294b157b04
Initial Population: | Initial
Measure Population: | Measure
Measure Population Exclusion: | None
Measure Observation: | GMCS Percentage
Stratifier Criteria:
: | None
: | None
Libraries: |
GMCSAU2024FHIR
Related Artifact Dependencies: | `Library/FHIRHelpers|4.3.000` Encounter Inpatient
Parameters: |
name | use | min | max | type
--- | --- | --- | --- | ---
Measurement Period | In | 0 | 1 | Period
Initial Population | Out | 0 | * | Resource
Measure Population | Out | 0 | * | Resource
DataRequirements: |
Type | Elements | Valueset Name | Valueset
--- | --- | --- | ---
Patient(QICorePatient) |  |  |
Encounter(QICoreEncounter) | type period status status.value | Encounter Inpatient | Encounter Inpatient
Encounter(QICoreEncounter) | type period status status.value | Encounter Inpatient | Encounter Inpatient
Encounter(QICoreEncounter) | type period status status.value | Encounter Inpatient | Encounter Inpatient
Logic Definitions: |
Group | Scoring | Population Criteria | Expression
--- | --- | --- | ---
64e8b0d12ad653247b573b14 | Group scoring: continuous-variable
|  | Initial Population |
    define &quot;Initial Population&quot;:
      &quot;Qualifying Encounter&quot;
|  | Measure Population |
    define &quot;Measure Population&quot;:
      &quot;Initial Population&quot;
|  | Measure Population Exclusion | None
|  | Measure Observation |
| 64ee08b80320a85d687669e5 | Group scoring: continuous-variable
|  | Initial Population |
    define &quot;Initial Population&quot;:
      &quot;Qualifying Encounter&quot;
|  | Measure Population |
    define &quot;Measure Population&quot;:
      &quot;Initial Population&quot;
|  | Measure Population Exclusion | None
|  | Measure Observation |
| 64ef459356d636294b157b01 | Group scoring: continuous-variable
|  | Initial Population |
    define &quot;Initial Population&quot;:
      &quot;Qualifying Encounter&quot;
|  | Measure Population |
    define &quot;Measure Population&quot;:
      &quot;Initial Population&quot;
|  | Measure Population Exclusion | None
|  | Measure Observation |
| 64ef45ad56d636294b157b02 | Group scoring: continuous-variable
|  | Initial Population |
    define &quot;Initial Population&quot;:
      &quot;Qualifying Encounter&quot;
|  | Measure Population |
    define &quot;Measure Population&quot;:
      &quot;Initial Population&quot;
|  | Measure Population Exclusion | None
|  | Measure Observation |
| 64ef45c156d636294b157b03 | Group scoring: continuous-variable
|  | Initial Population |
    define &quot;Initial Population&quot;:
      &quot;Qualifying Encounter&quot;
|  | Measure Population |
    define &quot;Measure Population&quot;:
      &quot;Initial Population&quot;
|  | Measure Population Exclusion | None
|  | Measure Observation |
| 64ef45d356d636294b157b04 | Group scoring: continuous-variable
|  | Initial Population |
    define &quot;Initial Population&quot;:
      &quot;Qualifying Encounter&quot;
|  | Measure Population |
    define &quot;Measure Population&quot;:
      &quot;Initial Population&quot;
|  | Measure Population Exclusion | None
|  | Measure Observation |
|  |  | None
|  |  | None

Library Name | Name
--- | ---
GMCSAU2024FHIR | Qualifying Encounter
    define &quot;Qualifying Encounter&quot;:
      [Encounter: &quot;Encounter Inpatient&quot;] EncounterInpatient
        where EncounterInpatient.period ends during day of &quot;Measurement Period&quot;
          and AgeInYearsAt(date from start of EncounterInpatient.period) &gt;= 65
          and ( duration in hours of EncounterInpatient.period &gt;= 24 )
          and EncounterInpatient.status = &#39;finished&#39;
Library Name | Name
GMCSAU2024FHIR | Initial Population
    define &quot;Initial Population&quot;:
      &quot;Qualifying Encounter&quot;
Library Name | Name
GMCSAU2024FHIR | Measure Population
    define &quot;Measure Population&quot;:
      &quot;Initial Population&quot;