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: Statin Therapy for the Prevention and Treatment of Cardiovascular DiseaseFHIR

Official URL: http://ecqi.healthit.gov/ecqms/Measure/StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Version: 0.1.000
Draft as of 2023-08-27 | Responsible: Centers for Medicare & Medicaid Services (CMS) | Computable Name: StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR
Other Identifiers: Short Name (use: usual, ), UUID:4d3066c5-88f7-48d2-8a93-9f946e1a41a6 (use: official, ), UUID:fd954048-8292-417e-bc77-aa0d99fb8540 (use: official, ), Publisher (use: official, )
Usage:Program: EP/EC
Copyright/Legal: 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. CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) is 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 is copyright 2022 World Health Organization. All Rights Reserved.

Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period:

- All patients who were previously diagnosed with or currently have a diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD), including an ASCVD procedure; OR
- Patients aged 20 - 75 years who have ever had a low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia; OR
- Patients aged 40 - 75 years with a diagnosis of diabetes; OR
- Patients aged 40 - 75 with a 10-year ASCVD risk score of >= 20 percent

UNKNOWN

Title: | Statin Therapy for the Prevention and Treatment of Cardiovascular DiseaseFHIR
Id: | StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR
Download cql: | StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR.cql
Version: | 0.1.000
Url: | Statin Therapy for the Prevention and Treatment of Cardiovascular DiseaseFHIR
short-name identifier: | CMS347FHIR
version-independent identifier: | urn:uuid:4d3066c5-88f7-48d2-8a93-9f946e1a41a6
version-specific identifier: | urn:uuid:fd954048-8292-417e-bc77-aa0d99fb8540
publisher (CMS) identifier: | 347FHIR
Effective Period: | 2024-01-01 ..2024-12-31
Status: | draft
Date: | 2023-08-27 20:52:19+0000
Approval Date: | 2023-08-28
Last Review Date: | 2023-08-28
Name: | StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR
Publisher: | Centers for Medicare & Medicaid Services (CMS)
Author: | Mathematica: https://www.mathematica.org/
Description: | Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period: All patients who were previously diagnosed with or currently have a diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD), including an ASCVD procedure; OR Patients aged 20 - 75 years who have ever had a low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia; OR Patients aged 40 - 75 years with a diagnosis of diabetes; OR Patients aged 40 - 75 with a 10-year ASCVD risk score of >= 20 percent
Use Context: |
code | value
--- | ---
program |
Purpose: | UNKNOWN
Copyright: | 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. CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) is 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 is copyright 2022 World Health Organization. All Rights Reserved.
Disclaimer: | These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Rationale: | "Cardiovascular disease (CVD) is the leading cause of death in the United States, causing approximately 1 of every 3 deaths in the United States in 2015. In 2015, stroke caused approximately 1 of every 19 deaths in the United States and the estimated annual costs for CVD and stroke were $329.7 billion, including $199.2 billion in direct costs (hospital services, physicians and other professionals, prescribed medications, home health care, and other medical durables) and $130.5 billion in indirect costs from lost future productivity (cardiovascular and stroke premature deaths). CVD costs more than any other diagnostic group" (Benjamin et al., 2018). Data collected between 2011 and 2014 indicates that more than 94.6 million U.S. adults, 20 years or older, had total cholesterol levels equal to 200 mg/dL or more, while almost 28.5 million had levels 240 mg/dL or more (Benjamin et al., 2018). Elevated blood cholesterol is a major risk factor for CVD and statin therapy has been associated with a reduced risk of CVD. Numerous randomized trials have demonstrated that treatment with a statin reduces LDL-C and reduces the risk of major cardiovascular events by approximately 20 percent (Ference, 2015). In 2018, updated guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults were published (Grundy et al., 2019). This guideline was published by an Expert Panel, which synthesized evidence from randomized controlled trials to identify people most likely to benefit from cholesterol-lowering therapy. The American College of Cardiology (ACC)/American Heart Association (AHA)/Multi-society (MS) Guideline recommendations are intended to provide a strong evidence-based foundation for the treatment of blood cholesterol for the primary and secondary prevention and treatment of ASCVD in patients of all ages. The document concludes that the addition of statin therapy reduces the risk of ASCVD among high-risk individuals, defined as follows: individuals with clinical ASCVD, with LDL-C >= 190 mg/dL, with diabetes, or individuals with >= 20% risk of ASCVD as determined via use of an ASCVD risk estimator derived from the Pooled Cohort Equations (Grundy et al., 2019). One study surveying U.S. cardiology, primary care, and endocrinology practices found that 1 in 4 guideline-eligible patients were not on a statin and less than half were on the recommended statin intensity. Untreated and undertreated patients had significantly higher LDL-C levels than those receiving guideline-directed statin treatment (Navar et al., 2017). In a follow-up study authored by Nanna et al., the same clinics were divided into tertiles based on the percentage of patients with guideline-recommended statin use. The researchers found that patients in the high-tertile clinics were more likely to achieve target LDL-C levels than patients at the low- or mid-tertile clinics, and this held true when patients were stratified by primary and secondary prevention (Nanna et al., 2019a). Research also indicates that certain populations are far less likely to receive guideline-recommended statin therapy than others. A retrospective study of the National Health and Nutrition Examination Survey found that Black and Hispanic race or ethnicity, low income, lack of health insurance coverage, poor health care access, young age, and female gender are predictors of lower statin utilization (Gu et al., 2018). In particular, there is extensive evidence that women are far less likely than men to be prescribed guideline-recommended statin therapy (Nanna et al., 2019b), despite research showing that female patients with cardiovascular disease derive the same or greater benefit from statin therapy as male patients with cardiovascular disease (Puri et al., 2014). The Statin Safety Expert Panel that participated in a National Lipid Association (NLA) Statin Safety Task Force meeting in October 2013 reaffirms the general safety of statin therapy. The panel members concluded that for most patients requiring statin therapy, the potential benefits of statin therapy outweigh the potential risks. In general terms, the benefits of statins to prevent non-fatal myocardial infarction, revascularization, stroke, and CVD mortality, far outweigh any potential harm related to the drug (Jacobson, 2014).
Clinical recommendation statement: | This electronic clinical quality measure is intended to align with the 2018 ACC/AHA/MS Guideline on the Management of Blood Cholesterol (Grundy et al., 2019), which indicates the use of statins as the first line of cholesterol-lowering medication therapy to lower the risk of ASCVD among at-risk populations. Recommendations for Management of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults - Statin Treatment: Secondary Prevention: In patients who are 75 years of age or younger with clinical ASCVD, high-intensity statin therapy should be initiated or continued with the aim of achieving a 50% or greater reduction in LDL-C levels (Class I Recommendation), (Grundy et al., 2019). In patients with clinical ASCVD in whom high-intensity statin therapy is contraindicated or who experience statin-associated side effects, moderate-intensity statin therapy should be initiated or continued with the aim of achieving a 30% to 49% reduction in LDL-C levels (Class I Recommendation), (Grundy et al., 2019). In patients older than 75 years of age with clinical ASCVD, it is reasonable to initiate moderate- or high-intensity statin therapy after evaluation of the potential for ASCVD risk reduction, adverse effects, and drug–drug interactions, as well as patient frailty and patient preferences (Class IIa Recommendation), (Grundy et al., 2019). Primary Prevention In patients 20 to 75 years of age with an LDL-C level of 190 mg/dL or higher (>= 4.9 mmol/L), maximally tolerated statin therapy is recommended. (Class I Recommendation), (Grundy et al., 2019). In adults 40 to 75 years of age with diabetes mellitus, regardless of estimated 10-year ASCVD risk, moderate-intensity statin therapy is indicated (Class I Recommendation), (Grundy et al., 2019). To facilitate decisions about preventive interventions, it is recommended to screen for traditional ASCVD risk factors and apply the race- and sex-specific Pooled Cohort Equations (PCE) to estimate 10-year ASCVD risk for asymptomatic adults 40 to 75 years of age. The higher the estimated risk, the more likely the patient is to benefit from statin treatment (Grundy et al., 2019). The US Preventive Services Task Force (USPSTF) concludes with moderate certainty that statin use for the prevention of CVD events and all-cause mortality in adults aged 40 to 75 years with no history of CVD and who have 1 or more of these CVD risk factors and an estimated 10-year CVD event risk of 7.5% to less than 10% has at least a small net benefit (USPSTF 2022). Statin Safety and Statin-Associated Side Effects A clinician–patient risk discussion is recommended before initiation of statin therapy to review net clinical benefit, weighing the potential for ASCVD risk reduction against the potential for statin-associated side effects, statin–drug interactions, and safety, while emphasizing that side effects can be addressed successfully (Class I Recommendation), (Grundy et al., 2019).
Guidance (Usage): | Initial Population Guidance: The initial population covers four distinct populations. Use the following process to prevent counting patients more than once. Initial Population 1: All patients who were previously diagnosed with or currently have a diagnosis of clinical ASCVD, including an ASCVD procedure before the end of the measurement period. - If YES, meets Initial Population 1 risk category - If NO, screen for next risk category Initial Population 2: Patients aged 20 to 75 years at the beginning of the measurement period who have ever had a laboratory test result of LDL-C >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia. - If YES, meets Initial Population 2 risk category - If NO, screen for next risk category Initial Population 3: Patients aged 40 to 75 years at the beginning of the measurement period with an active diagnosis of Type 1 or Type 2 diabetes at any time during the measurement period. - If YES, meets Initial Population 3 risk category - If NO, screen for next risk category Initial Population 4: Patients aged 40 to 75 at the beginning of the measurement period with a 10-year ASCVD risk score of >= 20 percent during the measurement period. - If YES, meets Initial Population 4 risk category - If NO, patient does NOT meet Initial Population criteria and is NOT eligible for measure inclusion. Initial Population Guidance for Encounter: In order for the patient to be included in the Initial Population, the patient must have ONE initial population-eligible visit, defined as follows: outpatient visit, initial or established office visit, face-to-face interaction, preventive care services, or annual wellness visit. LDL-C Laboratory test result options: The measure can be reported for all patients with a documented LDL-C level recorded as follows: To meet Initial Population 1: There is no LDL-C result required. To meet Initial Population 2: If a patient has ANY previous laboratory result of LDL-C >= 190 mg/dL, report the highest value >= 190 mg/dL. To meet Initial Population 3: There is no LDL-C result required. To meet Initial Population 4: There is no LDL-C result required. The 10-year ASCVD risk assessment options: The 10-year ASCVD risk score is calculated using the Pooled Cohort Equations: 1) the 2013 ACC/AHA ASCVD Risk Estimator (maps to LOINC Code 79423-0) OR 2) the ACC Risk Estimator Plus (maps to LOINC Code 99055-6). If your EHR does not have either of these risk calculators, we recommend that you use the on-line versions. The 10-year ASCVD risk score (quantitative result, i.e., result.value, "%") must be documented in a structured field. The 10-year ASCVD risk assessment must be performed during the measurement period. Numerator instructions and guidance: - Current statin therapy use must be documented in the patient's current medication list or ordered during the measurement period. - ONLY statin therapy meets the measure Numerator criteria (NOT other cholesterol lowering medications). - Prescription or order does NOT need to be linked to an encounter or visit; it may be called to the pharmacy. - Statin medication "samples" provided to patients can be documented as "current statin therapy" if documented in the medication list in health/medical record. - Patients who meet the denominator criteria for inclusion, but are not prescribed or using statin therapy, will NOT meet performance for this measure unless they have an allowable denominator exception. Patients with an allowable denominator exception should be removed from the denominator of the measure and reported as a valid exception. - There is only one performance rate calculated for this measure: the weighted average of the four populations. - Adherence to statin therapy is not calculated in this measure. - It may not be appropriate to prescribe statin therapy for some patients (see exceptions and exclusions for the complete list). Intensity of statin therapy in primary and secondary prevention: The expert panel of the 2018 ACC/AHA/MS Guidelines (Grundy et al., 2019) defines recommended intensity of statin therapy on the basis of the average expected LDL-C response to specific statin and dose. Although intensity of statin therapy is important in managing cholesterol, this measure assesses prescription of ANY statin therapy, irrespective of intensity. Assessment of appropriate intensity and dosage documentation added too much complexity to allow inclusion of statin therapy intensity in the measure at this time. Lifestyle modification coaching: A healthy lifestyle is important for the prevention of cardiovascular disease. However, lifestyle modification monitoring and documentation added too much complexity to allow its inclusion in the measure at this time. Millimoles per liter (mmol/L) should be converted to milligrams per deciliter (mg/dL) for reporting this measure. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS 347v7. Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html).
Population Criteria: |
64345cac7c12bd4a0fdf2869
Initial Population: | All patients who were previously diagnosed with or currently have a diagnosis of clinical ASCVD, including an ASCVD procedure.
Denominator: | Equals Initial Population
Denominator Exclusion: | Patients who are breastfeeding at any time during the measurement period. Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period.
Numerator: | Patients who are actively using or who receive an order (prescription) for statin therapy at any time during the measurement period
Numerator Exclusion: | None
Denominator Exception: | Patients with statin-associated muscle symptoms or an allergy to statin medication. Patients who are receiving palliative or hospice care. Patients with active liver disease or hepatic disease or insufficiency. Patients with end-stage renal disease (ESRD). Patients with documentation of a medical reason for not being prescribed statin therapy.
64345cac7c12bd4a0fdf286a
Initial Population: | Patients aged 20 to 75 years at the beginning of the measurement period who have ever had a laboratory result of LDL-C >=190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia.
Denominator: | Equals Initial Population
Denominator Exclusion: | Patients who are breastfeeding at any time during the measurement period. Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period.
Numerator: | Patients who are actively using or who receive an order (prescription) for statin therapy at any time during the measurement period
Numerator Exclusion: | None
Denominator Exception: | Patients with statin-associated muscle symptoms or an allergy to statin medication. Patients who are receiving palliative or hospice care. Patients with active liver disease or hepatic disease or insufficiency. Patients with end-stage renal disease (ESRD). Patients with documentation of a medical reason for not being prescribed statin therapy.
64345cac7c12bd4a0fdf286b
Initial Population: | Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes.
Denominator: | Equals Initial Population
Denominator Exclusion: | Patients who are breastfeeding at any time during the measurement period. Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period.
Numerator: | Patients who are actively using or who receive an order (prescription) for statin therapy at any time during the measurement period
Numerator Exclusion: | None
Denominator Exception: | Patients with statin-associated muscle symptoms or an allergy to statin medication. Patients who are receiving palliative or hospice care. Patients with active liver disease or hepatic disease or insufficiency. Patients with end-stage renal disease (ESRD). Patients with documentation of a medical reason for not being prescribed statin therapy.
64469d732adc647f6c92e98b
Initial Population: | Population 4: Patients aged 40 to 75 at the beginning of the measurement period with a 10-year ASCVD risk score (i.e., 2013 ACC/AHA ASCVD Risk Estimator or the ACC Risk Estimator Plus) of >= 20 percent during the measurement period.
Denominator: | Equals Initial Population
Denominator Exclusion: | Patients who are breastfeeding at any time during the measurement period. Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period.
Numerator: | Patients who are actively using or who receive an order (prescription) for statin therapy at any time during the measurement period
Numerator Exclusion: | None
Denominator Exception: | Patients with statin-associated muscle symptoms or an allergy to statin medication. Patients who are receiving palliative or hospice care. Patients with active liver disease or hepatic disease or insufficiency. Patients with end-stage renal disease (ESRD). Patients with documentation of a medical reason for not being prescribed statin therapy.
Supplemental Data Guidance : |
Supplemental Data Elements: | SDE Ethnicity SDE Payer SDE Race SDE Sex
Libraries: |
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR
Related Artifact Dependencies: | `Library/QICoreCommon|1.5.000` `Library/FHIRHelpers|4.3.000` `Library/FHIRHelpers|4.3.000` `Library/SupplementalDataElements|3.4.000` `Library/FHIRHelpers|4.3.000` `Library/Hospice|6.7.000` `Library/Status|1.6.000` `Library/QICoreCommon|1.5.000` `Library/FHIRHelpers|4.3.000` `Library/PalliativeCare|1.7.000` Condition Category Codes US Core Condition Category Extension Codes Condition Clinical Status Codes LOINC AllergyIntolerance Clinical Status Codes SNOMED CT (all versions) Observation Category Codes LOINC Myocardial Infarction Cerebrovascular Disease, Stroke, TIA Atherosclerosis and Peripheral Arterial Disease Ischemic Heart Disease or Other Related Diagnoses Stable and Unstable Angina PCI CABG Surgeries Carotid Intervention CABG, PCI Procedure Annual Wellness Visit Office Visit Outpatient Consultation Outpatient Encounters for Preventive Care Preventive Care Services - Established Office Visit, 18 and Up Preventive Care Services-Individual Counseling Preventive Care Services-Initial Office Visit, 18 and Up Preventive Care Services - Other LDL Cholesterol Hypercholesterolemia Diabetes Low Intensity Statin Therapy Moderate Intensity Statin Therapy High Intensity Statin Therapy Payer Breastfeeding Rhabdomyolysis Statin Allergen Encounter Inpatient Hospice Encounter Hospice Care Ambulatory Hospice Diagnosis Palliative Care Diagnosis Palliative Care Encounter Palliative Care Intervention Hepatitis A Hepatitis B Liver Disease Statin Associated Muscle Symptoms End Stage Renal Disease Medical Reason
Parameters: |
name | use | min | max | type
--- | --- | --- | --- | ---
Measurement Period | In | 0 | 1 | Period
Initial Population 1 | Out | 0 | 1 | boolean
Initial Population 2 | Out | 0 | 1 | boolean
SDE Race | Out | 0 | 1 | Resource
Initial Population 3 | Out | 0 | 1 | boolean
Initial Population 4 | Out | 0 | 1 | boolean
SDE Sex | Out | 0 | 1 | Coding
Denominator 3 | Out | 0 | 1 | boolean
Numerator | Out | 0 | 1 | boolean
Denominator 2 | Out | 0 | 1 | boolean
Denominator 4 | Out | 0 | 1 | boolean
SDE Payer | Out | 0 | * | Resource
SDE Ethnicity | Out | 0 | 1 | Resource
Denominator Exclusions | Out | 0 | 1 | boolean
Denominator 1 | Out | 0 | 1 | boolean
Denominator Exceptions | Out | 0 | 1 | boolean
DataRequirements: |
Type | Elements | Valueset Name | Valueset
--- | --- | --- | ---
Condition(`http://hl7.org/fhir/Condition`) | clinicalStatus |  |
Condition(QICoreCondition) | code | Myocardial Infarction | Myocardial Infarction
Condition(QICoreCondition) | code | Cerebrovascular Disease Stroke or TIA | Cerebrovascular Disease, Stroke, TIA
Condition(QICoreCondition) | code | Atherosclerosis and Peripheral Arterial Disease | Atherosclerosis and Peripheral Arterial Disease
Condition(QICoreCondition) | code | Ischemic Heart Disease or Other Related Diagnoses | Ischemic Heart Disease or Other Related Diagnoses
Condition(QICoreCondition) | code | Stable and Unstable Angina | Stable and Unstable Angina
Procedure(QICoreProcedure) | code | PCI | PCI
Procedure(QICoreProcedure) | code | CABG Surgeries | CABG Surgeries
Procedure(QICoreProcedure) | code | Carotid Intervention | Carotid Intervention
Procedure(QICoreProcedure) | code | CABG or PCI Procedure | CABG, PCI Procedure
Encounter(QICoreEncounter) | type | Annual Wellness Visit | Annual Wellness Visit
Encounter(QICoreEncounter) | type | Office Visit | Office Visit
Encounter(QICoreEncounter) | type | Outpatient Consultation | Outpatient Consultation
Encounter(QICoreEncounter) | type | Outpatient Encounters for Preventive Care | Outpatient Encounters for Preventive Care
Encounter(QICoreEncounter) | type | Preventive Care Services Established Office Visit, 18 and Up | Preventive Care Services - Established Office Visit, 18 and Up
Encounter(QICoreEncounter) | type | Preventive Care Services Individual Counseling | Preventive Care Services-Individual Counseling
Encounter(QICoreEncounter) | type | Preventive Care Services Initial Office Visit, 18 and Up | Preventive Care Services-Initial Office Visit, 18 and Up
Encounter(QICoreEncounter) | type | Preventive Care Services Other | Preventive Care Services - Other
Patient(QICorePatient) |  |  |
Patient(QICorePatient) |  |  |
Patient(`http://hl7.org/fhir/Patient`) | birthDate birthDate.value gender gender.value |  |
Observation(QICoreObservation) | code value effective status status.value | LDL Cholesterol | LDL Cholesterol
Condition(QICoreCondition) | code | Familial Hypercholesterolemia | Hypercholesterolemia
Patient(QICorePatient) |  |  |
uri(`http://hl7.org/fhir/uri`) | value |  |
Patient(QICorePatient) | url extension |  |
Patient(QICorePatient) | url extension |  |
Condition(QICoreCondition) | code | Diabetes | Diabetes
Observation(QICoreObservation) | code |  |
Observation(QICoreObservation) | code |  |
MedicationRequest(QICoreMedicationRequest) | medication | Low Intensity Statin Therapy | Low Intensity Statin Therapy
MedicationRequest(QICoreMedicationRequest) | medication | Low Intensity Statin Therapy | Low Intensity Statin Therapy
MedicationRequest(QICoreMedicationRequest) | medication | Moderate Intensity Statin Therapy | Moderate Intensity Statin Therapy
MedicationRequest(QICoreMedicationRequest) | medication | Moderate Intensity Statin Therapy | Moderate Intensity Statin Therapy
MedicationRequest(QICoreMedicationRequest) | medication | High Intensity Statin Therapy | High Intensity Statin Therapy
MedicationRequest(QICoreMedicationRequest) | medication | High Intensity Statin Therapy | High Intensity Statin Therapy
Coverage(QICoreCoverage) | type period | Payer Type | Payer
Patient(QICorePatient) | url extension |  |
Patient(QICorePatient) | url extension |  |
Condition(QICoreCondition) | code | Breastfeeding | Breastfeeding
Condition(QICoreCondition) | code | Rhabdomyolysis | Rhabdomyolysis
AllergyIntolerance(QICoreAllergyIntolerance) | code onset clinicalStatus | Statin Allergen | Statin Allergen
Encounter(QICoreEncounter) | type | Encounter Inpatient | Encounter Inpatient
Encounter(QICoreEncounter) | type hospitalization hospitalization.dischargeDisposition period | Encounter Inpatient | Encounter Inpatient
Encounter(QICoreEncounter) | type | Hospice Encounter | Hospice Encounter
Encounter(QICoreEncounter) | type period | Hospice Encounter | Hospice Encounter
Observation(QICoreObservation) | code |  |
Observation(QICoreObservation) | code value effective |  |
ServiceRequest(QICoreServiceRequest) | code | Hospice Care Ambulatory | Hospice Care Ambulatory
ServiceRequest(QICoreServiceRequest) | code authoredOn authoredOn.value | Hospice Care Ambulatory | Hospice Care Ambulatory
Procedure(QICoreProcedure) | code | Hospice Care Ambulatory | Hospice Care Ambulatory
Procedure(QICoreProcedure) | code performed | Hospice Care Ambulatory | Hospice Care Ambulatory
Condition(QICoreCondition) | code | Hospice Diagnosis | Hospice Diagnosis
Observation(QICoreObservation) | code |  |
Observation(QICoreObservation) | code effective |  |
Condition(QICoreCondition) | code | Palliative Care Diagnosis | Palliative Care Diagnosis
Encounter(QICoreEncounter) | type | Palliative Care Encounter | Palliative Care Encounter
Encounter(QICoreEncounter) | type period | Palliative Care Encounter | Palliative Care Encounter
Procedure(QICoreProcedure) | code | Palliative Care Intervention | Palliative Care Intervention
Procedure(QICoreProcedure) | code performed | Palliative Care Intervention | Palliative Care Intervention
Condition(QICoreCondition) | code | Hepatitis A | Hepatitis A
Condition(QICoreCondition) | code | Hepatitis B | Hepatitis B
Condition(QICoreCondition) | code | Liver Disease | Liver Disease
Condition(QICoreCondition) | code | Statin Associated Muscle Symptoms | Statin Associated Muscle Symptoms
Condition(QICoreCondition) | code | End Stage Renal Disease | End Stage Renal Disease
AdverseEvent(QICoreAdverseEvent) | event recordedDate recordedDate.value | Statin Allergen | Statin Allergen
MedicationRequest(QICoreMedicationNotRequested) | medication | Low Intensity Statin Therapy | Low Intensity Statin Therapy
MedicationRequest(QICoreMedicationNotRequested) | medication | Low Intensity Statin Therapy | Low Intensity Statin Therapy
MedicationRequest(QICoreMedicationNotRequested) | medication | Moderate Intensity Statin Therapy | Moderate Intensity Statin Therapy
MedicationRequest(QICoreMedicationNotRequested) | medication | Moderate Intensity Statin Therapy | Moderate Intensity Statin Therapy
MedicationRequest(QICoreMedicationNotRequested) | medication | High Intensity Statin Therapy | High Intensity Statin Therapy
MedicationRequest(QICoreMedicationNotRequested) | medication | High Intensity Statin Therapy | High Intensity Statin Therapy
Patient(QICorePatient) | url extension |  |
Coverage(QICoreCoverage) | type period | Payer Type | Payer
Patient(QICorePatient) | url extension |  |
Direct Reference Codes: |
display | code | system
--- | --- | ---
Problem List Item | problem-list-item | http://terminology.hl7.org/CodeSystem/condition-category
Health Concern | health-concern | http://hl7.org/fhir/us/core/CodeSystem/condition-category
| active | http://terminology.hl7.org/CodeSystem/condition-clinical
| recurrence | http://terminology.hl7.org/CodeSystem/condition-clinical
| relapse | http://terminology.hl7.org/CodeSystem/condition-clinical
Cardiovascular disease 10Y risk [Likelihood] | 99055-6 | http://loinc.org
Cardiovascular disease 10Y risk [Likelihood] ACC-AHA Pooled Cohort by Goff 2013 | 79423-0 | http://loinc.org
| active | http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical
Discharge to home for hospice care (procedure) | 428361000124107 | http://snomed.info/sct
Discharge to healthcare facility for hospice care (procedure) | 428371000124100 | http://snomed.info/sct
survey | survey | http://terminology.hl7.org/CodeSystem/observation-category
Hospice care [Minimum Data Set] | 45755-6 | http://loinc.org
Yes (qualifier value) | 373066001 | http://snomed.info/sct
Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal) | 71007-9 | http://loinc.org
Logic Definitions: |
Group | Scoring | Population Criteria | Expression
--- | --- | --- | ---
64345cac7c12bd4a0fdf2869 | Group scoring: proportion
|  | Initial Population |
    define "Initial Population 1":
      exists "ASVCD Diagnosis or Procedure before End of Measurement Period"
        and exists "Qualifying Encounter during day of Measurement Period"
|  | Denominator |
    define "Denominator 1":
      "Initial Population 1"
|  | Denominator Exclusion |
    define "Denominator Exclusions":
      exists ( ( [Condition: "Breastfeeding"]
          union [Condition: "Rhabdomyolysis"] ) ExclusionDiagnosis
          where ( ExclusionDiagnosis.isProblemListItem ( )
              or ExclusionDiagnosis.isHealthConcern ( )
          )
            and ExclusionDiagnosis.prevalenceInterval ( ) overlaps day of "Measurement Period"
            and ExclusionDiagnosis.isActive ( )
      )
|  | Numerator |
    define "Numerator":
      exists "Statin Therapy Prescribed Anytime during day of Measurement Period"
|  | Numerator Exclusion | None
|  | Denominator Exception |
    define "Denominator Exceptions":
      "Has Allergy to Statin"
        or Hospice."Has Hospice Services"
        or PalliativeCare."Has Palliative Care in the Measurement Period"
        or "Has Hepatitis or Liver Disease Diagnosis"
        or "Has Statin Associated Muscle Symptoms"
        or "Has ESRD Diagnosis"
        or "Has Adverse Reaction to Statin"
        or "Has Medical Reason for Not Ordering Statin Therapy"
| 64345cac7c12bd4a0fdf286a | Group scoring: proportion
|  | Initial Population |
    define "Initial Population 2":
      "Patients Aged 20 to 75 with LDL Cholesterol Result Greater than or Equal to 190 or Hypercholesterolemia without ASCVD"
        and exists "Qualifying Encounter during day of Measurement Period"
|  | Denominator |
    define "Denominator 2":
      "Initial Population 2"
|  | Denominator Exclusion |
    define "Denominator Exclusions":
      exists ( ( [Condition: "Breastfeeding"]
          union [Condition: "Rhabdomyolysis"] ) ExclusionDiagnosis
          where ( ExclusionDiagnosis.isProblemListItem ( )
              or ExclusionDiagnosis.isHealthConcern ( )
          )
            and ExclusionDiagnosis.prevalenceInterval ( ) overlaps day of "Measurement Period"
            and ExclusionDiagnosis.isActive ( )
      )
|  | Numerator |
    define "Numerator":
      exists "Statin Therapy Prescribed Anytime during day of Measurement Period"
|  | Numerator Exclusion | None
|  | Denominator Exception |
    define "Denominator Exceptions":
      "Has Allergy to Statin"
        or Hospice."Has Hospice Services"
        or PalliativeCare."Has Palliative Care in the Measurement Period"
        or "Has Hepatitis or Liver Disease Diagnosis"
        or "Has Statin Associated Muscle Symptoms"
        or "Has ESRD Diagnosis"
        or "Has Adverse Reaction to Statin"
        or "Has Medical Reason for Not Ordering Statin Therapy"
| 64345cac7c12bd4a0fdf286b | Group scoring: proportion
|  | Initial Population |
    define "Initial Population 3":
      "Patients Aged 40 to 75 Years with Diabetes without ASCVD or LDL Greater than 190 or Hypercholesterolemia"
        and exists "Qualifying Encounter during day of Measurement Period"
|  | Denominator |
    define "Denominator 3":
      "Initial Population 3"
|  | Denominator Exclusion |
    define "Denominator Exclusions":
      exists ( ( [Condition: "Breastfeeding"]
          union [Condition: "Rhabdomyolysis"] ) ExclusionDiagnosis
          where ( ExclusionDiagnosis.isProblemListItem ( )
              or ExclusionDiagnosis.isHealthConcern ( )
          )
            and ExclusionDiagnosis.prevalenceInterval ( ) overlaps day of "Measurement Period"
            and ExclusionDiagnosis.isActive ( )
      )
|  | Numerator |
    define "Numerator":
      exists "Statin Therapy Prescribed Anytime during day of Measurement Period"
|  | Numerator Exclusion | None
|  | Denominator Exception |
    define "Denominator Exceptions":
      "Has Allergy to Statin"
        or Hospice."Has Hospice Services"
        or PalliativeCare."Has Palliative Care in the Measurement Period"
        or "Has Hepatitis or Liver Disease Diagnosis"
        or "Has Statin Associated Muscle Symptoms"
        or "Has ESRD Diagnosis"
        or "Has Adverse Reaction to Statin"
        or "Has Medical Reason for Not Ordering Statin Therapy"
| 64469d732adc647f6c92e98b | Group scoring: proportion
|  | Initial Population |
    define "Initial Population 4":
      "Patients Age 40 to 75 Years and have a 10 Year CVD Risk of High without ASCVD and High LDL and Diabetes"
        and exists "Qualifying Encounter during day of Measurement Period"
|  | Denominator |
    define "Denominator 4":
      "Initial Population 4"
|  | Denominator Exclusion |
    define "Denominator Exclusions":
      exists ( ( [Condition: "Breastfeeding"]
          union [Condition: "Rhabdomyolysis"] ) ExclusionDiagnosis
          where ( ExclusionDiagnosis.isProblemListItem ( )
              or ExclusionDiagnosis.isHealthConcern ( )
          )
            and ExclusionDiagnosis.prevalenceInterval ( ) overlaps day of "Measurement Period"
            and ExclusionDiagnosis.isActive ( )
      )
|  | Numerator |
    define "Numerator":
      exists "Statin Therapy Prescribed Anytime during day of Measurement Period"
|  | Numerator Exclusion | None
|  | Denominator Exception |
    define "Denominator Exceptions":
      "Has Allergy to Statin"
        or Hospice."Has Hospice Services"
        or PalliativeCare."Has Palliative Care in the Measurement Period"
        or "Has Hepatitis or Liver Disease Diagnosis"
        or "Has Statin Associated Muscle Symptoms"
        or "Has ESRD Diagnosis"
        or "Has Adverse Reaction to Statin"
        or "Has Medical Reason for Not Ordering Statin Therapy"

Library Name | Name
--- | ---
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | ASVCD Diagnosis or Procedure before End of Measurement Period
    define "ASVCD Diagnosis or Procedure before End of Measurement Period":
      ( ( [Condition: "Myocardial Infarction"]
          union [Condition: "Cerebrovascular Disease Stroke or TIA"]
          union [Condition: "Atherosclerosis and Peripheral Arterial Disease"]
          union [Condition: "Ischemic Heart Disease or Other Related Diagnoses"]
          union [Condition: "Stable and Unstable Angina"] ) ASCVDDiagnosis
          where ( ASCVDDiagnosis.isProblemListItem ( )
              or ASCVDDiagnosis.isHealthConcern ( )
          )
            and ASCVDDiagnosis.prevalenceInterval ( ) starts on or before day of end of "Measurement Period"
            and ASCVDDiagnosis.isActive ( )
      )
        union ( ( [Procedure: "PCI"]
            union [Procedure: "CABG Surgeries"]
            union [Procedure: "Carotid Intervention"]
            union [Procedure: "CABG or PCI Procedure"] ) ASCVDProcedure
            where ASCVDProcedure.performed.toInterval ( ) starts on or before day of end of "Measurement Period"
              and ASCVDProcedure.status = 'completed'
        )
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Qualifying Encounter during day of Measurement Period
    define "Qualifying Encounter during day of Measurement Period":
      ( [Encounter: "Annual Wellness Visit"]
        union [Encounter: "Office Visit"]
        union [Encounter: "Outpatient Consultation"]
        union [Encounter: "Outpatient Encounters for Preventive Care"]
        union [Encounter: "Preventive Care Services Established Office Visit, 18 and Up"]
        union [Encounter: "Preventive Care Services Individual Counseling"]
        union [Encounter: "Preventive Care Services Initial Office Visit, 18 and Up"]
        union [Encounter: "Preventive Care Services Other"]
               /*union [Encounter: "UnlistedEncounter"This will change with a future standards update CQLIT-368*/
      ) QualifyingEncounter
        where QualifyingEncounter.period during day of "Measurement Period"
          and QualifyingEncounter.status = 'finished'
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Initial Population 1
    define "Initial Population 1":
      exists "ASVCD Diagnosis or Procedure before End of Measurement Period"
        and exists "Qualifying Encounter during day of Measurement Period"
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Patients Aged 20 to 75 at Start of Measurement Period
    define "Patients Aged 20 to 75 at Start of Measurement Period":
      AgeInYearsAt(date from start of "Measurement Period") in Interval[20, 75]
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | LDL Result Greater Than or Equal To 190
    define "LDL Result Greater Than or Equal To 190":
      [Observation: "LDL Cholesterol"] LDL190
        where LDL190.value as Quantity >= 190 'mg/dL'
          and LDL190.effective.toInterval ( ) starts before end of "Measurement Period"
          and LDL190.status in { 'final', 'amended', 'corrected', 'appended' }
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Hypercholesterolemia Diagnosis
    define "Hypercholesterolemia Diagnosis":
      ( [Condition: "Familial Hypercholesterolemia"] Hypercholesterolemia
          where ( Hypercholesterolemia.isProblemListItem ( )
              or Hypercholesterolemia.isHealthConcern ( )
          )
            and Hypercholesterolemia.prevalenceInterval ( ) starts on or before day of end of "Measurement Period"
            and Hypercholesterolemia.isActive ( )
      )
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Patients Aged 20 to 75 with LDL Cholesterol Result Greater than or Equal to 190 or Hypercholesterolemia without ASCVD
    define "Patients Aged 20 to 75 with LDL Cholesterol Result Greater than or Equal to 190 or Hypercholesterolemia without ASCVD":
      "Patients Aged 20 to 75 at Start of Measurement Period"
        and exists ( "LDL Result Greater Than or Equal To 190"
            union "Hypercholesterolemia Diagnosis"
        )
        and not exists ( "ASVCD Diagnosis or Procedure before End of Measurement Period" )
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Initial Population 2
    define "Initial Population 2":
      "Patients Aged 20 to 75 with LDL Cholesterol Result Greater than or Equal to 190 or Hypercholesterolemia without ASCVD"
        and exists "Qualifying Encounter during day of Measurement Period"
Library Name | Name
SupplementalDataElements | SDE Race
    define "SDE Race":
      Patient.race R
        return Tuple {
          codes: R.ombCategory union R.detailed,
          display: R.text
        }
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | SDE Race
    define "SDE Race":
      SDE."SDE Race"
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Has Diabetes Diagnosis
    define "Has Diabetes Diagnosis":
      exists ( [Condition: "Diabetes"] Diabetes
          where ( Diabetes.isProblemListItem ( )
              or Diabetes.isHealthConcern ( )
          )
            and Diabetes.prevalenceInterval ( ) overlaps day of "Measurement Period"
            and Diabetes.isActive ( )
      )
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Patients Aged 40 to 75 Years with Diabetes without ASCVD or LDL Greater than 190 or Hypercholesterolemia
    define "Patients Aged 40 to 75 Years with Diabetes without ASCVD or LDL Greater than 190 or Hypercholesterolemia":
      AgeInYearsAt(date from start of "Measurement Period") >= 40
        and AgeInYearsAt(date from start of "Measurement Period") <= 75
        and "Has Diabetes Diagnosis"
        and ( not exists "ASVCD Diagnosis or Procedure before End of Measurement Period"
            and not exists "LDL Result Greater Than or Equal To 190"
            and not exists "Hypercholesterolemia Diagnosis"
        )
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Initial Population 3
    define "Initial Population 3":
      "Patients Aged 40 to 75 Years with Diabetes without ASCVD or LDL Greater than 190 or Hypercholesterolemia"
        and exists "Qualifying Encounter during day of Measurement Period"
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Ten Year CVD Risk is High
    define "Ten Year CVD Risk is High":
      ( exists ( [Observation: "Cardiovascular disease 10Y risk [Likelihood]"]
          union [Observation: "Cardiovascular disease 10Y risk [Likelihood] ACC-AHA Pooled Cohort by Goff 2013"] ) AtRiskCVD
          where AtRiskCVD.value as Quantity >= 20 '%'
            and AtRiskCVD.effective.toInterval ( ) during day of "Measurement Period"
      )
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Patients Age 40 to 75 Years and have a 10 Year CVD Risk of High without ASCVD and High LDL and Diabetes
    define "Patients Age 40 to 75 Years and have a 10 Year CVD Risk of High without ASCVD and High LDL and Diabetes":
      AgeInYearsAt(date from start of "Measurement Period") in Interval[40, 75]
        and "Ten Year CVD Risk is High"
        and not ( exists "ASVCD Diagnosis or Procedure before End of Measurement Period"
            or exists "Hypercholesterolemia Diagnosis"
            or exists "LDL Result Greater Than or Equal To 190"
            or "Has Diabetes Diagnosis"
        )
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Initial Population 4
    define "Initial Population 4":
      "Patients Age 40 to 75 Years and have a 10 Year CVD Risk of High without ASCVD and High LDL and Diabetes"
        and exists "Qualifying Encounter during day of Measurement Period"
Library Name | Name
SupplementalDataElements | SDE Sex
    define "SDE Sex":
      case
          when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }
          when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }
          else null
        end
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | SDE Sex
    define "SDE Sex":
      SDE."SDE Sex"
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Denominator 3
    define "Denominator 3":
      "Initial Population 3"
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Statin Therapy Prescribed Anytime during day of Measurement Period
    define "Statin Therapy Prescribed Anytime during day of Measurement Period":
      ( [MedicationRequest: "Low Intensity Statin Therapy"]
        union [MedicationRequest: "Moderate Intensity Statin Therapy"]
        union [MedicationRequest: "High Intensity Statin Therapy"] ) StatinPrescribed
        where StatinPrescribed.status in { 'active', 'completed' }
          and StatinPrescribed.intent ~ 'order'
          and StatinPrescribed.doNotPerform is not true
          and ( StatinPrescribed.authoredOn during day of "Measurement Period"
              or exists ( StatinPrescribed.dosageInstruction.timing T
                  where T.repeat.bounds.toInterval ( ) overlaps day of "Measurement Period"
              )
          )
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Numerator
    define "Numerator":
      exists "Statin Therapy Prescribed Anytime during day of Measurement Period"
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Denominator 2
    define "Denominator 2":
      "Initial Population 2"
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Denominator 4
    define "Denominator 4":
      "Initial Population 4"
Library Name | Name
SupplementalDataElements | SDE Payer
    define "SDE Payer":
      [Coverage: type in "Payer Type"] Payer
        return {
          code: Payer.type,
          period: Payer.period
        }
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | SDE Payer
    define "SDE Payer":
      SDE."SDE Payer"
Library Name | Name
SupplementalDataElements | SDE Ethnicity
    define "SDE Ethnicity":
      Patient.ethnicity E
        return Tuple {
          codes: { E.ombCategory } union E.detailed,
          display: E.text
        }
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | SDE Ethnicity
    define "SDE Ethnicity":
      SDE."SDE Ethnicity"
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Denominator Exclusions
    define "Denominator Exclusions":
      exists ( ( [Condition: "Breastfeeding"]
          union [Condition: "Rhabdomyolysis"] ) ExclusionDiagnosis
          where ( ExclusionDiagnosis.isProblemListItem ( )
              or ExclusionDiagnosis.isHealthConcern ( )
          )
            and ExclusionDiagnosis.prevalenceInterval ( ) overlaps day of "Measurement Period"
            and ExclusionDiagnosis.isActive ( )
      )
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Denominator 1
    define "Denominator 1":
      "Initial Population 1"
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Has Allergy to Statin
    define "Has Allergy to Statin":
      exists ( [AllergyIntolerance: "Statin Allergen"] StatinAllergy
          where QICoreCommon."ToInterval" ( StatinAllergy.onset ) overlaps day of "Measurement Period"
            and StatinAllergy.clinicalStatus ~ QICoreCommon."allergy-active"
            or StatinAllergy.clinicalStatus is null
      )
Library Name | Name
Hospice | Has Hospice Services
    define "Has Hospice Services":
      exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter
          where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
              or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
          )
            and InpatientEncounter.period.toInterval() ends during day of "Measurement Period"
      )
        or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter
            where HospiceEncounter.period.toInterval() overlaps day of "Measurement Period"
        )
        or exists ((([Observation: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment
            where HospiceAssessment.value ~ "Yes (qualifier value)"
              and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period"
        )
        or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder
            where HospiceOrder.authoredOn.toInterval() during day of "Measurement Period"
        )
        or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed
            where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period"
        )
        or exists (([Condition: "Hospice Diagnosis"]) HospiceCareDiagnosis
            where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
        )
Library Name | Name
PalliativeCare | Has Palliative Care in the Measurement Period
    define "Has Palliative Care in the Measurement Period":
      exists ((([Observation: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"]).isAssessmentPerformed()) PalliativeAssessment
          where PalliativeAssessment.effective.toInterval() overlaps day of "Measurement Period"
      )
        or exists ([Condition: "Palliative Care Diagnosis"] PalliativeDiagnosis
            where PalliativeDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
        )
        or exists ((([Encounter: "Palliative Care Encounter"]).isEncounterPerformed()) PalliativeEncounter
            where PalliativeEncounter.period.toInterval() overlaps day of "Measurement Period"
        )
        or exists ((([Procedure: "Palliative Care Intervention"]).isInterventionPerformed()) PalliativeIntervention
            where PalliativeIntervention.performed.toInterval() overlaps day of "Measurement Period"
        )
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Has Hepatitis or Liver Disease Diagnosis
    define "Has Hepatitis or Liver Disease Diagnosis":
      exists ( ( [Condition: "Hepatitis A"]
          union [Condition: "Hepatitis B"]
          union [Condition: "Liver Disease"] ) HepatitisLiverDisease
          where ( HepatitisLiverDisease.isProblemListItem ( )
              or HepatitisLiverDisease.isHealthConcern ( )
          )
            and HepatitisLiverDisease.prevalenceInterval ( ) overlaps day of "Measurement Period"
            and HepatitisLiverDisease.isActive ( )
      )
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Has Statin Associated Muscle Symptoms
    define "Has Statin Associated Muscle Symptoms":
      exists ( [Condition: "Statin Associated Muscle Symptoms"] StatinMuscleSymptom
          where ( StatinMuscleSymptom.isProblemListItem ( )
              or StatinMuscleSymptom.isHealthConcern ( )
          )
            and StatinMuscleSymptom.prevalenceInterval ( ) overlaps day of "Measurement Period"
            and StatinMuscleSymptom.isActive ( )
      )
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Has ESRD Diagnosis
    define "Has ESRD Diagnosis":
      exists ( [Condition: "End Stage Renal Disease"] ESRD
          where ( ESRD.isProblemListItem ( )
              or ESRD.isHealthConcern ( )
          )
            and ESRD.prevalenceInterval ( ) overlaps day of "Measurement Period"
            and ESRD.isActive ( )
      )
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Has Adverse Reaction to Statin
    define "Has Adverse Reaction to Statin":
      exists ( [AdverseEvent: event in "Statin Allergen"] StatinReaction
          where StatinReaction.recordedDate during day of "Measurement Period"
      )
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Has Medical Reason for Not Ordering Statin Therapy
    define "Has Medical Reason for Not Ordering Statin Therapy":
      exists ( ( [MedicationNotRequested: "Low Intensity Statin Therapy"]
          union [MedicationNotRequested: "Moderate Intensity Statin Therapy"]
          union [MedicationNotRequested: "High Intensity Statin Therapy"] ) NoStatinTherapyOrdered
          with "Qualifying Encounter during day of Measurement Period" QualifyingEncounter
            such that NoStatinTherapyOrdered.authoredOn during QualifyingEncounter.period
              and NoStatinTherapyOrdered.status = 'completed'
              and NoStatinTherapyOrdered.reasonCode in "Medical Reason"
      )
Library Name | Name
StatinTherapyforthePreventionandTreatmentofCardiovascularDiseaseFHIR | Denominator Exceptions
    define "Denominator Exceptions":
      "Has Allergy to Statin"
        or Hospice."Has Hospice Services"
        or PalliativeCare."Has Palliative Care in the Measurement Period"
        or "Has Hepatitis or Liver Disease Diagnosis"
        or "Has Statin Associated Muscle Symptoms"
        or "Has ESRD Diagnosis"
        or "Has Adverse Reaction to Statin"
        or "Has Medical Reason for Not Ordering Statin Therapy"