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: Controlling High Blood PressureFHIR

Official URL: http://ecqi.healthit.gov/ecqms/Measure/ControllingHighBloodPressureFHIR | Version: 0.0.001
Draft as of 2023-09-07 | Responsible: National Committee for Quality Assurance | Computable Name: ControllingHighBloodPressureFHIR
Other Identifiers: Short Name (use: usual, ), UUID:9017d914-6748-45a9-bff1-8392ed644a7b (use: official, ), UUID:e254a6be-bec3-4304-87bc-d85ad3d8fa39 (use: official, ), Publisher (use: official, )
Usage:Program: EP/EC
Copyright/Legal: This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2022 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications. CPT(R) codes, descriptions and other data are copyright 2022. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 copyright 2022 World Health Organization. All Rights Reserved.

Percentage of patients 18-85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period, and whose most recent blood pressure was adequately controlled (<140/90 mmHg) during the measurement period

UNKNOWN

Title: | Controlling High Blood PressureFHIR
Id: | ControllingHighBloodPressureFHIR
Download cql: | ControllingHighBloodPressureFHIR.cql
Version: | 0.0.001
Url: | Controlling High Blood PressureFHIR
short-name identifier: | CMS165FHIR
version-independent identifier: | urn:uuid:9017d914-6748-45a9-bff1-8392ed644a7b
version-specific identifier: | urn:uuid:e254a6be-bec3-4304-87bc-d85ad3d8fa39
publisher (CMS) identifier: | 165FHIR
Effective Period: | 2024-01-01 ..2024-12-31
Status: | draft
Date: | 2023-09-07 19:36:39+0000
Approval Date: | 2023-08-28
Last Review Date: | 2023-08-28
Name: | ControllingHighBloodPressureFHIR
Publisher: | National Committee for Quality Assurance
Author: | National Committee for Quality Assurance: https://www.ncqa.org/
Description: | Percentage of patients 18-85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period, and whose most recent blood pressure was adequately controlled (<140/90 mmHg) during the measurement period
Use Context: |
code | value
--- | ---
program |
Purpose: | UNKNOWN
Copyright: | This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2022 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications. CPT(R) codes, descriptions and other data are copyright 2022. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 copyright 2022 World Health Organization. All Rights Reserved.
Disclaimer: | The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Rationale: | High blood pressure (HBP), also known as hypertension, is when the pressure in blood vessels is higher than normal (Centers for Disease Control and Prevention [CDC], 2021). The causes of hypertension are multiple and multifaceted and can be based on genetic predisposition, environmental risk factors, being overweight and obese, sodium intake, potassium intake, physical activity, and alcohol use. High blood pressure is common; according to the American Heart Association, between 2013-2016, approximately 121.5 million US adults >= 20 years of age had HBP and the prevalence of hypertension among US adults 65 and older was 77.0 percent (Virani et al., 2021). In an analysis of adults with hypertension in NHANES, the estimated age-adjusted proportion with controlled BP increased from 31.8 percent in 1999 to 53.8 percent in 2014. However, that proportion declined to 43.7 percent in 2017 to 2018 (Tsao et al., 2022). HBP, known as the “silent killer,” increases risks of heart disease and stroke which are two of the leading causes of death in the US; a person who has HBP is four times more likely to die from a stroke and three times more likely to die from heart disease (CDC, 2012). The National Center for Health Statistics reported that in 2020 there were over 670,000 deaths with HBP as a primary or contributing cause (CDC, 2022). Between 2009 and 2019 the number of deaths due to HBP rose by 65.3 percent (Tsao et al., 2022). Managing and treating HBP would reduce cardiovascular disease mortality for males and females by 30.4 percent and 38.0 percent, respectively (Patel et al., 2015). Age-adjusted death rates attributable to HBP in 2019 were more than twice as high in non-Hispanic Black males (56.7 percent) when compared to rates for non-Hispanic White males (25.7 percent) (Tsao et al., 2022). HBP costs the U.S. approximately 131 billion dollars each year, averaged over 12 years from 2003 to 2014 (Kirkland et al., 2018). A study on cost-effectiveness on treating hypertension found that controlling HBP in patients with cardiovascular disease and systolic blood pressures (SBP) of >= 160 mmHg could be effective and cost-saving (Moran, 2015). Many studies have shown that controlling high blood pressure reduces cardiovascular events and mortality. The Systolic Blood Pressure Intervention Trial (SPRINT) investigated the impact of obtaining a SBP goal of <120 mmHg compared to a SBP goal of <140 mmHg among patients 50 and older with established cardiovascular disease and found that the patients with the former goal had reduced cardiovascular events and mortality (SPRINT Research Group et al., 2015). Controlling HBP will significantly reduce the risks of cardiovascular disease mortality and lead to better health outcomes like reduction of heart attacks, stroke, and kidney disease (James et al., 2014). Thus, the relationship between the measure (control of hypertension) and the long-term clinical outcomes listed is well established.
Clinical recommendation statement: | U.S. Preventive Services Task Force (USPSTF) (2021): The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement (OBPM). The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. This is a grade A recommendation. American College of Cardiology/American Heart Association (2017): For adults with confirmed hypertension and known CVD or 10-year ASCVD event risk of 10 percent or higher, a blood pressure target of less than 130/80 mmHg is recommended (Level of evidence: B-R (for systolic blood pressures), Level of evidence: C-EO (for diastolic blood pressure)) For adults with confirmed hypertension, without additional markers of increased CVD risk, a blood pressure target of less than 130/80 mmHg may be reasonable (Note: clinical trial evidence is strongest for a target blood pressure of 140/90 mmHg in this population. However, observational studies suggest that these individuals often have a high lifetime risk and would benefit from blood pressure control earlier in life) (Level of evidence: B-NR (for systolic blood pressure), Level of evidence: C-EO (for diastolic blood pressure)). American College of Physicians and the American Academy of Family Physicians (2017): Initiate or intensify pharmacologic treatment in some adults aged 60 years or older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mmHg (Grade: weak recommendation, Quality of evidence: low) Initiate or intensify pharmacologic treatment in adults aged 60 years or older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mmHg to reduce the risk of recurrent stroke (Grade: weak recommendation, Quality of evidence: moderate) American Diabetes Association (2021): For individuals with diabetes and hypertension at higher cardiovascular risk (existing atherosclerotic cardiovascular disease or 10-year atherosclerotic cardiovascular disease risk >=15 percent), a blood pressure target of <130/80 mmHg may be appropriate, if it can be safely attained (Level of evidence: C) For individuals with diabetes and hypertension at lower risk for cardiovascular disease (10-year atherosclerotic cardiovascular disease risk <15 percent), treat to a blood pressure target of <140/90 mmHg (Level of evidence: A)
Guidance (Usage): | In reference to the numerator element, only blood pressure readings performed by a clinician or an automated blood pressure monitor or device are acceptable for numerator compliance with this measure. This includes blood pressures taken in person by a clinician and blood pressures measured remotely by electronic monitoring devices capable of transmitting the blood pressure data to the clinician. Blood pressure readings taken by an automated blood pressure monitor or device and conveyed by the patient to the clinician are also acceptable. It is the clinician’s responsibility and discretion to confirm the automated blood pressure monitor or device used to obtain the blood pressure is considered acceptable and reliable and whether the blood pressure reading is considered accurate before documenting it in the patient’s medical record. Do not include BP readings taken during an acute inpatient stay or an ED visit. If no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed "not controlled". If there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading. Ranges and thresholds do not meet criteria for this measure. A distinct numeric result for both the systolic and diastolic BP reading is required for numerator compliance. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS165v12. Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html).
Population Criteria: |
643716e4d4d7050edabb0444
Initial Population: | Patients 18-85 years of age by the end of the measurement period who had a visit during the meaurement period and diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period
Denominator: | Equals Initial Population
Denominator Exclusion: | Patients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period. Also exclude patients with a diagnosis of pregnancy during the measurement period. Exclude patients who are in hospice care for any part of the measurement period. Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients 66-80 by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness with two outpatient encounters during the measurement period or the year prior - OR advanced illness with one inpatient encounter during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients 81 and older by the end of the measurement period with an indication of frailty for any part of the measurement period. Exclude patients receiving palliative care for any part of the measurement period.
Denominator Exception: | None
Numerator: | Patients whose most recent blood pressure is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement period
Numerator Exclusion: | None
Supplemental Data Guidance : |
Supplemental Data Elements: | SDE Ethnicity SDE Payer SDE Race SDE Sex
Libraries: |
ControllingHighBloodPressureFHIR
Related Artifact Dependencies: | SupplementalDataElements version: 3.4.000 Status version: 1.6.000 FHIRHelpers version: 4.3.000 QICoreCommon version: 1.5.000 AdultOutpatientEncounters version: 4.6.000 Hospice version: 6.7.000 AdvancedIllnessandFrailty version: 1.6.000 CQMCommon version: 1.4.000 CumulativeMedicationDuration version: 3.3.000 PalliativeCare version: 1.7.000 LOINC SNOMED CT (all versions) Observation Category Codes Essential Hypertension Office Visit Annual Wellness Visit Preventive Care Services - Established Office Visit, 18 and Up Preventive Care Services-Initial Office Visit, 18 and Up Home Healthcare Services Virtual Encounter Telephone Visits Payer Encounter Inpatient Hospice Encounter Hospice Care Ambulatory Hospice Diagnosis Pregnancy End Stage Renal Disease Kidney Transplant Recipient Chronic Kidney Disease, Stage 5 Kidney Transplant Dialysis Services ESRD Monthly Outpatient Services Frailty Device Frailty Diagnosis Frailty Encounter Frailty Symptom Outpatient Observation Emergency Department Visit Nonacute Inpatient Advanced Illness Acute Inpatient Dementia Medications Palliative Care Diagnosis Palliative Care Encounter Palliative Care Intervention
Parameters: |
name | use | min | max | type
--- | --- | --- | --- | ---
Measurement Period | In | 0 | 1 | Period
ErrorLevel | In | 0 | 1 | string
SDE Sex | Out | 0 | 1 | Coding
Numerator | Out | 0 | 1 | boolean
Denominator | Out | 0 | 1 | boolean
SDE Payer | Out | 0 | * | Resource
Initial Population | Out | 0 | 1 | boolean
SDE Ethnicity | Out | 0 | 1 | Resource
Denominator Exclusions | Out | 0 | 1 | boolean
SDE Race | Out | 0 | 1 | Resource
DataRequirements: |
Type | Elements | Valueset Name | Valueset
--- | --- | --- | ---
Patient(QICorePatient) |  |  |
Patient(QICorePatient) | url extension |  |
Patient(QICorePatient) | url extension |  |
Encounter(QICoreEncounter) | id id.value |  |
Encounter(QICoreEncounter) | type hospitalization hospitalization.dischargeDisposition period | Encounter Inpatient | Encounter Inpatient
Encounter(QICoreEncounter) | type period | Hospice Encounter | Hospice Encounter
Encounter(QICoreEncounter) | type period | ESRD Monthly Outpatient Services | ESRD Monthly Outpatient Services
Encounter(QICoreEncounter) | type period | Frailty Encounter | Frailty Encounter
Encounter(QICoreEncounter) | type period | Acute Inpatient | Acute Inpatient
Encounter(QICoreEncounter) | type period | Palliative Care Encounter | Palliative Care Encounter
Observation(Observation Blood Pressure Profile) | encounter encounter.class encounter.class.code effective component |  |
Condition(QICoreCondition) | code | Essential Hypertension | Essential Hypertension
Condition(QICoreCondition) | code | Hospice Diagnosis | Hospice Diagnosis
Condition(QICoreCondition) | code | Frailty Diagnosis | Frailty Diagnosis
Condition(QICoreCondition) | id id.value |  |
Condition(QICoreCondition) | code | Palliative Care Diagnosis | Palliative Care Diagnosis
Coverage(QICoreCoverage) | type period | Payer Type | Payer
Observation(QICoreObservation) | code value effective |  |
Observation(QICoreObservation) | code value effective |  |
Observation(QICoreObservation) | code effective | Frailty Symptom | Frailty Symptom
Observation(QICoreObservation) | code effective value |  |
Observation(QICoreObservation) | code effective value |  |
Observation(QICoreObservation) | code effective |  |
ServiceRequest(QICoreServiceRequest) | code authoredOn authoredOn.value | Hospice Care Ambulatory | Hospice Care Ambulatory
Procedure(QICoreProcedure) | code performed | Hospice Care Ambulatory | Hospice Care Ambulatory
Procedure(QICoreProcedure) | code performed | Palliative Care Intervention | Palliative Care Intervention
Direct Reference Codes: |
display | code | system
--- | --- | ---
Systolic blood pressure | 8480-6 | http://loinc.org
Diastolic blood pressure | 8462-4 | http://loinc.org
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
Medical equipment used | 98181-1 | http://loinc.org
Housing status | 71802-3 | http://loinc.org
Lives in a nursing home (finding) | 160734000 | 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
--- | --- | --- | ---
643716e4d4d7050edabb0444 | Group scoring: proportion
|  | Initial Population |
    define "Initial Population":
      AgeInYearsAt(date from
        end of "Measurement Period"
      ) in Interval[18, 85]
        and exists "Essential Hypertension Diagnosis"
        and exists AdultOutpatientEncounters."Qualifying Encounters"
|  | Denominator |
    define "Denominator":
      "Initial Population"
|  | Denominator Exclusion |
    define "Denominator Exclusions":
      Hospice."Has Hospice Services"
        or exists ( "Pregnancy or Renal Diagnosis" )
        or exists ( "End Stage Renal Disease Procedures" )
        or exists ( "End Stage Renal Disease Encounter" )
        or AIFrailLTCF."Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty"
        or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home"
        or PalliativeCare."Has Palliative Care in the Measurement Period"
|  | Denominator Exception | None
|  | Numerator |
    define "Numerator":
      "Has Systolic Blood Pressure Less Than 140"
        and "Has Diastolic Blood Pressure Less Than 90"
|  | Numerator Exclusion | None

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
ControllingHighBloodPressureFHIR | SDE Sex
    define "SDE Sex":
      SDE."SDE Sex"
Library Name | Name
ControllingHighBloodPressureFHIR | Qualifying Systolic Blood Pressure Reading
    define "Qualifying Systolic Blood Pressure Reading":
      ( ( ["observation-bp"] ).isObservationBP ( ) ) BloodPressure
        where ( not ( ( BloodPressure.encounter.getEncounter ( ) ).class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS' } ) )
          and BloodPressure.effective.latest ( ) during day of "Measurement Period"
Library Name | Name
ControllingHighBloodPressureFHIR | Qualifying Diastolic Blood Pressure Reading
    define "Qualifying Diastolic Blood Pressure Reading":
      ( ( ["observation-bp"] ).isObservationBP ( ) ) BloodPressure
        where ( not ( ( BloodPressure.encounter.getEncounter ( ) ).class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS' } ) )
          and BloodPressure.effective.latest ( ) during day of "Measurement Period"
Library Name | Name
ControllingHighBloodPressureFHIR | Blood Pressure Days
    define "Blood Pressure Days":
      ( "Qualifying Diastolic Blood Pressure Reading" DBPExam
          return date from DBPExam.effective.latest ( )
      )
        intersect ( "Qualifying Systolic Blood Pressure Reading" SBPExam
            return date from SBPExam.effective.latest ( )
        )
Library Name | Name
ControllingHighBloodPressureFHIR | Most Recent Blood Pressure Day
    define "Most Recent Blood Pressure Day":
      Last("Blood Pressure Days" BPDays
          sort asc
      )
Library Name | Name
ControllingHighBloodPressureFHIR | Lowest Systolic Reading on Most Recent Blood Pressure Day
    define "Lowest Systolic Reading on Most Recent Blood Pressure Day":
      First("Qualifying Systolic Blood Pressure Reading" SBPReading
          where SBPReading.effective.latest() same day as "Most Recent Blood Pressure Day"
          return singleton from(SBPReading.component SBPComponent
              where SBPComponent.code ~ "Systolic blood pressure"
              return SBPComponent.value as Quantity
          )
          sort asc
      )
Library Name | Name
ControllingHighBloodPressureFHIR | Has Systolic Blood Pressure Less Than 140
    define "Has Systolic Blood Pressure Less Than 140":
      "Lowest Systolic Reading on Most Recent Blood Pressure Day" < 140 'mm[Hg]'
Library Name | Name
ControllingHighBloodPressureFHIR | Lowest Diastolic Reading on Most Recent Blood Pressure Day
    define "Lowest Diastolic Reading on Most Recent Blood Pressure Day":
      First("Qualifying Diastolic Blood Pressure Reading" DBPReading
          where DBPReading.effective.latest() same day as "Most Recent Blood Pressure Day"
          return singleton from(DBPReading.component DBPComponent
              where DBPComponent.code ~ "Diastolic blood pressure"
              return DBPComponent.value as Quantity
          )
          sort asc
      )
Library Name | Name
ControllingHighBloodPressureFHIR | Has Diastolic Blood Pressure Less Than 90
    define "Has Diastolic Blood Pressure Less Than 90":
      "Lowest Diastolic Reading on Most Recent Blood Pressure Day" < 90 'mm[Hg]'
Library Name | Name
ControllingHighBloodPressureFHIR | Numerator
    define "Numerator":
      "Has Systolic Blood Pressure Less Than 140"
        and "Has Diastolic Blood Pressure Less Than 90"
Library Name | Name
ControllingHighBloodPressureFHIR | Essential Hypertension Diagnosis
    define "Essential Hypertension Diagnosis":
      ( [Condition: "Essential Hypertension"] ) Hypertension
        where Hypertension.prevalenceInterval ( ) overlaps Interval[start of "Measurement Period", start of "Measurement Period" + 6 months )
Library Name | Name
AdultOutpatientEncounters | Qualifying Encounters
    define "Qualifying Encounters":
      ( ( [Encounter: "Office Visit"]
        union [Encounter: "Annual Wellness Visit"]
        union [Encounter: "Preventive Care Services Established Office Visit, 18 and Up"]
        union [Encounter: "Preventive Care Services Initial Office Visit, 18 and Up"]
        union [Encounter: "Home Healthcare Services"]
        union [Encounter: "Online Assessments"]
        union [Encounter: "Telephone Visits"] ).isEncounterPerformed() ) ValidEncounter
        where ValidEncounter.period.toInterval() during day of "Measurement Period"
Library Name | Name
ControllingHighBloodPressureFHIR | Initial Population
    define "Initial Population":
      AgeInYearsAt(date from
        end of "Measurement Period"
      ) in Interval[18, 85]
        and exists "Essential Hypertension Diagnosis"
        and exists AdultOutpatientEncounters."Qualifying Encounters"
Library Name | Name
ControllingHighBloodPressureFHIR | Denominator
    define "Denominator":
      "Initial Population"
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
ControllingHighBloodPressureFHIR | 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
ControllingHighBloodPressureFHIR | SDE Ethnicity
    define "SDE Ethnicity":
      SDE."SDE Ethnicity"
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
ControllingHighBloodPressureFHIR | Pregnancy or Renal Diagnosis
    define "Pregnancy or Renal Diagnosis":
      ( [Condition: "Pregnancy"]
        union [Condition: "End Stage Renal Disease"]
        union [Condition: "Kidney Transplant Recipient"]
        union [Condition: "Chronic Kidney Disease, Stage 5"] ) PregnancyESRDDiagnosis
        where PregnancyESRDDiagnosis.prevalenceInterval ( ) overlaps "Measurement Period"
Library Name | Name
ControllingHighBloodPressureFHIR | End Stage Renal Disease Procedures
    define "End Stage Renal Disease Procedures":
      ( ( [Procedure: "Kidney Transplant"]
          union [Procedure: "Dialysis Services"]
      ).isProcedurePerformed ( ) ) ESRDProcedure
        where ESRDProcedure.performed.toInterval ( ) ends on or before end of "Measurement Period"
Library Name | Name
ControllingHighBloodPressureFHIR | End Stage Renal Disease Encounter
    define "End Stage Renal Disease Encounter":
      ( ( [Encounter: "ESRD Monthly Outpatient Services"] ).isEncounterPerformed ( ) ) ESRDEncounter
        where ESRDEncounter.period.toInterval ( ) starts on or before end of "Measurement Period"
Library Name | Name
AdvancedIllnessandFrailty | Has Criteria Indicating Frailty
    define "Has Criteria Indicating Frailty":
      exists ( (([DeviceRequest: "Frailty Device"]).isDeviceOrder()) FrailtyDeviceOrder
          where FrailtyDeviceOrder.doNotPerform() is not true
          and FrailtyDeviceOrder.authoredOn.toInterval() during day of "Measurement Period"
      )
        or exists ( (([Observation: "Medical equipment used"]).isAssessmentPerformed()) EquipmentUsed
            where EquipmentUsed.value as Concept in "Frailty Device"
            and EquipmentUsed.effective.toInterval() ends during day of "Measurement Period"
        )
        or exists ( ([Condition: "Frailty Diagnosis"]) FrailtyDiagnosis
            where FrailtyDiagnosis.prevalenceInterval() overlaps "Measurement Period"
        )
        or exists ( (([Encounter: "Frailty Encounter"]).isEncounterPerformed()) FrailtyEncounter
            where FrailtyEncounter.period.toInterval() overlaps "Measurement Period"
        )
        or exists ( (([Observation: "Frailty Symptom"]).isSymptom()) FrailtySymptom
            where FrailtySymptom.effective.toInterval() overlaps "Measurement Period"
        )
Library Name | Name
AdvancedIllnessandFrailty | Outpatient Encounters with Advanced Illness
    define "Outpatient Encounters with Advanced Illness":
       (( [Encounter: "Outpatient"]
        union [Encounter: "Observation"]
        union [Encounter: "Emergency Department Evaluation and Management Visit"]
        union [Encounter: "Nonacute Inpatient"] ).isEncounterPerformed()) OutpatientEncounter
          where exists ((OutpatientEncounter.encounterDiagnosis()) Diagnosis where Diagnosis.code in "Advanced Illness")
            and OutpatientEncounter.period.toInterval() starts during day of Interval[start of "Measurement Period" - 1 year,
            end of "Measurement Period"]
Library Name | Name
AdvancedIllnessandFrailty | Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service
    define "Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service":
      exists ( from
          "Outpatient Encounters with Advanced Illness" OutpatientEncounter1,
          "Outpatient Encounters with Advanced Illness" OutpatientEncounter2
          where OutpatientEncounter2.period ends 1 day or more after day of
          end of OutpatientEncounter1.period
          return OutpatientEncounter1
      )
Library Name | Name
AdvancedIllnessandFrailty | Has Inpatient Encounter with Advanced Illness
    define "Has Inpatient Encounter with Advanced Illness":
      exists ( ( ([Encounter: "Acute Inpatient"]).isEncounterPerformed()) InpatientEncounter
          where exists ((InpatientEncounter.encounterDiagnosis()) Diagnosis where Diagnosis.code in "Advanced Illness")
            and InpatientEncounter.period.toInterval() starts during day of Interval[start of "Measurement Period" - 1 year,
              end of "Measurement Period"]
      )
Library Name | Name
AdvancedIllnessandFrailty | Has Dementia Medications in Year Before or During Measurement Period
    define "Has Dementia Medications in Year Before or During Measurement Period":
      exists (( ([MedicationRequest: "Dementia Medications"]).isMedicationActive()) DementiaMedication
          where DementiaMedication.doNotPerform is not true and
          CMD."MedicationRequestPeriod" ( DementiaMedication ) overlaps Interval[start of "Measurement Period" - 1 year,
            end of "Measurement Period"]
      )
Library Name | Name
AdvancedIllnessandFrailty | Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty
    define "Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty":
      ( AgeInYearsAt(date from end of "Measurement Period")in Interval[66, 80]
          and "Has Criteria Indicating Frailty"
          and ( "Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service"
              or "Has Inpatient Encounter with Advanced Illness"
              or "Has Dementia Medications in Year Before or During Measurement Period"
          )
      )
        or ( AgeInYearsAt(date from end of "Measurement Period")>= 81
            and "Has Criteria Indicating Frailty"
        )
Library Name | Name
AdvancedIllnessandFrailty | Is Age 66 or Older Living Long Term in a Nursing Home
    define "Is Age 66 or Older Living Long Term in a Nursing Home":
      AgeInYearsAt(date from
         end of "Measurement Period"
      )>= 66
        and ( ( Last( (([Observation: "Housing status"]).isAssessmentPerformed()) HousingStatus
              where HousingStatus.effective.toInterval() ends on or before
              end of "Measurement Period"
              sort by
              end of effective.toInterval() asc
          )) LastHousingStatus
            where LastHousingStatus.value ~ "Lives in a nursing home (finding)"
        ) is not null
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
ControllingHighBloodPressureFHIR | Denominator Exclusions
    define "Denominator Exclusions":
      Hospice."Has Hospice Services"
        or exists ( "Pregnancy or Renal Diagnosis" )
        or exists ( "End Stage Renal Disease Procedures" )
        or exists ( "End Stage Renal Disease Encounter" )
        or AIFrailLTCF."Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty"
        or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home"
        or PalliativeCare."Has Palliative Care in the 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
ControllingHighBloodPressureFHIR | SDE Race
    define "SDE Race":
      SDE."SDE Race"