{"resourceType":"Measure","id":"measure-EXM55-FHIR","contained":[{"resourceType":"Library","id":"EXM55","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-wg","valueCode":"cqi"}],"url":"http://hl7.org/fhir/uv/cqm/Library/EXM55","identifier":[{"use":"official","system":"http://example.org/fhir/cqi/ecqm/Library/Identifier","value":"EXM55"}],"version":"5.0.0","name":"EXM55","title":"EXM55 - Median Emergency Department Visit Duration Library (Example Continuous Variable Measure Library)","status":"active","experimental":true,"type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/library-type","code":"logic-library"}]},"date":"2019-09-03","publisher":"HL7 International / Clinical Quality Information","contact":[{"telecom":[{"system":"url","value":"http://www.hl7.org/Special/committees/cqi"}]}],"description":"This library is used as an example in the FHIR Continuous Variable Measure 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"identifier":[{"use":"official","system":"http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm","value":"55"}],"version":"5.0.0","name":"EXM55","title":"EXM55 - Median Emergency Department Visit Duration","status":"active","experimental":true,"date":"2025-08-13","publisher":"HL7 International / Clinical Quality Information","contact":[{"telecom":[{"system":"url","value":"http://www.hl7.org/Special/committees/cqi"}]}],"description":"This example illustrates a continuous variable measure represented as a FHIR eCQM","useContext":[{"code":{"system":"http://terminology.hl7.org/CodeSystem/usage-context-type","code":"venue","display":"Clinical 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improvement"}]},"population":[{"linkId":"primary-exm55-initial-population","code":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-population","code":"initial-population","display":"Initial Population"}]},"criteria":{"language":"text/cql-identifier","expression":"Initial Population"}},{"linkId":"primary-exm55-measure-population","code":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-population","code":"measure-population","display":"Measure Population"}]},"criteria":{"language":"text/cql-identifier","expression":"Measure Population"}},{"linkId":"primary-exm55-measure-population-exclusion","code":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-population","code":"measure-population-exclusion","display":"Measure Population Exclusion"}]},"criteria":{"language":"text/cql-identifier","expression":"Measure Population Exclusion"}},{"linkId":"primary-exm55-measure-population-identifier","code":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-population","code":"measure-observation","display":"Measure Observation"}]},"criteria":{"language":"text/cql-identifier","expression":"Measure Observation"},"inputPopulationId":"measure-population-identifier","aggregateMethod":{"coding":[{"system":"http://hl7.org/fhir/CodeSystem/measure-aggregate-method","code":"median","display":"Median"}]}}],"stratifier":[{"linkId":"primary-exm55-stratification-1","code":{"coding":[{"system":"http://example.org/stratification","code":"Stratification 1","display":"Stratification 1"}]},"criteria":{"language":"text/cql-identifier","expression":"Stratification 1"}},{"linkId":"primary-exm55-stratification-2","code":{"coding":[{"system":"http://example.org/stratification","code":"Stratification 2","display":"Stratification 2"}]},"criteria":{"language":"text/cql-identifier","expression":"Stratification 2"}},{"linkId":"primary-exm55-stratification-3","code":{"coding":[{"system":"http://example.org/stratification","code":"Stratification 3","display":"Stratification 3"}]},"criteria":{"language":"text/cql-identifier","expression":"Stratification 3"}}]}]}
{"resourceType":"Measure","id":"measure-hybrid-hospital-wide-mortality","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-wg","valueCode":"cqi"}],"url":"http://somewhere.org/fhir/uv/mycontentig/Measure/HybridHospitalWideMortalityFHIRExample","identifier":[{"use":"official","value":"hospital-wide-mortality-measure"}],"version":"0.5.3","name":"HybridHospitalWideMortality","title":"Core Clinical Data Elements for the Hybrid Hospital-Wide (All-Condition, All-Procedure) Risk-Standardized Mortality Measure (HWM) FHIR Example","status":"draft","experimental":false,"date":"2025-09-30T04:16:55+00:00","publisher":"HL7 International / Clinical Quality Information","contact":[{"telecom":[{"system":"url","value":"http://www.hl7.org/Special/committees/cqi"}]}],"description":"This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWM outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from encounters for adult Medicare Fee-For-Service patients admitted to acute care short stay hospitals.","copyright":"Limited proprietary coding is contained in these specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets.\n\nThis material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2021 International Health Terminology Standards Development Organisation. All rights reserved.\n\nLOINC(R) copyright 2004-2021 Regenstrief Institute, Inc.","approvalDate":"2023-08-14","lastReviewDate":"2023-08-14","effectivePeriod":{"start":"2024-07-01","end":"2025-06-30"},"library":["http://somewhere.org/fhir/uv/mycontentig/Library/HybridHospitalWideMortalityFHIRExample"],"disclaimer":"These performance specifications are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.\n\nTHE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.\n\nDue to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].","rationale":"The intent of this logic is to extract the FIRST set of clinical data elements from hospital electronic health records (EHRs) for all qualifying encounters. The data will be linked with administrative claims to risk adjust the Hybrid HWM outcome measure. This work addresses stakeholder concerns that clinical data garnered from patients, and used by clinicians to guide diagnostic decisions and treatment, are preferable to administrative claims data when profiling hospitals’ case mix. We are calling the list of data elements for extraction the \"HWM-specific core clinical data elements\". The core clinical data elements are the first set of vital signs and basic laboratory tests resulted from encounters for adult patients, age 65 to 94 (Initial Population), after they arrive at the hospital to which they are subsequently admitted. For example, this first set of data values are often captured in the emergency department or in the pre-operative area, sometimes hours before a patient is admitted to that same facility. \nEncounters over the age of 94 are not included to avoid holding hospitals responsible for the survival of the oldest elderly patients, who may be less likely to have survival as a primary goal. While we acknowledge that many elderly patients do have survival beyond 30 days as a primary goal for their hospitalization, with input from our Technical Expert Panel and work groups, we decided to only include encounters between 65 and 94 years of age.\n\nThese core clinical data elements were selected because they: 1. reflect patients\u0027 clinical status when they first present to the hospital; 2. are clinically and statistically relevant to patient outcomes; 3. are consistently obtained on adult inpatient encounters based on current clinical practice; 4. are captured with a standard definition and recorded in a standard format across providers; and 5. are entered in structured fields that are feasibly retrieved from current EHR systems (YNHHSC/CORE, 2015). \n\nAdditional data called Linking Variables are used to link EHR data files with administrative claims data for CMS to calculate results for the measure, which are: date of birth; sex; admission date; and discharge date.","clinicalRecommendationStatement":"The logic is not meant to guide or alter the care patients receive. The purpose of this core clinical data elements logic is to extract clinical data that are already routinely captured in EHRs from encounters for hospitalized adult patients. It is not intended to require that clinical staff perform additional measurements or tests that are not needed for diagnostic assessment or treatment of patients.","group":[{"id":"6385011c4ba3d47c885c02aa","type":[{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-type","code":"outcome","display":"Outcome"}]}],"basis":"Encounter","scoring":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-scoring","code":"cohort","display":"Cohort"}]},"population":[{"id":"24BB5BA9-820F-4958-B8AA-AA8962E9E398","code":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-population","code":"initial-population","display":"Initial Population"}]},"description":"All encounters age 65 to 94 years at the start of an inpatient admission, who are discharged during the measurement period (length of stay \u003c365 days).\n\nNOTE: All encounters meeting the above criteria should be included.","criteria":{"language":"text/cql-identifier","expression":"Initial Population"}}]}],"supplementalData":[{"id":"results","usage":[{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-data-usage","code":"supplemental-data"}]}],"description":"Results","criteria":{"language":"text/cql-identifier","expression":"Results"}}]}
{"resourceType":"Measure","id":"component-a-example","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eScreening for Alcohol Misuse\n    \n      \u003cp\u003eThis measure example is used to illustrate how a composite measure can be constructured. This measure is one component of the composite measure.\u003c/p\u003e\n    \u003c/div\u003e"},"extension":[{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-wg","valueCode":"cqi"}],"name":"ScreeningForAlcoholMisuse","title":"Screening for Alcohol Misuse","status":"draft","publisher":"HL7 International / Clinical Quality Information","contact":[{"telecom":[{"system":"url","value":"http://www.hl7.org/Special/committees/cqi"}]}],"description":"Screening for Alcohol Misuse","group":[{"id":"Main","population":[{"code":{"coding":[{"code":"initial-population"}]},"criteria":{"language":"text/cql-identifier","expression":"Initial Population"}},{"code":{"coding":[{"code":"denominator"}]},"criteria":{"language":"text/cql-identifier","expression":"Denominator"}},{"code":{"coding":[{"code":"numerator"}]},"criteria":{"language":"text/cql-identifier","expression":"Numerator"}}]}]}
{"resourceType":"Measure","id":"measure-exclusive-breastfeeding","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003e\n      \u003ctable class\u003d\"grid dict\"\u003e\n        \u003ctr\u003e\n          \u003ctd\u003e\n            \u003cb\u003eId: \u003c/b\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n        \u003ctr\u003e\n          \u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003eMeasure/measure-exclusive-breastfeeding\u003c/td\u003e\n        \u003c/tr\u003e\n      \u003c/table\u003e\n      \u003cp/\u003e\n      \u003ctable class\u003d\"grid dict\"\u003e\n        \u003ctr\u003e\n          \u003ctd\u003e\n            \u003cb\u003eIdentifier: \u003c/b\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n        \u003ctr\u003e\n          \u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003e\n            \u003cb\u003evalue: \u003c/b\u003e\n            \u003cspan\u003eexclusive-breastfeeding-measure\u003c/span\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n      \u003c/table\u003e\n      \u003cp/\u003e\n      \u003ctable class\u003d\"grid dict\"\u003e\n        \u003ctr\u003e\n          \u003ctd\u003e\n            \u003cb\u003eTitle: \u003c/b\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n        \u003ctr\u003e\n          \u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003eExclusive Breastfeeding Measure\u003c/td\u003e\n        \u003c/tr\u003e\n      \u003c/table\u003e\n      \u003cp/\u003e\n      \u003ctable class\u003d\"grid dict\"\u003e\n        \u003ctr\u003e\n          \u003ctd\u003e\n            \u003cb\u003eStatus: \u003c/b\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n        \u003ctr\u003e\n          \u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003eactive\u003c/td\u003e\n        \u003c/tr\u003e\n      \u003c/table\u003e\n      \u003cp/\u003e\n      \u003ctable class\u003d\"grid dict\"\u003e\n        \u003ctr\u003e\n          \u003ctd\u003e\n            \u003cb\u003eDescription: \u003c/b\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n        \u003ctr\u003e\n          \u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003eExclusive breastfeeding measure of outcomes for exclusive breastmilk feeding of newborns.\u003c/td\u003e\n        \u003c/tr\u003e\n      \u003c/table\u003e\n      \u003cp/\u003e\n      \u003ctable class\u003d\"grid dict\"\u003e\n        \u003ctr\u003e\n          \u003ctd\u003e\n            \u003cb\u003ePurpose: \u003c/b\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n        \u003ctr\u003e\n          \u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003eExclusive breast milk feeding for the first 6 months of neonatal life can result in numerous long-term health benefits for both mother and newborn and is recommended by a number of national and international organizations. Evidence suggests that the prenatal and intrapartum period is critical for the success of exclusive (or any) breast feeding. Therefore, it is recommended that newborns are fed breast milk only from birth to discharge.\u003c/td\u003e\n        \u003c/tr\u003e\n      \u003c/table\u003e\n      \u003cp/\u003e\n      \u003ctable class\u003d\"grid dict\"\u003e\n        \u003ctr\u003e\n          \u003ctd\u003e\n            \u003cb\u003eTopic: \u003c/b\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n        \u003ctr\u003e\n          \u003ctd style\u003d\"padding-right: 25px;\"\u003e\n            \u003cspan style\u003d\"padding-left: 25px;\"\u003e\n              \u003cb\u003etext: \u003c/b\u003e\n              \u003cspan\u003eExclusive Breastfeeding\u003c/span\u003e\n              \u003cbr/\u003e\n            \u003c/span\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n      \u003c/table\u003e\n      \u003cp/\u003e\n      \u003ctable class\u003d\"grid dict\"\u003e\n        \u003ctr\u003e\n          \u003ctd\u003e\n            \u003cb\u003eLibrary: \u003c/b\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n        \u003ctr\u003e\n          \u003ctd style\u003d\"padding-left: 25px; 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padding-right: 25px;\"\u003e\n            \u003cb\u003ePopulation:\u003c/b\u003e\n            \u003cbr/\u003e\n            \u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\n              \u003cb\u003etype:\u003c/b\u003e\n              \u003cspan\u003edenominator\u003c/span\u003e\n            \u003c/p\u003e\n            \u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\n              \u003cb\u003eIdentifier:\u003c/b\u003e\n              \u003cbr/\u003e\n              \u003cspan style\u003d\"padding-left: 25px;\"\u003e\n                \u003cb\u003evalue: \u003c/b\u003e\n                \u003cspan\u003edenominator-1-identifier\u003c/span\u003e\n                \u003cbr/\u003e\n              \u003c/span\u003e\n            \u003c/p\u003e\n            \u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\n              \u003cb\u003ecriteria: \u003c/b\u003e\n              \u003cspan\u003eDenominator1\u003c/span\u003e\n            \u003c/p\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n        \u003ctr\u003e\n          \u003ctd style\u003d\"padding-left: 25px; 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padding-right: 25px;\"\u003e\n            \u003cb\u003ePopulation:\u003c/b\u003e\n            \u003cbr/\u003e\n            \u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\n              \u003cb\u003etype:\u003c/b\u003e\n              \u003cspan\u003enumerator\u003c/span\u003e\n            \u003c/p\u003e\n            \u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\n              \u003cb\u003eIdentifier:\u003c/b\u003e\n              \u003cbr/\u003e\n              \u003cspan style\u003d\"padding-left: 25px;\"\u003e\n                \u003cb\u003evalue: \u003c/b\u003e\n                \u003cspan\u003enumerator-1-identifier\u003c/span\u003e\n                \u003cbr/\u003e\n              \u003c/span\u003e\n            \u003c/p\u003e\n            \u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\n              \u003cb\u003ecriteria: \u003c/b\u003e\n              \u003cspan\u003eNumerator1\u003c/span\u003e\n            \u003c/p\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n      \u003c/table\u003e\n      \u003ctable class\u003d\"grid dict\"\u003e\n        \u003ctr\u003e\n          \u003ctd\u003e\n            \u003cb\u003eGroup:\u003c/b\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n        \u003ctr\u003e\n          \u003ctd style\u003d\"padding-left: 25px; 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padding-left: 25px;\"\u003e\n              \u003cb\u003ecriteria: \u003c/b\u003e\n              \u003cspan\u003eDenominatorExclusions2\u003c/span\u003e\n            \u003c/p\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n        \u003ctr\u003e\n          \u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003e\n            \u003cb\u003ePopulation:\u003c/b\u003e\n            \u003cbr/\u003e\n            \u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\n              \u003cb\u003etype:\u003c/b\u003e\n              \u003cspan\u003enumerator\u003c/span\u003e\n            \u003c/p\u003e\n            \u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\n              \u003cb\u003eIdentifier:\u003c/b\u003e\n              \u003cbr/\u003e\n              \u003cspan style\u003d\"padding-left: 25px;\"\u003e\n                \u003cb\u003evalue: \u003c/b\u003e\n                \u003cspan\u003enumerator-2-identifier\u003c/span\u003e\n                \u003cbr/\u003e\n              \u003c/span\u003e\n            \u003c/p\u003e\n            \u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\n              \u003cb\u003ecriteria: \u003c/b\u003e\n              \u003cspan\u003eNumerator2\u003c/span\u003e\n            \u003c/p\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n      \u003c/table\u003e\n    \u003c/div\u003e"},"extension":[{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-wg","valueCode":"cqi"}],"identifier":[{"use":"official","value":"exclusive-breastfeeding-measure"}],"version":"6.0.0","name":"ExclusiveBreastfeedingMeasure","title":"Exclusive Breastfeeding Measure","status":"active","date":"2015-03-08","publisher":"HL7 International / Clinical Quality Information","contact":[{"telecom":[{"system":"url","value":"http://www.hl7.org/Special/committees/cqi"}]}],"description":"Exclusive breastfeeding measure of outcomes for exclusive breastmilk feeding of newborns.","purpose":"Measure of newborns who were fed breast milk only since birth","relatedArtifact":[{"type":"documentation","citation":"American Academy of Pediatrics. (2005). Section on Breastfeeding. Policy Statement:Breastfeeding and the Use of Human Milk. Pediatrics.115:496-506."},{"type":"documentation","citation":"American College of Obstetricians and Gynecologists. (Feb. 2007). Committee on Obstetric Practice and Committee on Health Care for Underserved Women. Breastfeeding: Maternal and Infant Aspects. ACOG Committee Opinion 361."},{"type":"documentation","citation":"California Department of Public Health. (2006). Genetic Disease Branch. California In-Hospital Breastfeeding as Indicated on the Newborn Screening Test Form, Statewide, County and Hospital of Occurrence: Available at: http://www.cdph.ca.gov/data/statistics/Pages/BreastfeedingStatistics.aspx."},{"type":"documentation","citation":"Centers for Disease Control and Prevention. (Aug 3, 2007). Breastfeeding trends and updated national health objectives for exclusive breastfeeding--United States birth years 2000-2004. MMWR - Morbidity \u0026 Mortality Weekly Report. 56(30):760-3."},{"type":"documentation","citation":"Centers for Disease Control and Prevention. (2014). Division of Nutrition, Physical Activity and Obesity. Breastfeeding Report Card. Available at: http://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf"},{"type":"documentation","citation":"Ip, S., Chung, M., Raman, G., et al. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD: US Department of Health and Human Services. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf"},{"type":"documentation","citation":"Kramer, M.S. \u0026 Kakuma, R. (2002).Optimal duration of exclusive breastfeeding. [107 refs] Cochrane Database of Systematic Reviews. (1):CD003517."},{"type":"documentation","citation":"Petrova, A., Hegyi, T., \u0026 Mehta, R. (2007). Maternal race/ethnicity and one-month exclusive breastfeeding in association with the in-hospital feeding modality. Breastfeeding Medicine. 2(2):92-8."},{"type":"documentation","citation":"Shealy, K.R., Li, R., Benton-Davis, S., \u0026 Grummer-Strawn, L.M. (2005).The CDC guide to breastfeeding interventions. Atlanta, GA: US Department of Health and Human Services, CDC. Available at: http://www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf."},{"type":"documentation","citation":"Taveras, E.M., Li, R., Grummer-Strawn, L., Richardson, M., Marshall, R., Rego, V.H., Miroshnik, I., \u0026 Lieu, T.A. (2004). Opinions and practices of clinicians associated with continuation of exclusive breastfeeding. Pediatrics. 113(4):e283-90."},{"type":"documentation","citation":"US Department of Health and Human Services. (2007). Healthy People 2010 Midcourse Review. Washington, DC: US Department of Health and Human Services. Available at: http://www.healthypeople.gov/2010/data/midcourse/?visit\u003d1."},{"type":"documentation","citation":"World Health Organization. (1991). Indicators for assessing breastfeeding practices. Geneva, Switzerland: World Health Organization. Available at: http://whqlibdoc.who.int/hq/1991/WHO_CDD_SER_91.14.pdf?ua\u003d1."},{"type":"predecessor","resource":"http://example.org/fhir/Measure/measure-predecessor-example"},{"type":"derived-from","resource":"http://example.org/fhir/Measure/measure-predecessor-example"}],"library":["http://example.org/fhir/Library/library-exclusive-breastfeeding-cqm-logic"],"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 without warranty.","rationale":"Exclusive breast milk feeding for the first 6 months of neonatal life has long been the expressed goal of World Health Organization (WHO), Department of Health and Human Services (DHHS), American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG). ACOG has recently reiterated its position (ACOG, 2007). A recent Cochrane review substantiates the benefits (Kramer et al., 2002). Much evidence has now focused on the prenatal and intrapartum period as critical for the success of exclusive (or any) BF (Centers for Disease Control and Prevention [CDC], 2007; Petrova et al., 2007; Shealy et al., 2005; Taveras et al., 2004). Exclusive breast milk feeding rate during birth hospital stay has been calculated by the California Department of Public Health for the last several years using newborn genetic disease testing data. Healthy People 2010 and the CDC have also been active in promoting this goal.","clinicalRecommendationStatement":"Exclusive breast milk feeding for the first 6 months of neonatal life can result in numerous long-term health benefits for both mother and newborn and is recommended by a number of national and international organizations. Evidence suggests that the prenatal and intrapartum period is critical for the success of exclusive (or any) breast feeding. Therefore, it is recommended that newborns are fed breast milk only from birth to discharge.","term":[{"definition":"Gestational age is calculated using the ACOG ReVITALize guidelines with Estimated Due Date (EDD) http://www.acog.org/about_acog/acog_departments/patient_safety_and_quality_improvement/~/media/departments/patient%20safety%20and%20quality%20improvement/201213issuesandrationale-gestationalageterm.pdf. The exam used needs to be the most recent exam associated with this pregnancy"}],"group":[{"id":"PopulationGroup1","improvementNotation":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-improvement-notation","code":"increase"}]},"population":[{"code":{"coding":[{"code":"initial-population"}]},"criteria":{"language":"text/cql-identifier","expression":"InitialPopulation1"}},{"code":{"coding":[{"code":"denominator"}]},"criteria":{"language":"text/cql-identifier","expression":"Denominator1"}},{"code":{"coding":[{"code":"denominator-exclusions"}]},"criteria":{"language":"text/cql-identifier","expression":"DenominatorExclusions1"}},{"code":{"coding":[{"code":"numerator"}]},"criteria":{"language":"text/cql-identifier","expression":"Numerator1"}}]},{"id":"PopulationGroup2","improvementNotation":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-improvement-notation","code":"increase"}]},"population":[{"code":{"coding":[{"code":"initial-population"}]},"criteria":{"language":"text/cql-identifier","expression":"InitialPopulation2"}},{"code":{"coding":[{"code":"denominator"}]},"criteria":{"language":"text/cql-identifier","expression":"Denominator2"}},{"code":{"coding":[{"code":"denominator-exclusion"}]},"criteria":{"language":"text/cql-identifier","expression":"DenominatorExclusions2"}},{"code":{"coding":[{"code":"numerator"}]},"criteria":{"language":"text/cql-identifier","expression":"Numerator2"}}]}]}
{"resourceType":"Measure","id":"component-b-example","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eScreening for Depression\n    \n      \u003cp\u003eThis measure example is used to illustrate how a composite measure can be constructured. This measure is one component of the composite measure.\u003c/p\u003e\n    \u003c/div\u003e"},"extension":[{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-wg","valueCode":"cqi"}],"name":"ScreeningForDepression","title":"Screening for Depression","status":"draft","publisher":"HL7 International / Clinical Quality Information","contact":[{"telecom":[{"system":"url","value":"http://www.hl7.org/Special/committees/cqi"}]}],"description":"Screening for Depression","group":[{"id":"Main","population":[{"code":{"coding":[{"code":"initial-population"}]},"criteria":{"language":"text/cql-identifier","expression":"Initial Population"}},{"code":{"coding":[{"code":"denominator"}]},"criteria":{"language":"text/cql-identifier","expression":"Denominator"}},{"code":{"coding":[{"code":"numerator"}]},"criteria":{"language":"text/cql-identifier","expression":"Numerator"}}]}]}
{"resourceType":"Measure","id":"composite-example","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eBehavioral Assessment Composite Measure\n    \n      \u003cp\u003eThis measure example is used to illustrate how a composite measure can be constructured. This measure is a composite measure of the Screening for Alcohol Misuse and Screening for Depression measures.\u003c/p\u003e\n    \u003c/div\u003e"},"extension":[{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-wg","valueCode":"cqi"}],"name":"BehavioralAssessmentCompositeMeasure","title":"Behavioral Assessment Composite Measure","status":"draft","publisher":"HL7 International / Clinical Quality Information","contact":[{"telecom":[{"system":"url","value":"http://www.hl7.org/Special/committees/cqi"}]}],"description":"Behavioral Assessment Composite Measure","relatedArtifact":[{"type":"composed-of","resource":"http://example.org/fhir/Measure/component-a-example"},{"type":"composed-of","resource":"http://example.org/fhir/Measure/component-b-example"}]}
{"resourceType":"Measure","id":"measure-cms146-example","text":{"status":"additional","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003e\u003ctable class\u003d\"grid dict\"\u003e\u003ctr\u003e\u003ctd\u003e\u003cb\u003eId: \u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003eMeasure/measure-cms146-example\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003cp/\u003e\u003ctable class\u003d\"grid dict\"\u003e\u003ctr\u003e\u003ctd\u003e\u003cb\u003eIdentifier: \u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003e\u003cb\u003esystem: \u003c/b\u003e\u003cspan\u003ehttp://hl7.org/fhir/cqi/ecqm/Measure/Identifier/cms\u003c/span\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003e\u003cb\u003evalue: \u003c/b\u003e\u003cspan\u003e146\u003c/span\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003ctable class\u003d\"grid dict\"\u003e\u003ctr\u003e\u003ctd\u003e\u003cb\u003eIdentifier: \u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003e\u003cb\u003esystem: \u003c/b\u003e\u003cspan\u003ehttp://hl7.org/fhir/cqi/ecqm/Measure/Identifier/nqf\u003c/span\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003e\u003cb\u003evalue: \u003c/b\u003e\u003cspan\u003e0002\u003c/span\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003cp/\u003e\u003ctable class\u003d\"grid dict\"\u003e\u003ctr\u003e\u003ctd\u003e\u003cb\u003eTitle: \u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003eAppropriate Testing for Children with Pharyngitis\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003cp/\u003e\u003ctable class\u003d\"grid dict\"\u003e\u003ctr\u003e\u003ctd\u003e\u003cb\u003eStatus: \u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003eactive\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003cp/\u003e\u003ctable class\u003d\"grid dict\"\u003e\u003ctr\u003e\u003ctd\u003e\u003cb\u003eDescription: \u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003ePercentage of children 2-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode.\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003cp/\u003e\u003ctable class\u003d\"grid dict\"\u003e\u003ctr\u003e\u003ctd\u003e\u003cb\u003ePurpose: \u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003eThe Infectious Diseases Society of America (IDSA) \u0026quot;recommends swabbing the throat and testing for GAS pharyngitis by rapid antigen detection test (RADT) and/or culture because the clinical features alone do not reliably discriminate between GAS and viral pharyngitis except when overt viral features like rhinorrhea, cough, oral ulcers, and/or hoarseness are present\u0026quot;\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003cp/\u003e\u003ctable class\u003d\"grid dict\"\u003e\u003ctr\u003e\u003ctd\u003e\u003cb\u003eTopic: \u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-right: 25px;\"\u003e\u003cspan\u003e\u003cspan\u003e\u003cspan style\u003d\"padding-left: 25px;\"\u003e\u003cb\u003esystem: \u003c/b\u003e\u003cspan\u003ehttp://loinc.org\u003c/span\u003e\u003cbr/\u003e\u003c/span\u003e\u003cspan style\u003d\"padding-left: 25px;\"\u003e\u003cb\u003ecode: \u003c/b\u003e\u003cspan\u003e57024-2\u003c/span\u003e\u003cbr/\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003cp/\u003e\u003ctable class\u003d\"grid dict\"\u003e\u003ctr\u003e\u003ctd\u003e\u003cb\u003eLibrary: \u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003e\u003cb\u003ereference: \u003c/b\u003e\u003cspan\u003eLibrary/library-cms146-example\u003c/span\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003cp/\u003e\u003ctable class\u003d\"grid dict\"\u003e\u003ctr\u003e\u003ctd\u003e\u003cb\u003eScoring: \u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003eproportion\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003cp/\u003e\u003ctable class\u003d\"grid dict\"\u003e\u003ctr\u003e\u003ctd\u003e\u003cb\u003eType: \u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003eprocess\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003cp/\u003e\u003ctable class\u003d\"grid dict\"\u003e\u003ctr\u003e\u003ctd\u003e\u003cb\u003eGroup:\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003e\u003cb\u003eIdentifier:\u003c/b\u003e\u003cbr/\u003e\u003cspan style\u003d\"padding-left: 25px;\"\u003e\u003cb\u003evalue: \u003c/b\u003e\u003cspan\u003eCMS146-group-1\u003c/span\u003e\u003cbr/\u003e\u003c/span\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003e\u003cb\u003ePopulation:\u003c/b\u003e\u003cbr/\u003e\u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\u003cb\u003etype:\u003c/b\u003e\u003cspan\u003einitial-population\u003c/span\u003e\u003c/p\u003e\u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\u003cb\u003eIdentifier:\u003c/b\u003e\u003cbr/\u003e\u003cspan style\u003d\"padding-left: 25px;\"\u003e\u003cb\u003evalue: \u003c/b\u003e\u003cspan\u003einitial-population-identifier\u003c/span\u003e\u003cbr/\u003e\u003c/span\u003e\u003c/p\u003e\u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\u003cb\u003ecriteria: \u003c/b\u003e\u003cspan\u003eCMS146.InInitialPopulation\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003e\u003cb\u003ePopulation:\u003c/b\u003e\u003cbr/\u003e\u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\u003cb\u003etype:\u003c/b\u003e\u003cspan\u003enumerator\u003c/span\u003e\u003c/p\u003e\u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\u003cb\u003eIdentifier:\u003c/b\u003e\u003cbr/\u003e\u003cspan style\u003d\"padding-left: 25px;\"\u003e\u003cb\u003evalue: \u003c/b\u003e\u003cspan\u003enumerator-identifier\u003c/span\u003e\u003cbr/\u003e\u003c/span\u003e\u003c/p\u003e\u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\u003cb\u003ecriteria: \u003c/b\u003e\u003cspan\u003eCMS146.InNumerator\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003e\u003cb\u003ePopulation:\u003c/b\u003e\u003cbr/\u003e\u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\u003cb\u003etype:\u003c/b\u003e\u003cspan\u003edenominator\u003c/span\u003e\u003c/p\u003e\u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\u003cb\u003eIdentifier:\u003c/b\u003e\u003cbr/\u003e\u003cspan style\u003d\"padding-left: 25px;\"\u003e\u003cb\u003evalue: \u003c/b\u003e\u003cspan\u003edenominator-identifier\u003c/span\u003e\u003cbr/\u003e\u003c/span\u003e\u003c/p\u003e\u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\u003cb\u003ecriteria: \u003c/b\u003e\u003cspan\u003eCMS146.InDenominator\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003e\u003cb\u003ePopulation:\u003c/b\u003e\u003cbr/\u003e\u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\u003cb\u003etype:\u003c/b\u003e\u003cspan\u003edenominator-exclusion\u003c/span\u003e\u003c/p\u003e\u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\u003cb\u003eIdentifier:\u003c/b\u003e\u003cbr/\u003e\u003cspan style\u003d\"padding-left: 25px;\"\u003e\u003cb\u003evalue: \u003c/b\u003e\u003cspan\u003edenominator-exclusions-identifier\u003c/span\u003e\u003cbr/\u003e\u003c/span\u003e\u003c/p\u003e\u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\u003cb\u003ecriteria: \u003c/b\u003e\u003cspan\u003eCMS146.InDenominatorExclusions\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003e\u003cb\u003eStratifier:\u003c/b\u003e\u003cbr/\u003e\u003cp style\u003d\"padding-left: 25px; margin-bottom: 5px;\"\u003e\u003cb\u003eIdentifier:\u003c/b\u003e\u003cbr/\u003e\u003cspan style\u003d\"padding-left: 25px;\"\u003e\u003cb\u003evalue: \u003c/b\u003e\u003cspan\u003estratifier-ages-up-to-9\u003c/span\u003e\u003cbr/\u003e\u003c/span\u003e\u003c/p\u003e\u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\u003cb\u003ecriteria: \u003c/b\u003e\u003cspan\u003eCMS146.AgesUpToNine\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003e\u003cb\u003eStratifier:\u003c/b\u003e\u003cbr/\u003e\u003cp style\u003d\"padding-left: 25px; margin-bottom: 5px;\"\u003e\u003cb\u003eIdentifier:\u003c/b\u003e\u003cbr/\u003e\u003cspan style\u003d\"padding-left: 25px;\"\u003e\u003cb\u003evalue: \u003c/b\u003e\u003cspan\u003estratifier-ages-10-plus\u003c/span\u003e\u003cbr/\u003e\u003c/span\u003e\u003c/p\u003e\u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\u003cb\u003ecriteria: \u003c/b\u003e\u003cspan\u003eCMS146.AgesTenPlus\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003e\u003cb\u003eStratifier:\u003c/b\u003e\u003cbr/\u003e\u003cp style\u003d\"padding-left: 25px; margin-bottom: 5px;\"\u003e\u003cb\u003eIdentifier:\u003c/b\u003e\u003cbr/\u003e\u003cspan style\u003d\"padding-left: 25px;\"\u003e\u003cb\u003evalue: \u003c/b\u003e\u003cspan\u003estratifier-ages-up-to-9\u003c/span\u003e\u003cbr/\u003e\u003c/span\u003e\u003c/p\u003e\u003cp style\u003d\"margin-bottom: 5px; padding-left: 25px;\"\u003e\u003cb\u003epath: \u003c/b\u003e\u003cspan\u003ePatient.gender\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003cp/\u003e\u003ctable class\u003d\"grid dict\"\u003e\u003ctr\u003e\u003ctd\u003e\u003cb\u003eSupplemental Data:\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003e\u003cp style\u003d\"margin-bottom: 5px;\"\u003e\u003cb\u003eIdentifier:\u003c/b\u003e\u003cbr/\u003e\u003cspan style\u003d\"padding-left: 25px;\"\u003e\u003cb\u003evalue: \u003c/b\u003e\u003cspan\u003esupplemental-data-gender\u003c/span\u003e\u003cbr/\u003e\u003c/span\u003e\u003c/p\u003e\u003cp style\u003d\"margin-bottom: 5px;\"\u003e\u003cb\u003epath: \u003c/b\u003e\u003cspan\u003ePatient.gender\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003ctable class\u003d\"grid dict\"\u003e\u003ctr\u003e\u003ctd\u003e\u003cb\u003eSupplemental Data:\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003e\u003cp style\u003d\"margin-bottom: 5px;\"\u003e\u003cb\u003eIdentifier:\u003c/b\u003e\u003cbr/\u003e\u003cspan style\u003d\"padding-left: 25px;\"\u003e\u003cb\u003evalue: \u003c/b\u003e\u003cspan\u003esupplemental-data-deceased\u003c/span\u003e\u003cbr/\u003e\u003c/span\u003e\u003c/p\u003e\u003cp style\u003d\"margin-bottom: 5px;\"\u003e\u003cb\u003epath: \u003c/b\u003e\u003cspan\u003edeceasedBoolean\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003c/div\u003e"},"extension":[{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-wg","valueCode":"cqi"}],"url":"http://hl7.org/fhir/Measure/measure-cms146-example","identifier":[{"system":"urn:ietf:rfc:3986","value":"urn:oid:2.16.840.1.113883.4.642.28.1"},{"use":"official","system":"http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/cms","value":"146"},{"use":"official","system":"http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/nqf","value":"0002"}],"version":"1.0.0","name":"CMS146","title":"Appropriate Testing for Children with Pharyngitis","status":"active","experimental":true,"date":"2017-03-10","publisher":"HL7 International / Clinical Quality Information","contact":[{"telecom":[{"system":"url","value":"http://www.hl7.org/Special/committees/cqi"}]}],"description":"Percentage of children 3-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode.","useContext":[{"code":{"system":"http://terminology.hl7.org/CodeSystem/usage-context-type","code":"program"},"valueCodeableConcept":{"text":"Eligible Clinician (EC)"}},{"code":{"system":"http://terminology.hl7.org/CodeSystem/usage-context-type","code":"age"},"valueRange":{"low":{"value":3,"unit":"a"},"high":{"value":18,"unit":"a"}}}],"jurisdiction":[{"coding":[{"system":"urn:iso:std:iso:3166","code":"US"}]}],"purpose":"Measure of children with a group A streptococcus test in the 7-day period from 3 days prior through 3 days after the diagnosis of pharyngitis","copyright":"Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA).  The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures.  (c) 2008-2016 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 CPT or other codes contained in the specifications.  CPT(R) contained in the Measure specifications is copyright 2004-2015 American Medical Association. LOINC(R) copyright 2004-2015 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2015 International Health Terminology Standards Development Organisation. ICD-10 copyright 2015 World Health Organization. All Rights Reserved.","approvalDate":"2016-01-01","lastReviewDate":"2016-09-01","effectivePeriod":{"start":"2017-01-01","end":"2017-12-31"},"author":[{"name":"National Committee for Quality Assurance"}],"relatedArtifact":[{"type":"documentation","citation":"Linder, J.A., D.W. Bates, G.M. Lee, J.A. Finkelstein. 2005. _Antibiotic treatment of children with sore throat._ JAMA 294(18):2315-2322. "},{"type":"documentation","citation":"Infectious Diseases Society of America. 2012. _Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update._ "},{"type":"documentation","citation":"Roberts, R.R., B. Hota, I. Ahmad, et al. _Hospital and Societal Costs of Antimicrobial-Resistant Infections in a Chicago Teaching Hospital: Implications for Antibiotic Stewardship._ Clin Infect Dis. Oct 2009; 49(8):1175-84."}],"library":["http://hl7.org/fhir/Library/library-cms146-example"],"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":"Group A streptococcal bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms (IDSA 2002). The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment (Linder et al. 2005). Estimated economic costs of pediatric streptococcal pharyngitis in the United States range from $224 million to $539 million per year, including indirect costs related to parental work losses. At a higher level, the economic cost of antibiotic resistance vary but have extended as high as $20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as $35 billion a year (2008 dollars) (Roberts et al. 2009).","clinicalRecommendationStatement":"The Infectious Diseases Society of America (IDSA) \"recommends swabbing the throat and testing for GAS pharyngitis by rapid antigen detection test (RADT) and/or culture because the clinical features alone do not reliably discriminate between GAS and viral pharyngitis except when overt viral features like rhinorrhea, cough, oral ulcers, and/or hoarseness are present\"","group":[{"linkId":"CMS146-group-1","scoring":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-scoring","code":"proportion"}]},"improvementNotation":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-improvement-notation","code":"increase"}]},"population":[{"linkId":"CMS146-group-1-ip","code":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-population","code":"initial-population"}]},"description":"Outpatient, telephone, virtual encounter (i.e., e-visit or virtual check-in), or emergency department (ED) visits with a diagnosis of pharyngitis or tonsillitis from January 1 to December 28 of the measurement period and an antibiotic order on or three days after the episode date among patients 3 years or older","criteria":{"language":"text/cql-identifier","expression":"InitialPopulation"}},{"linkId":"CMS146-group-1-num","code":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-population","code":"numerator"}]},"description":"A group A streptococcus test in the seven-day period from three days prior to the episode date through three days after the episode date","criteria":{"language":"text/cql-identifier","expression":"Numerator"}},{"linkId":"CMS146-group-1-den","code":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-population","code":"denominator"}]},"description":"Equals Initial Population","criteria":{"language":"text/cql-identifier","expression":"Denominator"}},{"linkId":"CMS146-group-1-denex","code":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-population","code":"denominator-exclusion"}]},"description":"Exclude pharyngitis episodes when the patient had hospice care for any part of the measurement period.\\n\\nExclude pharyngitis episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date.\\n\\nExclude pharyngitis episodes where the patient is taking antibiotics in the 30 days prior to the episode date.\\n\\nExclude pharyngitis episodes where the patient had a competing diagnosis on or three days after the episode date.","criteria":{"language":"text/cql-identifier","expression":"DenominatorExclusion"}}],"stratifier":[{"linkId":"CMS146-group-1-stratifier-ages-up-to-9","code":{"text":"stratifier-ages-up-to-9"},"description":"3-9 years","criteria":{"language":"text/cql-identifier","expression":"AgesUpToNine"}},{"linkId":"CMS146-group-1-stratifier-ages-10-plus","code":{"text":"stratifier-ages-10-plus"},"description":"10 years or older","criteria":{"language":"text/cql-identifier","expression":"AgesTenPlus"}},{"linkId":"CMS146-group-1-stratifier-gender","code":{"text":"stratifier-gender"},"description":"Stratification based on gender of patient","criteria":{"language":"text/fhirpath","expression":"Patient.gender"}}]}],"supplementalData":[{"linkId":"CMS146-supplemental-data-gender","code":{"text":"supplemental-data-gender"},"criteria":{"language":"text/fhirpath","expression":"Patient.gender"}},{"linkId":"CMS146-supplemental-data-deceased","code":{"text":"supplemental-data-deceased"},"criteria":{"language":"text/fhirpath","expression":"Patient.deceased"}}]}
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{"resourceType":"Measure","id":"measure-predecessor-example","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003e\n      \u003ctable class\u003d\"grid dict\"\u003e\n        \u003ctr\u003e\n          \u003ctd\u003e\n            \u003cb\u003eId: \u003c/b\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n        \u003ctr\u003e\n          \u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003eMeasure/measure-predecessor-example\u003c/td\u003e\n        \u003c/tr\u003e\n      \u003c/table\u003e\n      \u003cp/\u003e\n      \u003ctable class\u003d\"grid dict\"\u003e\n        \u003ctr\u003e\n          \u003ctd\u003e\n            \u003cb\u003eIdentifier: \u003c/b\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n        \u003ctr\u003e\n          \u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003e\n            \u003cb\u003evalue: \u003c/b\u003e\n            \u003cspan\u003eexclusive-breastfeeding-measure\u003c/span\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n      \u003c/table\u003e\n      \u003cp/\u003e\n      \u003ctable class\u003d\"grid dict\"\u003e\n        \u003ctr\u003e\n          \u003ctd\u003e\n            \u003cb\u003eTitle: \u003c/b\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n        \u003ctr\u003e\n          \u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003eExclusive Breastfeeding Measure\u003c/td\u003e\n        \u003c/tr\u003e\n      \u003c/table\u003e\n      \u003cp/\u003e\n      \u003ctable class\u003d\"grid dict\"\u003e\n        \u003ctr\u003e\n          \u003ctd\u003e\n            \u003cb\u003eStatus: \u003c/b\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n        \u003ctr\u003e\n          \u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003eactive\u003c/td\u003e\n        \u003c/tr\u003e\n      \u003c/table\u003e\n      \u003cp/\u003e\n      \u003ctable class\u003d\"grid dict\"\u003e\n        \u003ctr\u003e\n          \u003ctd\u003e\n            \u003cb\u003eDescription: \u003c/b\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n        \u003ctr\u003e\n          \u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003eExclusive breastfeeding measure of outcomes for exclusive breastmilk feeding of newborns.\u003c/td\u003e\n        \u003c/tr\u003e\n      \u003c/table\u003e\n      \u003cp/\u003e\n      \u003ctable class\u003d\"grid dict\"\u003e\n        \u003ctr\u003e\n          \u003ctd\u003e\n            \u003cb\u003ePurpose: \u003c/b\u003e\n          \u003c/td\u003e\n        \u003c/tr\u003e\n        \u003ctr\u003e\n          \u003ctd style\u003d\"padding-left: 25px; padding-right: 25px;\"\u003eExclusive breast milk feeding for the first 6 months of neonatal life can result in numerous long-term health benefits for both mother and newborn and is recommended by a number of national and international organizations. Evidence suggests that the prenatal and intrapartum period is critical for the success of exclusive (or any) breast feeding. 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(2005). Section on Breastfeeding. Policy Statement:Breastfeeding and the Use of Human Milk. Pediatrics.115:496-506."},{"type":"documentation","citation":"American College of Obstetricians and Gynecologists. (Feb. 2007). Committee on Obstetric Practice and Committee on Health Care for Underserved Women. Breastfeeding: Maternal and Infant Aspects. ACOG Committee Opinion 361."},{"type":"documentation","citation":"California Department of Public Health. (2006). Genetic Disease Branch. California In-Hospital Breastfeeding as Indicated on the Newborn Screening Test Form, Statewide, County and Hospital of Occurrence: Available at: http://www.cdph.ca.gov/data/statistics/Pages/BreastfeedingStatistics.aspx."},{"type":"documentation","citation":"Centers for Disease Control and Prevention. (Aug 3, 2007). Breastfeeding trends and updated national health objectives for exclusive breastfeeding--United States birth years 2000-2004. MMWR - Morbidity \u0026 Mortality Weekly Report. 56(30):760-3."},{"type":"documentation","citation":"Centers for Disease Control and Prevention. (2014). Division of Nutrition, Physical Activity and Obesity. Breastfeeding Report Card. Available at: http://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf"},{"type":"documentation","citation":"Ip, S., Chung, M., Raman, G., et al. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD: US Department of Health and Human Services. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf"},{"type":"documentation","citation":"Kramer, M.S. \u0026 Kakuma, R. (2002).Optimal duration of exclusive breastfeeding. [107 refs] Cochrane Database of Systematic Reviews. (1):CD003517."},{"type":"documentation","citation":"Petrova, A., Hegyi, T., \u0026 Mehta, R. (2007). Maternal race/ethnicity and one-month exclusive breastfeeding in association with the in-hospital feeding modality. Breastfeeding Medicine. 2(2):92-8."},{"type":"documentation","citation":"Shealy, K.R., Li, R., Benton-Davis, S., \u0026 Grummer-Strawn, L.M. (2005).The CDC guide to breastfeeding interventions. Atlanta, GA: US Department of Health and Human Services, CDC. Available at: http://www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf."},{"type":"documentation","citation":"Taveras, E.M., Li, R., Grummer-Strawn, L., Richardson, M., Marshall, R., Rego, V.H., Miroshnik, I., \u0026 Lieu, T.A. (2004). Opinions and practices of clinicians associated with continuation of exclusive breastfeeding. Pediatrics. 113(4):e283-90."},{"type":"documentation","citation":"US Department of Health and Human Services. (2007). Healthy People 2010 Midcourse Review. Washington, DC: US Department of Health and Human Services. Available at: http://www.healthypeople.gov/2010/data/midcourse/?visit\u003d1."},{"type":"documentation","citation":"World Health Organization. (1991). Indicators for assessing breastfeeding practices. Geneva, Switzerland: World Health Organization. Available at: http://whqlibdoc.who.int/hq/1991/WHO_CDD_SER_91.14.pdf?ua\u003d1."},{"type":"successor","resource":"http://example.org/fhir/Measure/measure-exclusive-breastfeeding"}],"library":["http://example.org/fhir/Library/library-exclusive-breastfeeding-cqm-logic"],"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 without warranty.","rationale":"Exclusive breast milk feeding for the first 6 months of neonatal life has long been the expressed goal of World Health Organization (WHO), Department of Health and Human Services (DHHS), American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG). ACOG has recently reiterated its position (ACOG, 2007). A recent Cochrane review substantiates the benefits (Kramer et al., 2002). Much evidence has now focused on the prenatal and intrapartum period as critical for the success of exclusive (or any) BF (Centers for Disease Control and Prevention [CDC], 2007; Petrova et al., 2007; Shealy et al., 2005; Taveras et al., 2004). Exclusive breast milk feeding rate during birth hospital stay has been calculated by the California Department of Public Health for the last several years using newborn genetic disease testing data. Healthy People 2010 and the CDC have also been active in promoting this goal.","clinicalRecommendationStatement":"Exclusive breast milk feeding for the first 6 months of neonatal life can result in numerous long-term health benefits for both mother and newborn and is recommended by a number of national and international organizations. Evidence suggests that the prenatal and intrapartum period is critical for the success of exclusive (or any) breast feeding. 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