Quality Measure Implementation Guide
1.0.0-ballot - ballot
Quality Measure Implementation Guide
1.0.0-ballot - ballot
Quality Measure Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/cqf-measures/ and changes regularly. See the Directory of published versions
| Active as of 2022-02-22 |
{
"resourceType" : "Measure",
"id" : "EXM146-FHIR",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/proportion-measure-cqfm"🔗 ,
"http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/computable-measure-cqfm"🔗 ,
"http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cql-measure-cqfm"
]
},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <table class=\"narrative-table\">\n <tbody>\n<tr>\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Knowledge Artifact Metadata</th>\n\n</tr>\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Name (machine-readable)</th>\n\n<td class=\"content-container\">EXM146</td>\n</tr>\n\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Title (human-readable)</th>\n\n<td class=\"content-container\">EXM146 - Appropriate Testing for Children with Pharyngitis</td>\n</tr>\n\n\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Status</th>\n\n<td class=\"content-container\">Active</td>\n</tr>\n\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Experimental</th>\n\n<td class=\"content-container\">true</td>\n</tr>\n\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Description</th>\n\n<td class=\"content-container\"><div><p>Percentage 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.</p>\n</div></td>\n</tr>\n\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Purpose</th>\n\n<td class=\"content-container\"><div><p>This measure has been developed to support improvement in clinical care.</p>\n</div></td>\n</tr>\n\n\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Approval Date</th>\n\n<td class=\"content-container\">2016-01-01</td>\n</tr>\n\n\n\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Effective Period</th>\n\n<td class=\"content-container\">2018-01-01..2018-12-31</td>\n</tr>\n\n\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Use Context</th>\n\n<td class=\"content-container\"><span title=\"{http://terminology.hl7.org/CodeSystem/usage-context-type venue}\">Venue</span> = <span title=\"Codes:{http://hl7.org/fhir/uv/cqfmeasures/CodeSystem/intended-venue-codes ec}\">EC</span></td>\n</tr>\n\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Topic</th>\n\n<td class=\"content-container\"><span title=\"Codes:{http://loinc.org 57024-2}\">Health Quality Measure Document</span></td>\n</tr>\n\n\n\n\n\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Measure Steward</th>\n\n<td class=\"content-container\">HL7 International / Clinical Quality Information</td>\n</tr>\n\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Steward Contact Details</th>\n\n<td class=\"content-container\"><a href=\"http://www.hl7.org/Special/committees/cqi\">http://www.hl7.org/Special/committees/cqi</a></td>\n</tr>\n\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Copyright</th>\n\n<td class=\"content-container\"><div><p>Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA).\nThe 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.\n(c) 2008 -2014 National Committee for Quality Assurance. All Rights Reserved.\nLimited 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.\nCPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2013 World Health Organization. All Rights Reserved.</p>\n</div></td>\n</tr>\n\n\n\n\n\n\n\n\n\n\n<tr>\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Metadata</th>\n\n</tr>\n\n\n\n\n\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Version Number</th>\n\n<td class=\"content-container\">4.0.0</td>\n</tr>\n\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Measure Scoring</th>\n\n<td class=\"content-container\"><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-scoring proportion}\">Proportion</span></td>\n</tr>\n\n\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Measure Type</th>\n\n<td class=\"content-container\"><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-type process}\">Process</span></td>\n</tr>\n\n\n\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Rationale</th>\n\n<td class=\"content-container\"><div><p>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). A study on antibiotic treatment of children with sore throat found that although only 15 to 36 percent of children with sore throat have Strep A pharyngitis, physicians prescribed antibiotics to 53 percent of children with a chief complaint of sore throat between 1995 and 2003 (Linder et al. 2005).</p>\n</div></td>\n</tr>\n\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Clinical Recommendation Statement</th>\n\n<td class=\"content-container\"><div><p>Institute for Clinical Systems Improvement (ICSI) (2007)\nReduce unnecessary use of antibiotics. Antibiotic treatment should be reserved for a bacterial illness. Diagnosis of group A beta streptococcal Pharyngitis should be made by laboratory testing rather than clinically.\nInfectious Disease Society of America (Bisno et al. 2002)\nThe signs and symptoms of group A streptococcal and other (most frequently viral) pharyngitides overlap broadly. Therefore, unless the physician is able with confidence to exclude the diagnosis of streptococcal pharyngitis on epidemiological and clinical grounds alone, a laboratory test should be done to determine whether group A streptococci are present in the pharynx.\nWith the exception of very rare infections by certain other pharyngeal bacterial pathogens (eg, Corynebacterium diphtheriae and Neisseria gonorrhoeae), antimicrobial therapy is of no proven benefit as treatment for acute pharyngitis due to bacteria other than group A streptococci. Therefore, it is extremely important that physicians exclude the diagnosis of group A streptococcal pharyngitis to prevent inappropriate administration of antimicrobials to large numbers of patients with pharyngitis.\nMichigan Quality Improvement Consortium (2007)\nProbability of group A beta hemolytic streptococci (GABHS): Low; Testing: None; Treatment: Symptomatic treatment only. Avoid antibiotics. Probability of GABHS: Intermediate or High; Testing: Throat Culture (TC) OR Rapid Screen; Treatment: If TC is positive, use antibiotics. If TC is negative, use symptomatic treatment only. Avoid antibiotics. If treatment is started and culture result is negative, stop antibiotics. If Rapid Screen is positive, use antibiotics. If Rapid Screen is negative, culture (Culture is optional for age 16 and over) and only use antibiotics if throat culture is positive. (Michigan, 2007)</p>\n</div></td>\n</tr>\n\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Improvement Notation</th>\n\n<td class=\"content-container\"><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-improvement-notation increase}\">Increased score indicates improvement</span></td>\n</tr>\n\n\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Guidance</th>\n\n<td class=\"content-container\"><div><p>This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. If the patient has more than one episode, include all episodes in the measure.</p>\n</div></td>\n</tr>\n\n\n\n\n\n\n \n <tr>\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Population Criteria</th>\n\n</tr>\n \n \n \n \n <tr>\n \n \n<th scope=\"row\" class=\"row-header\">Initial Population</th>\n\n \n <td class=\"content-container\">\n \n \n <em>Description</em>: No description provided\n \n \n \n \n <em>Logic Definition</em>: <a href=\"#exm146-fhir-initial-population\">Initial Population</a> \n \n \n </td>\n </tr>\n \n\n \n <tr>\n \n \n<th scope=\"row\" class=\"row-header\">Numerator</th>\n\n \n <td class=\"content-container\">\n \n \n <em>Description</em>: No description provided\n \n \n \n \n <em>Logic Definition</em>: <a href=\"#exm146-fhir-numerator\">Numerator</a> \n \n \n </td>\n </tr>\n \n\n \n <tr>\n \n \n<th scope=\"row\" class=\"row-header\">Denominator</th>\n\n \n <td class=\"content-container\">\n \n \n <em>Description</em>: No description provided\n \n \n \n \n <em>Logic Definition</em>: <a href=\"#exm146-fhir-denominator\">Denominator</a> \n \n \n </td>\n </tr>\n \n\n \n <tr>\n \n \n<th scope=\"row\" class=\"row-header\">Denominator Exclusion</th>\n\n \n <td class=\"content-container\">\n \n \n <em>Description</em>: No description provided\n \n \n \n \n <em>Logic Definition</em>: <a href=\"#exm146-fhir-denominator-exclusion\">Denominator Exclusion</a> \n \n \n </td>\n </tr>\n \n\n \n \n\n\n\n\n\n\n\n\n\n\n\n\n\n<tr>\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Logic</th>\n\n</tr>\n\n<tr>\n\n<th scope=\"row\" class=\"row-header\">Primary Library</th>\n\n<td class=\"content-container\"><a href=\"Library-EXM146-FHIR.html\">EXM146 - Example Proportion Measure Library</a></td>\n</tr>\n\n\n\n\n \n \n\n<tr>\n \n \n \n \n \n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n \n <td class=\"content-container\">\n \n <em>Description</em>: Library FHIRHelpers\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: <code>http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1</code>\n <br/>\n <em>Canonical URL</em>: <tt>http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1</tt>\n \n </td>\n</tr>\n\n<tr>\n \n \n \n \n \n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n \n <td class=\"content-container\">\n \n <em>Description</em>: Library Global\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: <a href=\"Library-MATGlobalCommonFunctions.html\">MAT Global Common Functions FHIR Libraryversion: null5.0.000)</a>\n <br/>\n <em>Canonical URL</em>: <tt>http://hl7.org/fhir/uv/cqfmeasures/Library/MATGlobalCommonFunctions|5.0.000</tt>\n \n </td>\n</tr>\n\n<tr>\n \n \n \n \n \n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n \n <td class=\"content-container\">\n \n <em>Description</em>: Library Common\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: <a href=\"Library-Common.html\">Common Libraryversion: null2.0.0)</a>\n <br/>\n <em>Canonical URL</em>: <tt>http://hl7.org/fhir/uv/cqfmeasures/Library/Common|2.0.0</tt>\n \n </td>\n</tr>\n\n<tr>\n \n \n \n \n \n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n \n <td class=\"content-container\">\n \n <em>Description</em>: Code system ConditionClinicalStatusCodes\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: <a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html\">Condition Clinical Status Codes</a>\n <br/>\n <em>Canonical URL</em>: <tt>http://terminology.hl7.org/CodeSystem/condition-clinical</tt>\n \n </td>\n</tr>\n\n<tr>\n \n \n \n \n \n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n \n <td class=\"content-container\">\n \n <em>Description</em>: Code system ConditionVerificationStatusCodes\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: <a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-ver-status.html\">ConditionVerificationStatus</a>\n <br/>\n <em>Canonical URL</em>: <tt>http://terminology.hl7.org/CodeSystem/condition-ver-status</tt>\n \n </td>\n</tr>\n\n<tr>\n \n \n \n \n \n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n \n <td class=\"content-container\">\n \n <em>Description</em>: Value set Ambulatory/ED Visit\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: <code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061</code>\n <br/>\n <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061</tt>\n \n </td>\n</tr>\n\n<tr>\n \n \n \n \n \n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n \n <td class=\"content-container\">\n \n <em>Description</em>: Value set Acute Pharyngitis\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: <code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011</code>\n <br/>\n <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011</tt>\n \n </td>\n</tr>\n\n<tr>\n \n \n \n \n \n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n \n <td class=\"content-container\">\n \n <em>Description</em>: Value set Acute Tonsillitis\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: <code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012</code>\n <br/>\n <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012</tt>\n \n </td>\n</tr>\n\n<tr>\n \n \n \n \n \n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n \n <td class=\"content-container\">\n \n <em>Description</em>: Value set Antibiotic Medications\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: <code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001</code>\n <br/>\n <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001</tt>\n \n </td>\n</tr>\n\n<tr>\n \n \n \n \n \n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n \n <td class=\"content-container\">\n \n <em>Description</em>: Value set Group A Streptococcus Test\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: <code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012</code>\n <br/>\n <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012</tt>\n \n </td>\n</tr>\n\n\n \n <tr>\n <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n <td class=\"content-container\">\n \n <em>Code</em>: active\n <br/>\n <em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/condition-clinical</tt>\n </td>\n </tr>\n\n <tr>\n <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n <td class=\"content-container\">\n \n <em>Code</em>: confirmed\n <br/>\n <em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/condition-ver-status</tt>\n </td>\n </tr>\n\n \n <tr>\n \n<th scope=\"row\" class=\"row-header\">Parameter</th>\n\n <td class=\"content-container\">\n <em>Name</em>: Measurement Period\n <br/>\n <em>Use</em>: In\n <br/>\n <em>Min Cardinality</em>: 0\n <br/>\n <em>Max Cardinality</em>: 1\n <br/>\n <em>Type</em>: Period\n </td>\n</tr>\n \n <tr>\n \n<th scope=\"row\" class=\"row-header\">Parameter</th>\n\n <td class=\"content-container\">\n <em>Name</em>: Numerator\n <br/>\n <em>Use</em>: Out\n <br/>\n <em>Min Cardinality</em>: 0\n <br/>\n <em>Max Cardinality</em>: *\n <br/>\n <em>Type</em>: Encounter\n </td>\n</tr>\n \n <tr>\n \n<th scope=\"row\" class=\"row-header\">Parameter</th>\n\n <td class=\"content-container\">\n <em>Name</em>: Initial Population\n <br/>\n <em>Use</em>: Out\n <br/>\n <em>Min Cardinality</em>: 0\n <br/>\n <em>Max Cardinality</em>: *\n <br/>\n <em>Type</em>: Encounter\n </td>\n</tr>\n \n \n <tr>\n <th colspan=\"2\" scope=\"row\" class=\"section-header\"><a name=\"effective-data-requirements\"> </a>Measure Logic Data Requirements</th>\n </tr>\n \n \n<tr>\n <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n <td class=\"content-container\">\n <em>Type</em>: Condition\n <br/>\n \n <em>Profile(s)</em>: \n \n <a href=\"http://hl7.org/fhir/R4/condition.html\">Condition</a>\n <br/> \n \n \n \n <em>Must Support Elements</em>: code\n <br/>\n \n \n <em>Code Filter(s)</em>: \n <br/>\n \n \n <span class=\"tab-one\"><em>Path</em>: code</span>\n <br/>\n \n \n \n <span class=\"tab-one\"><em>ValueSet</em>:</span> <code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011</code>\n <br/> \n \n \n \n \n </td>\n</tr>\n\n<tr>\n <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n <td class=\"content-container\">\n <em>Type</em>: Condition\n <br/>\n \n <em>Profile(s)</em>: \n \n <a href=\"http://hl7.org/fhir/R4/condition.html\">Condition</a>\n <br/> \n \n \n \n <em>Must Support Elements</em>: code\n <br/>\n \n \n <em>Code Filter(s)</em>: \n <br/>\n \n \n <span class=\"tab-one\"><em>Path</em>: code</span>\n <br/>\n \n \n \n <span class=\"tab-one\"><em>ValueSet</em>:</span> <code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012</code>\n <br/> \n \n \n \n \n </td>\n</tr>\n\n<tr>\n <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n <td class=\"content-container\">\n <em>Type</em>: Observation\n <br/>\n \n <em>Profile(s)</em>: \n \n <a href=\"http://hl7.org/fhir/R4/observation.html\">Observation</a>\n <br/> \n \n \n \n <em>Must Support Elements</em>: effective, code, value\n <br/>\n \n \n <em>Code Filter(s)</em>: \n <br/>\n \n \n <span class=\"tab-one\"><em>Path</em>: code</span>\n <br/>\n \n \n \n <span class=\"tab-one\"><em>ValueSet</em>:</span> <code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012</code>\n <br/> \n \n \n \n \n </td>\n</tr>\n\n<tr>\n <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n <td class=\"content-container\">\n <em>Type</em>: Patient\n <br/>\n \n <em>Profile(s)</em>: \n \n <a href=\"http://hl7.org/fhir/R4/patient.html\">Patient</a>\n <br/> \n \n \n \n \n </td>\n</tr>\n\n<tr>\n <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n <td class=\"content-container\">\n <em>Type</em>: Encounter\n <br/>\n \n <em>Profile(s)</em>: \n \n <a href=\"http://hl7.org/fhir/R4/encounter.html\">Encounter</a>\n <br/> \n \n \n \n <em>Must Support Elements</em>: period, type, status\n <br/>\n \n \n <em>Code Filter(s)</em>: \n <br/>\n \n \n <span class=\"tab-one\"><em>Path</em>: type</span>\n <br/>\n \n \n \n <span class=\"tab-one\"><em>ValueSet</em>:</span> <code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061</code>\n <br/> \n \n \n \n \n </td>\n</tr>\n\n<tr>\n <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n <td class=\"content-container\">\n <em>Type</em>: MedicationRequest\n <br/>\n \n <em>Profile(s)</em>: \n \n <a href=\"http://hl7.org/fhir/R4/medicationrequest.html\">MedicationRequest</a>\n <br/> \n \n \n \n <em>Must Support Elements</em>: authoredOn, medication, intent, status\n <br/>\n \n \n <em>Code Filter(s)</em>: \n <br/>\n \n \n <span class=\"tab-one\"><em>Path</em>: medication</span>\n <br/>\n \n \n \n <span class=\"tab-one\"><em>ValueSet</em>:</span> <code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001</code>\n <br/> \n \n \n \n \n </td>\n</tr>\n\n \n <tr>\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Logic Definitions</th>\n\n</tr>\n \n \n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"exm146-fhir-is-between-2-and-17-years-of-age-at-start-of-measurement-period\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> EXM146-FHIR</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">// Region: Initial Population\ndefine "Is Between 2 and 17 Years of Age at Start of Measurement Period":\n AgeInYearsAt(start of "Measurement Period") >= 2\n and AgeInYearsAt(start of "Measurement Period") <= 17</code></pre>\n </td>\n\n</tr>\n \n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"exm146-fhir-measurement-period-encounters\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> EXM146-FHIR</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Measurement Period Encounters":\n [Encounter: "Ambulatory/ED Visit"] Encounter\n where Encounter.period during "Measurement Period"\n and Encounter.status = 'finished'\n and "Is Between 2 and 17 Years of Age at Start of Measurement Period"</code></pre>\n </td>\n\n</tr>\n \n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"exm146-fhir-pharyngitis\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> EXM146-FHIR</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Pharyngitis":\n ([Condition: code in "Acute Pharyngitis"]\n union [Condition: code in "Acute Tonsillitis"]) Pharyngitis\n where Pharyngitis.clinicalStatus ~ Global.active\n and Pharyngitis.verificationStatus ~ Global.confirmed</code></pre>\n </td>\n\n</tr>\n \n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"exm146-fhir-antibiotics\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> EXM146-FHIR</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Antibiotics":\n [MedicationRequest: medication in "Antibiotic Medications"] Prescription\n where Prescription.status = 'active'\n and Prescription.intent = 'order'</code></pre>\n </td>\n\n</tr>\n \n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"exm146-fhir-pharyngitis-encounters-with-antibiotics\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> EXM146-FHIR</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Pharyngitis Encounters With Antibiotics":\n "Measurement Period Encounters" Encounters\n with "Pharyngitis" Pharyngitis such that\n Common."Includes Or Starts During"(Pharyngitis, Encounters)\n with "Antibiotics" Antibiotics such that Antibiotics.authoredOn\n 3 days or less after FHIRHelpers.ToInterval(Encounters.period)</code></pre>\n </td>\n\n</tr>\n \n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"exm146-fhir-strep-test-encounters\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> EXM146-FHIR</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">// EndRegion: Denominator Exclusions\n\n// Region: Denominator Exceptions\n\n// None\n\n// EndRegion: Denominator Exceptions\n\n// Region: Numerator\ndefine "Strep Test Encounters":\n "Pharyngitis Encounters With Antibiotics" Encounters\n with [Observation: code in "Group A Streptococcus Test"] Tests\n such that Tests.value is not null\n and Tests.effective starts during\n Interval[start of FHIRHelpers.ToInterval(Encounters.period) - 3 days,\n end of FHIRHelpers.ToInterval(Encounters.period) + 3 days]</code></pre>\n </td>\n\n</tr>\n \n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"exm146-fhir-numerator\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> EXM146-FHIR</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Numerator":\n "Strep Test Encounters"</code></pre>\n </td>\n\n</tr>\n \n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"exm146-fhir-initial-population\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> EXM146-FHIR</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Initial Population":\n "Pharyngitis Encounters With Antibiotics"</code></pre>\n </td>\n\n</tr>\n\n \n\n<tr>\n <th colspan=\"2\" scope=\"row\" class=\"row-header\">Generated using version 0.4.6 of the sample-content-ig Liquid templates</th>\n</tr>\n </tbody>\n </table>\n</div>"
},
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"valueString" : "define \"Pharyngitis Encounters With Antibiotics\":\n \"Measurement Period Encounters\" Encounters\n with \"Pharyngitis\" Pharyngitis such that\n Common.\"Includes Or Starts During\"(Pharyngitis, Encounters)\n with \"Antibiotics\" Antibiotics such that Antibiotics.authoredOn\n 3 days or less after FHIRHelpers.ToInterval(Encounters.period)"
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{
"url" : "statement",
"valueString" : "// EndRegion: Denominator Exclusions\n\n// Region: Denominator Exceptions\n\n// None\n\n// EndRegion: Denominator Exceptions\n\n// Region: Numerator\ndefine \"Strep Test Encounters\":\n \"Pharyngitis Encounters With Antibiotics\" Encounters\n with [Observation: code in \"Group A Streptococcus Test\"] Tests\n such that Tests.value is not null\n and Tests.effective starts during\n Interval[start of FHIRHelpers.ToInterval(Encounters.period) - 3 days,\n end of FHIRHelpers.ToInterval(Encounters.period) + 3 days]"
},
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"url" : "statement",
"valueString" : "define \"Numerator\":\n \"Strep Test Encounters\""
},
{
"url" : "displaySequence",
"valueInteger" : 6
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
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{
"extension" : [
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"url" : "libraryName",
"valueString" : "EXM146-FHIR"
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{
"url" : "name",
"valueString" : "Initial Population"
},
{
"url" : "statement",
"valueString" : "define \"Initial Population\":\n \"Pharyngitis Encounters With Antibiotics\""
},
{
"url" : "displaySequence",
"valueInteger" : 7
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
}
],
"url" : "http://hl7.org/fhir/uv/cqfmeasures/Library/effective-data-requirements-exm146",
"version" : "1.0.0",
"name" : "EffectiveDataRequirements",
"title" : "Module Definition Library - EXM146",
"status" : "active",
"type" : {
"coding" : [
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"system" : "http://terminology.hl7.org/CodeSystem/library-type",
"code" : "module-definition"
}
]
},
"date" : "2022-02-22T10:37:03-07:00",
"description" : "This library is used as an example module definition in the FHIR Quality Measure Implementation Guide",
"relatedArtifact" : [
{
"type" : "depends-on",
"display" : "Library FHIRHelpers",
"resource" : "http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1"
},
{
"type" : "depends-on",
"display" : "Library Global",
"resource" : "http://hl7.org/fhir/uv/cqfmeasures/Library/MATGlobalCommonFunctions|5.0.000"
},
{
"type" : "depends-on",
"display" : "Library Common",
"resource" : "http://hl7.org/fhir/uv/cqfmeasures/Library/Common|2.0.0"
},
{
"type" : "depends-on",
"display" : "Code system ConditionClinicalStatusCodes",
"resource" : "http://terminology.hl7.org/CodeSystem/condition-clinical"
},
{
"type" : "depends-on",
"display" : "Code system ConditionVerificationStatusCodes",
"resource" : "http://terminology.hl7.org/CodeSystem/condition-ver-status"
},
{
"type" : "depends-on",
"display" : "Value set Ambulatory/ED Visit",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061"
},
{
"type" : "depends-on",
"display" : "Value set Acute Pharyngitis",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011"
},
{
"type" : "depends-on",
"display" : "Value set Acute Tonsillitis",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012"
},
{
"type" : "depends-on",
"display" : "Value set Antibiotic Medications",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001"
},
{
"type" : "depends-on",
"display" : "Value set Group A Streptococcus Test",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012"
}
],
"parameter" : [
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"use" : "in",
"min" : 0,
"max" : "1",
"type" : "Period"
},
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"name" : "Numerator",
"use" : "out",
"min" : 0,
"max" : "*",
"type" : "Encounter"
},
{
"name" : "Initial Population",
"use" : "out",
"min" : 0,
"max" : "*",
"type" : "Encounter"
}
],
"dataRequirement" : [
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"profile" : [
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"mustSupport" : [
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],
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"valueCode" : "Encounter"
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🔗 "reference" : "Device/software-system-example"
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"url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
"valueCanonical" : "#effective-data-requirements-exm146"
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],
"url" : "http://hl7.org/fhir/uv/cqfmeasures/Measure/EXM146-FHIR",
"identifier" : [
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"use" : "official",
"system" : "http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm",
"value" : "146"
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],
"version" : "4.0.0",
"name" : "EXM146",
"title" : "EXM146 - Appropriate Testing for Children with Pharyngitis",
"status" : "active",
"experimental" : true,
"date" : "2022-02-22",
"publisher" : "HL7 International / Clinical Quality Information",
"contact" : [
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"value" : "http://www.hl7.org/Special/committees/cqi"
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],
"description" : "Percentage 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.",
"useContext" : [
{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "venue",
"display" : "Venue"
},
"valueCodeableConcept" : {
"coding" : [
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"code" : "ec",
"display" : "EC"
}
]
}
}
],
"jurisdiction" : [
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"coding" : [
{
"system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code" : "001"
}
]
}
],
"purpose" : "This measure has been developed to support improvement in clinical care.",
"copyright" : "Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). \r\nThe 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. \r\n(c) 2008 -2014 National Committee for Quality Assurance. All Rights Reserved. \r\nLimited 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.\r\nCPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2013 World Health Organization. All Rights Reserved.",
"approvalDate" : "2016-01-01",
"lastReviewDate" : "2016-09-01",
"effectivePeriod" : {
"start" : "2018-01-01",
"end" : "2018-12-31"
},
"topic" : [
{
"coding" : [
{
"system" : "http://loinc.org",
"code" : "57024-2",
"display" : "Health Quality Measure Document"
}
]
}
],
"library" : [
🔗 "http://hl7.org/fhir/uv/cqfmeasures/Library/EXM146-FHIR"
],
"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. \n Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].",
"scoring" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
"code" : "proportion",
"display" : "Proportion"
}
]
},
"type" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-type",
"code" : "process"
}
]
}
],
"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). A study on antibiotic treatment of children with sore throat found that although only 15 to 36 percent of children with sore throat have Strep A pharyngitis, physicians prescribed antibiotics to 53 percent of children with a chief complaint of sore throat between 1995 and 2003 (Linder et al. 2005).",
"clinicalRecommendationStatement" : "Institute for Clinical Systems Improvement (ICSI) (2007) \n Reduce unnecessary use of antibiotics. Antibiotic treatment should be reserved for a bacterial illness. Diagnosis of group A beta streptococcal Pharyngitis should be made by laboratory testing rather than clinically. \nInfectious Disease Society of America (Bisno et al. 2002) \nThe signs and symptoms of group A streptococcal and other (most frequently viral) pharyngitides overlap broadly. Therefore, unless the physician is able with confidence to exclude the diagnosis of streptococcal pharyngitis on epidemiological and clinical grounds alone, a laboratory test should be done to determine whether group A streptococci are present in the pharynx. \nWith the exception of very rare infections by certain other pharyngeal bacterial pathogens (eg, Corynebacterium diphtheriae and Neisseria gonorrhoeae), antimicrobial therapy is of no proven benefit as treatment for acute pharyngitis due to bacteria other than group A streptococci. Therefore, it is extremely important that physicians exclude the diagnosis of group A streptococcal pharyngitis to prevent inappropriate administration of antimicrobials to large numbers of patients with pharyngitis. \nMichigan Quality Improvement Consortium (2007)\nProbability of group A beta hemolytic streptococci (GABHS): Low; Testing: None; Treatment: Symptomatic treatment only. Avoid antibiotics. Probability of GABHS: Intermediate or High; Testing: Throat Culture (TC) OR Rapid Screen; Treatment: If TC is positive, use antibiotics. If TC is negative, use symptomatic treatment only. Avoid antibiotics. If treatment is started and culture result is negative, stop antibiotics. If Rapid Screen is positive, use antibiotics. If Rapid Screen is negative, culture (Culture is optional for age 16 and over) and only use antibiotics if throat culture is positive. (Michigan, 2007)",
"improvementNotation" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
"code" : "increase",
"display" : "Increased score indicates improvement"
}
]
},
"guidance" : "This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. If the patient has more than one episode, include all episodes in the measure.",
"group" : [
{
"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"
}
},
{
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "numerator",
"display" : "Numerator"
}
]
},
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Numerator"
}
},
{
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "denominator",
"display" : "Denominator"
}
]
},
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Denominator"
}
},
{
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "denominator-exclusion",
"display" : "Denominator Exclusion"
}
]
},
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Denominator Exclusion"
}
}
]
}
]
}
IG © 2019+ HL7 International / Clinical Quality Information. Package hl7.fhir.uv.cqm#1.0.0-ballot based on FHIR 4.0.1. Generated 2024-12-10
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