Metadata Title EXM124 - Cervical Cancer Screening Version 9.0.000 Short Name Cervical Cancer Screening GUID (Version Independent) http://example.org/fhir/us/cqm/Measure/EXM124-FHIR GUID (Version Specific) http://example.org/fhir/us/cqm/Measure/CMS124v7 Identifier 124 Identifier 309 Identifier urn:oid:2.16.840.1.113883.4.642.40.61.29.4 Effective Period 2018-01-01 through 2018-12-31 Approval Date 2016-01-01 Last Review Date 2016-09-01 Experimental true Use Context Clinical Venue = EC Jurisdiction Global (Whole world) Topic Health Quality Measure Document Steward (Publisher) HL7 International / Clinical Quality Information Description Percentage of women 21-64 years of age who were screened for cervical cancer using either of the following criteria: Women age 21-64 who had cervical cytology performed every 3 years Women age 30-64 who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years Purpose This measure has been developed to support improvement in clinical care. Copyright This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2017 American Medical Association. LOINC(R) copyright 2004-2017 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R] ) copyright 2004-2017 International Health Terminology Standards Development Organisation. ICD-10 copyright 2017 World Health Organization. All Rights Reserved. Disclaimer The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]. Measure Basis boolean Measure Scoring Proportion Measure Type Process Rationale Breast cancer is one of the most common types of cancers, accounting for 15 percent of all new cancer diagnoses in the U.S. (Howlader et al, 2016). In 2013, over 3 million women were estimated to be living with breast cancer in the U.S. and it is estimated that 12 percent of women will be diagnosed with breast cancer at some point during their lifetime (Howlader et al, 2016). While there are other factors that affect a woman's risk of developing breast cancer, advancing age is a primary risk factor. Breast cancer is most frequently diagnosed among women ages 55-64; the median age at diagnosis is 62 years (Howlader et al, 2016). The chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 40, the chances are 1 in 235; by age 50 it becomes 1 in 54; by age 60, it is 1 in 25 (National Business Group on Health, 2011). In the U.S., costs associated with a diagnosis of breast cancer range from $451 to $2,520, factoring in continued testing, multiple office visits and procedures. The total costs related to breast cancer add up to nearly $7 billion per year in the U.S., including $2 billion spent on late-stage treatment (National Business Group on Health, 2011). If breast cancer is detected through mammography screening and diagnosed in its earliest stages, treatment may be less expensive (Feig, 2011). Clinical Recommendation Statement The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50-74 years (B recommendation). The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years (C recommendation). (USPSTF, 2016) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older (I statement). (USPSTF, 2016) The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis (DBT) as a primary screening method for breast cancer (I Statement). (USPSTF, 2016) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, magnetic resonance imaging, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram (I statement). (USPSTF, 2016) Improvement Notation Increased score indicates improvement Guidance (Usage) To ensure the measure is only looking for a cervical cytology test only after a woman turns 21 years of age, the youngest age in the initial population is 23. Patient self-report for procedures as well as diagnostic studies should be recorded in 'Procedure, Performed' template or 'Diagnostic Study, Performed' template in QRDA-1. Include only cytology and HPV "co-testing"; in co-testing, both cytology and HPV tests are performed (i.e., the samples are collected and both tests are ordered, regardless of the cytology result) on the same date of service. Do not include reflex testing. In addition, if the medical record indicates the HPV test was performed only after determining the cytology result, this is considered reflex testing and does not meet criteria for the measure. Measure Group (Rate) (ID: primary) Summary Percentage of women 21-64 years of age who were screened for cervical cancer using either of the following criteria: * Women age 21-64 who had cervical cytology performed every 3 years * Women age 30-64 who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years Initial Population ID: primary-exm124-initial-population Description: Women 23-64 years of age with a visit during the measurement period Criteria: Initial Population Numerator ID: primary-exm124-numerator Description: Women with one or more screenings for cervical cancer. Appropriate screenings are defined by any one of the following criteria: * Cervical cytology performed during the measurement period or the two years prior to the measurement period for women who are at least 21 years old at the time of the test * Cervical human papillomavirus (HPV) testing performed during the measurement period or the four years prior to the measurement period for women who are 30 years or older at the time of the test Criteria: Numerator Denominator ID: primary-exm124-denominator Description: Equals Initial Population Criteria: Denominator Denominator Exclusion ID: primary-exm124-denominator-exclusion Description: Women who had a hysterectomy with no residual cervix or a congenital absence of cervix. Exclude patients who are in hospice care for any part of the measurement period. Exclude patients receiving palliative care during the measurement period. Criteria: Denominator Exclusion Supplemental Data Elements Supplemental Data Element Usage Code: Supplemental Data Description: No description provided Logic Definition: SDE Ethnicity Supplemental Data Element Usage Code: Supplemental Data Description: No description provided Logic Definition: SDE Payer Supplemental Data Element Usage Code: Supplemental Data Description: Race Logic Definition: SDE Race Supplemental Data Element Usage Code: Supplemental Data Description: No description provided Logic Definition: SDE Sex Measure Logic Primary Library EXM124 - Cervical Cancer Screening Library Contents Population Criteria Logic Definitions Terminology Dependencies Data Requirements Population Criteria Measure Group (Rate) (ID: primary) Initial Population define "Initial Population": Patient.gender = 'female' and Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of "Measurement Period") in Interval[23, 64] and exists AdultOutpatientEncounters."Qualifying Encounters" Definition Numerator define "Numerator": exists "Cervical Cytology Within 3 Years" or exists "HPV Test Within 5 Years for Women Age 30 and Older" Definition Denominator define "Denominator": "Initial Population" Definition Denominator Exclusion define "Denominator Exclusion": Hospice."Has Hospice" or exists "Absence of Cervix" Definition Logic Definitions Logic Definition Library Name: AdultOutpatientEncounters define "Qualifying Encounters": ( [Encounter: "Office Visit"] union [Encounter: "Annual Wellness Visit"] union [Encounter: "Preventive Care Services - Established Office Visit, 18 and Up"] union [Encounter: "Preventive Care Services-Initial Office Visit, 18 and Up"] union [Encounter: "Home Healthcare Services"] ) ValidEncounter where ValidEncounter.period during "Measurement Period" and ValidEncounter.status = 'finished' Logic Definition Library Name: Hospice define "Has Hospice": exists ( [Encounter: "Encounter Inpatient"] DischargeHospice where DischargeHospice.status = 'finished' and ( DischargeHospice.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)" or DischargeHospice.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)" ) and DischargeHospice.period ends during "Measurement Period" ) or exists ( [ServiceRequest: "Hospice care ambulatory"] HospiceOrder where HospiceOrder.intent = 'order' and HospiceOrder.authoredOn in "Measurement Period" ) or exists ( [Procedure: "Hospice care ambulatory"] HospicePerformed where HospicePerformed.status = 'completed' and Global."Normalize Interval"(HospicePerformed.performed) overlaps "Measurement Period" ) Logic Definition Library Name: SupplementalDataElements define "SDE Sex": case when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' } when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' } else null end Logic Definition Library Name: SupplementalDataElements define "SDE Payer": [Coverage: type in "Payer"] Payer return { code: Payer.type, period: Payer.period } Logic Definition Library Name: SupplementalDataElements define "SDE Ethnicity": (flatten ( Patient.extension Extension where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity' return Extension.extension )) E where E.url = 'ombCategory' or E.url = 'detailed' return E.value as Coding Logic Definition Library Name: SupplementalDataElements define "SDE Race": (flatten ( Patient.extension Extension where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race' return Extension.extension )) E where E.url = 'ombCategory' or E.url = 'detailed' return E.value as Coding Logic Definition Library Name: EXM124 define "SDE Sex": SDE."SDE Sex" Logic Definition Library Name: EXM124 define "Cervical Cytology Within 3 Years": [Observation: "Pap Test"] CervicalCytology where CervicalCytology.value is not null and CervicalCytology.status in { 'final', 'amended', 'corrected', 'preliminary' } and Global."Normalize Interval"(CervicalCytology.effective) ends 3 years or less on or before end of "Measurement Period" Logic Definition Library Name: EXM124 define "HPV Test Within 5 Years for Women Age 30 and Older": [Observation: "HPV Test"] HPVTest where HPVTest.value is not null and HPVTest.status in { 'final', 'amended', 'corrected', 'preliminary' } and Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of Global."Normalize Interval"(HPVTest.effective))>= 30 and Global."Normalize Interval"(HPVTest.effective) ends 5 years or less on or before end of "Measurement Period" Logic Definition Library Name: EXM124 define "Numerator": exists "Cervical Cytology Within 3 Years" or exists "HPV Test Within 5 Years for Women Age 30 and Older" Logic Definition Library Name: EXM124 define "Initial Population": Patient.gender = 'female' and Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of "Measurement Period") in Interval[23, 64] and exists AdultOutpatientEncounters."Qualifying Encounters" Logic Definition Library Name: EXM124 define "Denominator": "Initial Population" Logic Definition Library Name: EXM124 define "SDE Payer": SDE."SDE Payer" Logic Definition Library Name: EXM124 define "SDE Ethnicity": SDE."SDE Ethnicity" Logic Definition Library Name: EXM124 define "Absence of Cervix": ([Procedure: "Hysterectomy with No Residual Cervix"] NoCervixProcedure where Global."Normalize Interval"(NoCervixProcedure.performed) ends on or before end of "Measurement Period" and NoCervixProcedure.status = 'completed' ) union [Condition : "Congenital absence of cervix (disorder)"] NoCervixBirth where Global."Normalize Interval"(NoCervixBirth.onset) starts on or before end of "Measurement Period" Logic Definition Library Name: EXM124 define "Denominator Exclusion": Hospice."Has Hospice" or exists "Absence of Cervix" Logic Definition Library Name: EXM124 define "SDE Race": SDE."SDE Race" Logic Definition Library Name: MATGlobalCommonFunctions define function "CalendarAgeInYearsAt"(BirthDateTime DateTime, AsOf DateTime): years between ToDate(BirthDateTime)and ToDate(AsOf) Logic Definition Library Name: MATGlobalCommonFunctions define function "ToDate"(Value DateTime): DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezoneoffset from Value) Logic Definition Library Name: FHIRHelpers define function ToString(value AdministrativeGender): value.value Logic Definition Library Name: FHIRHelpers define function ToString(value ObservationStatus): value.value Logic Definition Library Name: FHIRHelpers define function ToDate(value date): value.value Logic Definition Library Name: FHIRHelpers /* @description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period) value to a CQL DateTime Interval @comment: If the start value of the given period is unspecified, the starting boundary of the resulting interval will be open (meaning the start of the interval is unknown, as opposed to interpreted as the beginning of time). */ define function ToInterval(period FHIR.Period): if period is null then null else if period."start" is null then Interval(period."start".value, period."end".value] else Interval[period."start".value, period."end".value] Logic Definition Library Name: FHIRHelpers define function ToString(value EncounterStatus): value.value Logic Definition Library Name: FHIRHelpers define function ToString(value uri): value.value Logic Definition Library Name: FHIRHelpers /* @description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept. */ define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value } Logic Definition Library Name: FHIRHelpers /* @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code. */ define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value } Logic Definition Library Name: FHIRHelpers define function ToString(value ServiceRequestIntent): value.value Logic Definition Library Name: FHIRHelpers define function ToDateTime(value dateTime): value.value Logic Definition Library Name: FHIRHelpers define function ToString(value ProcedureStatus): value.value Terminology Code System Description: Code system SNOMEDCT:2017-09 Resource: http://snomed.info/sct|http://snomed.info/sct/731000124108/version/201709 Canonical URL: http://snomed.info/sct|http://snomed.info/sct/731000124108/version/201709 Value Set Description: Value set Pap Test Resource: Pap Test Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1017 Value Set Description: Value set HPV Test Resource: HPV Test Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1059 Value Set Description: Value set Office Visit Resource: Office Visit Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001 Value Set Description: Value set Annual Wellness Visit Resource: Annual Wellness Visit Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240 Value Set Description: Value set Preventive Care Services - Established Office Visit, 18 and Up Resource: Preventive Care Services Established Office Visit, 18 and Up Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025 Value Set Description: Value set Preventive Care Services-Initial Office Visit, 18 and Up Resource: Preventive Care Services Initial Office Visit, 18 and Up Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023 Value Set Description: Value set Home Healthcare Services Resource: Home Healthcare Services Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016 Value Set Description: Value set Payer Resource: Payer Type Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591 Value Set Description: Value set Encounter Inpatient Resource: Encounter Inpatient Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307 Value Set Description: Value set Hospice care ambulatory Resource: Hospice Care Ambulatory Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15 Value Set Description: Value set Hysterectomy with No Residual Cervix Resource: Hysterectomy with No Residual Cervix Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1014 Direct Reference Code Display: Discharge to home for hospice care (procedure) Code: 428361000124107 System: http://snomed.info/sct Direct Reference Code Display: Discharge to healthcare facility for hospice care (procedure) Code: 428371000124100 System: http://snomed.info/sct Direct Reference Code Display: Congenital absence of cervix (disorder) Code: 37687000 System: http://snomed.info/sct Dependencies Dependency Description: Library SDE Resource: Supplemental Data Elementsversion: null2.0.000) Canonical URL: http://hl7.org/fhir/uv/cqm/Library/SupplementalDataElements|2.0.000 Dependency Description: Library FHIRHelpers Resource: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1 Canonical URL: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1 Dependency Description: Library Global Resource: MAT Global Common Functions FHIR Libraryversion: null5.0.000) Canonical URL: http://hl7.org/fhir/uv/cqm/Library/MATGlobalCommonFunctions|5.0.000 Dependency Description: Library AdultOutpatientEncounters Resource: Adult Outpatient Encounters Common Libraryversion: null2.0.000) Canonical URL: http://hl7.org/fhir/uv/cqm/Library/AdultOutpatientEncounters|2.0.000 Dependency Description: Library Hospice Resource: Hospice FHIR Libraryversion: null2.0.000) Canonical URL: http://hl7.org/fhir/uv/cqm/Library/Hospice|2.0.000 Data Requirements Data Requirement Type: Patient Profile(s): Patient Must Support Elements: url, extension, value Data Requirement Type: Observation Profile(s): Observation Must Support Elements: code, value, status, effective Code Filter(s): Path: code ValueSet: Pap Test Data Requirement Type: Observation Profile(s): Observation Must Support Elements: code, value, status, effective Code Filter(s): Path: code ValueSet: HPV Test Data Requirement Type: Encounter Profile(s): Encounter Must Support Elements: type, period, status Code Filter(s): Path: type ValueSet: Office Visit Data Requirement Type: Encounter Profile(s): Encounter Must Support Elements: type, period, status Code Filter(s): Path: type ValueSet: Annual Wellness Visit Data Requirement Type: Encounter Profile(s): Encounter Must Support Elements: type, period, status Code Filter(s): Path: type ValueSet: Preventive Care Services Established Office Visit, 18 and Up Data Requirement Type: Encounter Profile(s): Encounter Must Support Elements: type, period, status Code Filter(s): Path: type ValueSet: Preventive Care Services Initial Office Visit, 18 and Up Data Requirement Type: Encounter Profile(s): Encounter Must Support Elements: type, period, status Code Filter(s): Path: type ValueSet: Home Healthcare Services Data Requirement Type: Encounter Profile(s): Encounter Must Support Elements: type, status, hospitalization, hospitalization.dischargeDisposition, period Code Filter(s): Path: type ValueSet: Encounter Inpatient Data Requirement Type: Coverage Profile(s): Coverage Must Support Elements: type, period Code Filter(s): Path: type ValueSet: Payer Type Data Requirement Type: ServiceRequest Profile(s): ServiceRequest Must Support Elements: code, intent, authoredOn Code Filter(s): Path: code ValueSet: Hospice Care Ambulatory Data Requirement Type: Procedure Profile(s): Procedure Must Support Elements: code, status, performed Code Filter(s): Path: code ValueSet: Hospice Care Ambulatory Data Requirement Type: Procedure Profile(s): Procedure Must Support Elements: code, performed, status Code Filter(s): Path: code ValueSet: Hysterectomy with No Residual Cervix Data Requirement Type: Condition Profile(s): Condition Must Support Elements: code, onset Code Filter(s): Path: code Code(s): SNOMED CT: 37687000 (Congenital absence of cervix (disorder)) (version = http://snomed.info/sct/731000124108/version/201709 ) Generated using version 0.4.9 of the sample-content-ig Liquid templates
Discharge to home for hospice care (procedure)
Discharge to healthcare facility for hospice care (procedure)
define "SDE Sex": case when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' } when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' } else null end
define "Cervical Cytology Within 3 Years": [Observation: "Pap Test"] CervicalCytology where CervicalCytology.value is not null and CervicalCytology.status in { 'final', 'amended', 'corrected', 'preliminary' } and Global."Normalize Interval"(CervicalCytology.effective) ends 3 years or less on or before end of "Measurement Period"
HPV Test Within 5 Years for Women Age 30 and Older
define "HPV Test Within 5 Years for Women Age 30 and Older": [Observation: "HPV Test"] HPVTest where HPVTest.value is not null and HPVTest.status in { 'final', 'amended', 'corrected', 'preliminary' } and Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of Global."Normalize Interval"(HPVTest.effective))>= 30 and Global."Normalize Interval"(HPVTest.effective) ends 5 years or less on or before end of "Measurement Period"
define "Numerator": exists "Cervical Cytology Within 3 Years" or exists "HPV Test Within 5 Years for Women Age 30 and Older"
define "Qualifying Encounters": ( [Encounter: "Office Visit"] union [Encounter: "Annual Wellness Visit"] union [Encounter: "Preventive Care Services - Established Office Visit, 18 and Up"] union [Encounter: "Preventive Care Services-Initial Office Visit, 18 and Up"] union [Encounter: "Home Healthcare Services"] ) ValidEncounter where ValidEncounter.period during "Measurement Period" and ValidEncounter.status = 'finished'
define "Initial Population": Patient.gender = 'female' and Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of "Measurement Period") in Interval[23, 64] and exists AdultOutpatientEncounters."Qualifying Encounters"
define "Denominator": "Initial Population"
define "SDE Payer": [Coverage: type in "Payer"] Payer return { code: Payer.type, period: Payer.period }
define "SDE Ethnicity": (flatten ( Patient.extension Extension where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity' return Extension.extension )) E where E.url = 'ombCategory' or E.url = 'detailed' return E.value as Coding
define "SDE Ethnicity": SDE."SDE Ethnicity"
define "Has Hospice": exists ( [Encounter: "Encounter Inpatient"] DischargeHospice where DischargeHospice.status = 'finished' and ( DischargeHospice.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)" or DischargeHospice.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)" ) and DischargeHospice.period ends during "Measurement Period" ) or exists ( [ServiceRequest: "Hospice care ambulatory"] HospiceOrder where HospiceOrder.intent = 'order' and HospiceOrder.authoredOn in "Measurement Period" ) or exists ( [Procedure: "Hospice care ambulatory"] HospicePerformed where HospicePerformed.status = 'completed' and Global."Normalize Interval"(HospicePerformed.performed) overlaps "Measurement Period" )
define "Absence of Cervix": ([Procedure: "Hysterectomy with No Residual Cervix"] NoCervixProcedure where Global."Normalize Interval"(NoCervixProcedure.performed) ends on or before end of "Measurement Period" and NoCervixProcedure.status = 'completed' ) union [Condition : "Congenital absence of cervix (disorder)"] NoCervixBirth where Global."Normalize Interval"(NoCervixBirth.onset) starts on or before end of "Measurement Period"
define "Denominator Exclusion": Hospice."Has Hospice" or exists "Absence of Cervix"
define "SDE Race": (flatten ( Patient.extension Extension where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race' return Extension.extension )) E where E.url = 'ombCategory' or E.url = 'detailed' return E.value as Coding
define function ToString(value AdministrativeGender): value.value
define function ToString(value ObservationStatus): value.value
define function "CalendarAgeInYearsAt"(BirthDateTime DateTime, AsOf DateTime): years between ToDate(BirthDateTime)and ToDate(AsOf)
define function "ToDate"(Value DateTime): DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezoneoffset from Value)
define function ToDate(value date): value.value
/* @description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period) value to a CQL DateTime Interval @comment: If the start value of the given period is unspecified, the starting boundary of the resulting interval will be open (meaning the start of the interval is unknown, as opposed to interpreted as the beginning of time). */ define function ToInterval(period FHIR.Period): if period is null then null else if period."start" is null then Interval(period."start".value, period."end".value] else Interval[period."start".value, period."end".value]
define function ToString(value EncounterStatus): value.value
define function ToString(value uri): value.value
/* @description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept. */ define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value }
/* @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code. */ define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value }
define function ToString(value ServiceRequestIntent): value.value
define function ToDateTime(value dateTime): value.value
define function ToString(value ProcedureStatus): value.value
Value set Preventive Care Services - Established Office Visit, 18 and Up
Value set Preventive Care Services-Initial Office Visit, 18 and Up
Value set Hysterectomy with No Residual Cervix
HL7 International / Clinical Quality Information
Percentage of women 21-64 years of age who were screened for cervical cancer using either of the following criteria: * Women age 21-64 who had cervical cytology performed every 3 years * Women age 30-64 who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years
This measure has been developed to support improvement in clinical care.
To ensure the measure is only looking for a cervical cytology test only after a woman turns 21 years of age, the youngest age in the initial population is 23. Patient self-report for procedures as well as diagnostic studies should be recorded in 'Procedure, Performed' template or 'Diagnostic Study, Performed' template in QRDA-1. Include only cytology and HPV "co-testing"; in co-testing, both cytology and HPV tests are performed (i.e., the samples are collected and both tests are ordered, regardless of the cytology result) on the same date of service. Do not include reflex testing. In addition, if the medical record indicates the HPV test was performed only after determining the cytology result, this is considered reflex testing and does not meet criteria for the measure.
This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2017 American Medical Association. LOINC(R) copyright 2004-2017 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R] ) copyright 2004-2017 International Health Terminology Standards Development Organisation. ICD-10 copyright 2017 World Health Organization. All Rights Reserved.
The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Breast cancer is one of the most common types of cancers, accounting for 15 percent of all new cancer diagnoses in the U.S. (Howlader et al, 2016). In 2013, over 3 million women were estimated to be living with breast cancer in the U.S. and it is estimated that 12 percent of women will be diagnosed with breast cancer at some point during their lifetime (Howlader et al, 2016). While there are other factors that affect a woman's risk of developing breast cancer, advancing age is a primary risk factor. Breast cancer is most frequently diagnosed among women ages 55-64; the median age at diagnosis is 62 years (Howlader et al, 2016). The chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 40, the chances are 1 in 235; by age 50 it becomes 1 in 54; by age 60, it is 1 in 25 (National Business Group on Health, 2011). In the U.S., costs associated with a diagnosis of breast cancer range from $451 to $2,520, factoring in continued testing, multiple office visits and procedures. The total costs related to breast cancer add up to nearly $7 billion per year in the U.S., including $2 billion spent on late-stage treatment (National Business Group on Health, 2011). If breast cancer is detected through mammography screening and diagnosed in its earliest stages, treatment may be less expensive (Feig, 2011).
The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50-74 years (B recommendation). The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years (C recommendation). (USPSTF, 2016) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older (I statement). (USPSTF, 2016) The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis (DBT) as a primary screening method for breast cancer (I Statement). (USPSTF, 2016) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, magnetic resonance imaging, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram (I statement). (USPSTF, 2016)
Women 23-64 years of age with a visit during the measurement period
Women with one or more screenings for cervical cancer. Appropriate screenings are defined by any one of the following criteria: * Cervical cytology performed during the measurement period or the two years prior to the measurement period for women who are at least 21 years old at the time of the test * Cervical human papillomavirus (HPV) testing performed during the measurement period or the four years prior to the measurement period for women who are 30 years or older at the time of the test
Women who had a hysterectomy with no residual cervix or a congenital absence of cervix. Exclude patients who are in hospice care for any part of the measurement period. Exclude patients receiving palliative care during the measurement period.