Metadata Title EXM125 - Breast Cancer Screening Version 8.0.000 Identifier 125 Identifier 112 Identifier urn:oid:2.16.840.1.113883.4.642.40.61.29.5 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 50-74 years of age who had a mammogram to screen for breast cancer 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). The Measure is copyrighted but 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 must be approved by NCQA and are subject to a license at the discretion of 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. (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 CPT or other codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2016 American Medical Association. LOINC(R) copyright 2004-2016 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2016 International Health Terminology Standards Development Organisation. ICD-10 copyright 2016 World Health Organization. All Rights Reserved. The American Hospital Association holds a copyright to the National Uniform Billing Committee (NUBC) codes contained in the measure specifications. The NUBC codes in the specifications are included with the permission of the AHA. The NUBC codes contained in the specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting Measure results or using Measure results for their internal quality improvement purposes. All other uses of the NUBC codes require a license from the AHA. Anyone desiring to use the NUBC codes in a commercial product to generate Measure results, or for any other commercial use, must obtain a commercial use license directly from the AHA. To inquire about licensing, contact ub04@healthforum.com. 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. Measure Basis boolean Measure Scoring Proportion Measure Type Process Rationale Breast cancer is one of the most common types of cancers, accounting for a quarter of all new cancer diagnoses for women in the U.S. (BreastCancer.Org, 2011). It ranks as the second leading cause of cancer-related mortality in women, accounting for nearly 40,000 estimated deaths in 2013 (American Cancer Society, 2011). According to the National Cancer Institute's Surveillance Epidemiology and End Results program, the chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 30, it is one in 2,212. By age 40, the chances increase to one in 235, by age 50, it becomes one in 54, and, by age 60, it is one in 25. From 2004 to 2008, the median age at the time of breast cancer diagnosis was 61 years among adult women (Tangka et al, 2010). 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 varying 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 (Lavigne et al, 2008; Boykoff et al, 2009). 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 regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms (C recommendation). The Task Force concludes the evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years and older (I statement). U.S. Preventive Services Task Force (2009) Grade: B recommendation. The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. Grade: C recommendation. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. Grade: D recommendation. The USPSTF recommends against teaching breast self-examination (BSE). Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older. Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer. Improvement Notation Increased score indicates improvement Measure Group (Rate) (ID: primary) Initial Population ID: primary-exm125-initial-population Description: No description provided Criteria: Initial Population Numerator ID: primary-exm125-numerator Description: No description provided Criteria: Numerator Denominator ID: primary-exm125-denominator Description: No description provided Criteria: Denominator Denominator Exclusion ID: primary-exm125-denominator-exclusion Description: No description provided 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: No description provided Logic Definition: SDE Race Supplemental Data Element Usage Code: Supplemental Data Description: No description provided Logic Definition: SDE Sex Measure Logic Primary Library EXM125 - Breast 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[51, 74] and exists AdultOutpatientEncounters."Qualifying Encounters" Definition Numerator define "Numerator": exists ( [DiagnosticReport: "Mammography"] Mammogram where ( Global."Normalize Interval"(Mammogram.effective) ends 27 months or less before day of end of "Measurement Period" ) and Mammogram.status in { 'final', 'amended', 'corrected', 'appended' } ) Definition Denominator define "Denominator": "Initial Population" Definition Denominator Exclusion define "Denominator Exclusion": Hospice."Has Hospice" or ( Count("Unilateral Mastectomy Procedure") = 2 ) or ( exists "Right Mastectomy" and exists "Left Mastectomy" ) or exists "History Bilateral Mastectomy" or exists "Bilateral Mastectomy Procedure" 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: EXM125 define "SDE Sex": SDE."SDE Sex" Logic Definition Library Name: EXM125 define "Numerator": exists ( [DiagnosticReport: "Mammography"] Mammogram where ( Global."Normalize Interval"(Mammogram.effective) ends 27 months or less before day of end of "Measurement Period" ) and Mammogram.status in { 'final', 'amended', 'corrected', 'appended' } ) Logic Definition Library Name: EXM125 define "Initial Population": Patient.gender = 'female' and Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of "Measurement Period") in Interval[51, 74] and exists AdultOutpatientEncounters."Qualifying Encounters" Logic Definition Library Name: EXM125 define "Denominator": "Initial Population" Logic Definition Library Name: EXM125 define "SDE Payer": SDE."SDE Payer" Logic Definition Library Name: EXM125 define "SDE Ethnicity": SDE."SDE Ethnicity" Logic Definition Library Name: EXM125 define "Unilateral Mastectomy Procedure": [Procedure: "Unilateral Mastectomy"] UnilateralMastectomyProcedure where Global."Normalize Interval"(UnilateralMastectomyProcedure.performed) ends before day of end of "Measurement Period" and UnilateralMastectomyProcedure.status = 'completed' Logic Definition Library Name: EXM125 define "Right Mastectomy": ( ( [Condition: "Status Post Right Mastectomy"] C where C.clinicalStatus ~ ToConcept(Global."active") ) union ( [Condition: "Unilateral Mastectomy, Unspecified Laterality"] UnilateralMastectomyDiagnosis where UnilateralMastectomyDiagnosis.bodySite in "Right" and UnilateralMastectomyDiagnosis.clinicalStatus ~ ToConcept(Global."active") ) ) RightMastectomy where Global."Normalize Interval"(RightMastectomy.onset) starts before day of end of "Measurement Period" Logic Definition Library Name: EXM125 define "Left Mastectomy": ( ( [Condition: "Status Post Left Mastectomy"] C where C.clinicalStatus ~ ToConcept(Global."active") ) union ( [Condition: "Unilateral Mastectomy, Unspecified Laterality"] UnilateralMastectomyDiagnosis where UnilateralMastectomyDiagnosis.bodySite in "Left" and UnilateralMastectomyDiagnosis.clinicalStatus ~ ToConcept(Global."active") ) ) LeftMastectomy where Global."Normalize Interval"(LeftMastectomy.onset) starts before day of end of "Measurement Period" Logic Definition Library Name: EXM125 define "History Bilateral Mastectomy": [Condition: "History of bilateral mastectomy"] BilateralMastectomyHistory where Global."Normalize Interval"(BilateralMastectomyHistory.onset) starts before day of end of "Measurement Period" and BilateralMastectomyHistory.clinicalStatus ~ ToConcept(Global."active") Logic Definition Library Name: EXM125 define "Bilateral Mastectomy Procedure": [Procedure: "Bilateral Mastectomy"] BilateralMastectomyPerformed where Global."Normalize Interval"(BilateralMastectomyPerformed.performed) ends before day of end of "Measurement Period" and BilateralMastectomyPerformed.status = 'completed' Logic Definition Library Name: EXM125 define "Denominator Exclusion": Hospice."Has Hospice" or ( Count("Unilateral Mastectomy Procedure") = 2 ) or ( exists "Right Mastectomy" and exists "Left Mastectomy" ) or exists "History Bilateral Mastectomy" or exists "Bilateral Mastectomy Procedure" Logic Definition Library Name: EXM125 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 DiagnosticReportStatus): 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 Code System Description: Code system ConditionClinicalStatusCodes Resource: Condition Clinical Status Codes Canonical URL: http://terminology.hl7.org/CodeSystem/condition-clinical Value Set Description: Value set Mammography Resource: Mammography Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1018 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 Unilateral Mastectomy Resource: Unilateral Mastectomy Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1020 Value Set Description: Value set Status Post Right Mastectomy Resource: Status Post Right Mastectomy Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1070 Value Set Description: Value set Unilateral Mastectomy, Unspecified Laterality Resource: Unilateral Mastectomy, Unspecified Laterality Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1071 Value Set Description: Value set Right Resource: Right Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.122.12.1035 Value Set Description: Value set Status Post Left Mastectomy Resource: Status Post Left Mastectomy Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1069 Value Set Description: Value set Left Resource: Left Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.122.12.1036 Value Set Description: Value set History of bilateral mastectomy Resource: History of bilateral mastectomy Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1068 Value Set Description: Value set Bilateral Mastectomy Resource: Bilateral Mastectomy Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1005 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 Code: active System: http://terminology.hl7.org/CodeSystem/condition-clinical 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: DiagnosticReport Profile(s): DiagnosticReport Must Support Elements: code, effective, status Code Filter(s): Path: code ValueSet: Mammography 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: Unilateral Mastectomy Data Requirement Type: Procedure Profile(s): Procedure Must Support Elements: code, performed, status Code Filter(s): Path: code ValueSet: Bilateral Mastectomy Data Requirement Type: Condition Profile(s): Condition Must Support Elements: code, clinicalStatus, onset Code Filter(s): Path: code ValueSet: Status Post Right Mastectomy Data Requirement Type: Condition Profile(s): Condition Must Support Elements: code, clinicalStatus, onset Code Filter(s): Path: code ValueSet: Status Post Left Mastectomy Data Requirement Type: Condition Profile(s): Condition Must Support Elements: code, bodySite, clinicalStatus, onset Code Filter(s): Path: code ValueSet: Unilateral Mastectomy, Unspecified Laterality Data Requirement Type: Condition Profile(s): Condition Must Support Elements: code, onset, clinicalStatus Code Filter(s): Path: code ValueSet: History of bilateral mastectomy 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 "Numerator": exists ( [DiagnosticReport: "Mammography"] Mammogram where ( Global."Normalize Interval"(Mammogram.effective) ends 27 months or less before day of end of "Measurement Period" ) and Mammogram.status in { 'final', 'amended', 'corrected', 'appended' } )
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[51, 74] 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 "Unilateral Mastectomy Procedure": [Procedure: "Unilateral Mastectomy"] UnilateralMastectomyProcedure where Global."Normalize Interval"(UnilateralMastectomyProcedure.performed) ends before day of end of "Measurement Period" and UnilateralMastectomyProcedure.status = 'completed'
define "Right Mastectomy": ( ( [Condition: "Status Post Right Mastectomy"] C where C.clinicalStatus ~ ToConcept(Global."active") ) union ( [Condition: "Unilateral Mastectomy, Unspecified Laterality"] UnilateralMastectomyDiagnosis where UnilateralMastectomyDiagnosis.bodySite in "Right" and UnilateralMastectomyDiagnosis.clinicalStatus ~ ToConcept(Global."active") ) ) RightMastectomy where Global."Normalize Interval"(RightMastectomy.onset) starts before day of end of "Measurement Period"
define "Left Mastectomy": ( ( [Condition: "Status Post Left Mastectomy"] C where C.clinicalStatus ~ ToConcept(Global."active") ) union ( [Condition: "Unilateral Mastectomy, Unspecified Laterality"] UnilateralMastectomyDiagnosis where UnilateralMastectomyDiagnosis.bodySite in "Left" and UnilateralMastectomyDiagnosis.clinicalStatus ~ ToConcept(Global."active") ) ) LeftMastectomy where Global."Normalize Interval"(LeftMastectomy.onset) starts before day of end of "Measurement Period"
define "History Bilateral Mastectomy": [Condition: "History of bilateral mastectomy"] BilateralMastectomyHistory where Global."Normalize Interval"(BilateralMastectomyHistory.onset) starts before day of end of "Measurement Period" and BilateralMastectomyHistory.clinicalStatus ~ ToConcept(Global."active")
define "Bilateral Mastectomy Procedure": [Procedure: "Bilateral Mastectomy"] BilateralMastectomyPerformed where Global."Normalize Interval"(BilateralMastectomyPerformed.performed) ends before day of end of "Measurement Period" and BilateralMastectomyPerformed.status = 'completed'
define "Denominator Exclusion": Hospice."Has Hospice" or ( Count("Unilateral Mastectomy Procedure") = 2 ) or ( exists "Right Mastectomy" and exists "Left Mastectomy" ) or exists "History Bilateral Mastectomy" or exists "Bilateral Mastectomy Procedure"
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 DiagnosticReportStatus): 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
Code system ConditionClinicalStatusCodes
Value set Preventive Care Services - Established Office Visit, 18 and Up
Value set Preventive Care Services-Initial Office Visit, 18 and Up
Value set Unilateral Mastectomy, Unspecified Laterality
Value set History of bilateral mastectomy
HL7 International / Clinical Quality Information
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer
This measure has been developed to support improvement in clinical care.
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Breast cancer is one of the most common types of cancers, accounting for a quarter of all new cancer diagnoses for women in the U.S. (BreastCancer.Org, 2011). It ranks as the second leading cause of cancer-related mortality in women, accounting for nearly 40,000 estimated deaths in 2013 (American Cancer Society, 2011). According to the National Cancer Institute's Surveillance Epidemiology and End Results program, the chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 30, it is one in 2,212. By age 40, the chances increase to one in 235, by age 50, it becomes one in 54, and, by age 60, it is one in 25. From 2004 to 2008, the median age at the time of breast cancer diagnosis was 61 years among adult women (Tangka et al, 2010). 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 varying 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 (Lavigne et al, 2008; Boykoff et al, 2009).
The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50-74 years (B recommendation). The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms (C recommendation). The Task Force concludes the evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years and older (I statement). U.S. Preventive Services Task Force (2009) Grade: B recommendation. The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. Grade: C recommendation. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. Grade: D recommendation. The USPSTF recommends against teaching breast self-examination (BSE). Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older. Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.
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. Patient self-report is not allowed for laboratory tests. This measure evaluates primary screening. Do not count biopsies, breast ultrasounds, MRIs or tomosynthesis (3D mammography), because they are not appropriate methods for primary breast cancer screening.