Metadata Title EXM130 - Colorectal Cancer Screening Measure Version 8.0.000 Identifier 130 Identifier 0034 Identifier urn:oid:2.16.840.1.113883.4.642.40.61.29.6 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 adults 50-75 years of age who had appropriate screening for colorectal 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). 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 Colorectal cancer represents 8 percent of all new cancer cases and is the second leading cause of cancer deaths in the United States. In 2017, there were an estimated 135,430 new cases of colorectal cancer and an estimated 50,260 deaths attributed to it. According to the National Cancer Institute, about 4.3 percent of men and women will be diagnosed with colorectal cancer at some point during their lifetimes. For most adults, older age is the most important risk factor for colorectal cancer, although being male and black are also associated with higher incidence and mortality. Colorectal cancer is most frequently diagnosed among people 65 to 74 years old (Howlader et al. 2017). Screening can be effective for finding precancerous lesions (polyps) that could later become malignant, and for detecting early cancers that can be more easily and effectively treated. Precancerous polyps usually take about 10 to 15 years to develop into colorectal cancer, and most can be found and removed before turning into cancer. The five-year relative survival rate for people whose colorectal cancer is found in the early stage before it has spread is about 90 percent (American Cancer Society 2017). Clinical Recommendation Statement The U. S. Preventive Services Task Force (2016) recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. This is a Grade A recommendation (U.S. Preventive Services Task Force 2016). Screening tests: -Colonoscopy (every 10 years) -Flexible sigmoidoscopy (every 5 years) -Fecal occult blood test (annually) -FIT-DNA (every 3 years) -Computed tomographic colonography (every 5 years) Improvement Notation Increased score indicates improvement Measure Group (Rate) (ID: primary) Initial Population ID: primary-exm130-initial-population Description: No description provided Criteria: Initial Population Numerator ID: primary-exm130-numerator Description: No description provided Criteria: Numerator Denominator ID: primary-exm130-denominator Description: No description provided Criteria: Denominator Denominator Exclusion ID: primary-exm130-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 EXM130 - Colorectal Cancer Screening Library Contents Population Criteria Logic Definitions Terminology Dependencies Data Requirements Population Criteria Measure Group (Rate) (ID: primary) Initial Population define "Initial Population": Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of "Measurement Period") in Interval[50, 75] and exists AdultOutpatientEncounters."Qualifying Encounters" Definition Numerator define "Numerator": exists "Colonoscopy Performed" or exists "Fecal Occult Blood Test Performed" or exists "Flexible Sigmoidoscopy Performed" or exists "Fecal Immunochemical Test DNA" or exists "CT Colonography Performed" Definition Denominator define "Denominator": true Definition Denominator Exclusion define "Denominator Exclusion": Hospice."Has Hospice" or exists "Malignant Neoplasm Ever" or exists "Total Colectomy Performed" 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: EXM130 define "SDE Sex": SDE."SDE Sex" Logic Definition Library Name: EXM130 define "Colonoscopy Performed": [Procedure: "Colonoscopy"] Colonoscopy where Colonoscopy.status = 'completed' and Global."Normalize Interval"(Colonoscopy.performed) ends 10 years or less on or before end of "Measurement Period" Logic Definition Library Name: EXM130 define "Fecal Occult Blood Test Performed": [Observation: "Fecal Occult Blood Test (FOBT)"] FecalOccultResult where FecalOccultResult.status in {'final', 'amended', 'corrected', 'preliminary'} and FecalOccultResult.value is not null and Global."Normalize Interval"(FecalOccultResult.effective) during day of "Measurement Period" Logic Definition Library Name: EXM130 define "Flexible Sigmoidoscopy Performed": [Procedure: "Flexible Sigmoidoscopy"] FlexibleSigmoidoscopy where FlexibleSigmoidoscopy.status = 'completed' and Global."Normalize Interval"(FlexibleSigmoidoscopy.performed) ends 5 years or less on or before end of "Measurement Period" Logic Definition Library Name: EXM130 define "Fecal Immunochemical Test DNA": [Observation: "FIT DNA"] FitDNA where FitDNA.status in {'final', 'amended', 'corrected', 'preliminary'} and FitDNA.value is not null and Global."Normalize Interval"(FitDNA.effective) occurs 3 years or less on or before day of end of "Measurement Period" Logic Definition Library Name: EXM130 define "CT Colonography Performed": [Procedure: "CT Colonography"] Colonography where Colonography.status = 'completed' and Global."Normalize Interval"(Colonography.performed) ends 5 years or less on or before end of "Measurement Period" Logic Definition Library Name: EXM130 define "Numerator": exists "Colonoscopy Performed" or exists "Fecal Occult Blood Test Performed" or exists "Flexible Sigmoidoscopy Performed" or exists "Fecal Immunochemical Test DNA" or exists "CT Colonography Performed" Logic Definition Library Name: EXM130 define "Denominator": true Logic Definition Library Name: EXM130 define "SDE Payer": SDE."SDE Payer" Logic Definition Library Name: EXM130 define "Initial Population": Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of "Measurement Period") in Interval[50, 75] and exists AdultOutpatientEncounters."Qualifying Encounters" Logic Definition Library Name: EXM130 define "SDE Ethnicity": SDE."SDE Ethnicity" Logic Definition Library Name: EXM130 define "Malignant Neoplasm Ever": [Condition: "Malignant Neoplasm of Colon"] ColorectalCancer where Global."Normalize Interval"(ColorectalCancer.onset) starts on or before end of "Measurement Period" Logic Definition Library Name: EXM130 define "Total Colectomy Performed": [Procedure: "Total Colectomy"] Colectomy where Colectomy.status = 'completed' and Global."Normalize Interval"(Colectomy.performed) starts on or before end of "Measurement Period" Logic Definition Library Name: EXM130 define "Denominator Exclusion": Hospice."Has Hospice" or exists "Malignant Neoplasm Ever" or exists "Total Colectomy Performed" Logic Definition Library Name: EXM130 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 ProcedureStatus): 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 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 Colonoscopy Resource: Colonoscopy Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020 Value Set Description: Value set Fecal Occult Blood Test (FOBT) Resource: Fecal Occult Blood Test (FOBT) Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011 Value Set Description: Value set Flexible Sigmoidoscopy Resource: Flexible Sigmoidoscopy Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010 Value Set Description: Value set FIT DNA Resource: sDNA FIT Test Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039 Value Set Description: Value set CT Colonography Resource: CT Colonography Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038 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 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 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 Malignant Neoplasm of Colon Resource: Malignant Neoplasm of Colon Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001 Value Set Description: Value set Total Colectomy Resource: Total Colectomy Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019 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 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: Procedure Profile(s): Procedure Must Support Elements: code, status, performed Code Filter(s): Path: code ValueSet: Colonoscopy Data Requirement Type: Procedure Profile(s): Procedure Must Support Elements: code, status, performed Code Filter(s): Path: code ValueSet: Flexible Sigmoidoscopy Data Requirement Type: Procedure Profile(s): Procedure Must Support Elements: code, status, performed Code Filter(s): Path: code ValueSet: CT Colonography 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, status, performed Code Filter(s): Path: code ValueSet: Total Colectomy Data Requirement Type: Observation Profile(s): Observation Must Support Elements: code, status, value, effective Code Filter(s): Path: code ValueSet: Fecal Occult Blood Test (FOBT) Data Requirement Type: Observation Profile(s): Observation Must Support Elements: code, status, value, effective Code Filter(s): Path: code ValueSet: sDNA FIT Test Data Requirement Type: Coverage Profile(s): Coverage Must Support Elements: type, period Code Filter(s): Path: type ValueSet: Payer Type 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: ServiceRequest Profile(s): ServiceRequest Must Support Elements: code, intent, authoredOn Code Filter(s): Path: code ValueSet: Hospice Care Ambulatory Data Requirement Type: Condition Profile(s): Condition Must Support Elements: code, onset Code Filter(s): Path: code ValueSet: Malignant Neoplasm of Colon 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 "Colonoscopy Performed": [Procedure: "Colonoscopy"] Colonoscopy where Colonoscopy.status = 'completed' and Global."Normalize Interval"(Colonoscopy.performed) ends 10 years or less on or before end of "Measurement Period"
define "Fecal Occult Blood Test Performed": [Observation: "Fecal Occult Blood Test (FOBT)"] FecalOccultResult where FecalOccultResult.status in {'final', 'amended', 'corrected', 'preliminary'} and FecalOccultResult.value is not null and Global."Normalize Interval"(FecalOccultResult.effective) during day of "Measurement Period"
define "Flexible Sigmoidoscopy Performed": [Procedure: "Flexible Sigmoidoscopy"] FlexibleSigmoidoscopy where FlexibleSigmoidoscopy.status = 'completed' and Global."Normalize Interval"(FlexibleSigmoidoscopy.performed) ends 5 years or less on or before end of "Measurement Period"
define "Fecal Immunochemical Test DNA": [Observation: "FIT DNA"] FitDNA where FitDNA.status in {'final', 'amended', 'corrected', 'preliminary'} and FitDNA.value is not null and Global."Normalize Interval"(FitDNA.effective) occurs 3 years or less on or before day of end of "Measurement Period"
define "CT Colonography Performed": [Procedure: "CT Colonography"] Colonography where Colonography.status = 'completed' and Global."Normalize Interval"(Colonography.performed) ends 5 years or less on or before end of "Measurement Period"
define "Numerator": exists "Colonoscopy Performed" or exists "Fecal Occult Blood Test Performed" or exists "Flexible Sigmoidoscopy Performed" or exists "Fecal Immunochemical Test DNA" or exists "CT Colonography Performed"
define "SDE Payer": [Coverage: type in "Payer"] Payer return { code: Payer.type, period: Payer.period }
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": Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of "Measurement Period") in Interval[50, 75] and exists AdultOutpatientEncounters."Qualifying Encounters"
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 "Malignant Neoplasm Ever": [Condition: "Malignant Neoplasm of Colon"] ColorectalCancer where Global."Normalize Interval"(ColorectalCancer.onset) starts on or before end of "Measurement Period"
define "Total Colectomy Performed": [Procedure: "Total Colectomy"] Colectomy where Colectomy.status = 'completed' and Global."Normalize Interval"(Colectomy.performed) starts on or before end of "Measurement Period"
define "Denominator Exclusion": Hospice."Has Hospice" or exists "Malignant Neoplasm Ever" or exists "Total Colectomy Performed"
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 ProcedureStatus): 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
Value set Fecal Occult Blood Test (FOBT)
Value set Preventive Care Services - Established Office Visit, 18 and Up
Value set Preventive Care Services-Initial Office Visit, 18 and Up
EXM130 - Colorectal Cancer Screening Measure
HL7 International / Clinical Quality Information
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
This measure has been developed to support improvement in clinical care.
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].
Colorectal cancer represents 8 percent of all new cancer cases and is the second leading cause of cancer deaths in the United States. In 2017, there were an estimated 135,430 new cases of colorectal cancer and an estimated 50,260 deaths attributed to it. According to the National Cancer Institute, about 4.3 percent of men and women will be diagnosed with colorectal cancer at some point during their lifetimes. For most adults, older age is the most important risk factor for colorectal cancer, although being male and black are also associated with higher incidence and mortality. Colorectal cancer is most frequently diagnosed among people 65 to 74 years old (Howlader et al. 2017). Screening can be effective for finding precancerous lesions (polyps) that could later become malignant, and for detecting early cancers that can be more easily and effectively treated. Precancerous polyps usually take about 10 to 15 years to develop into colorectal cancer, and most can be found and removed before turning into cancer. The five-year relative survival rate for people whose colorectal cancer is found in the early stage before it has spread is about 90 percent (American Cancer Society 2017).
The U. S. Preventive Services Task Force (2016) recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. This is a Grade A recommendation (U.S. Preventive Services Task Force 2016). Screening tests: -Colonoscopy (every 10 years) -Flexible sigmoidoscopy (every 5 years) -Fecal occult blood test (annually) -FIT-DNA (every 3 years) -Computed tomographic colonography (every 5 years)
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. Do not count DRE, FOBT tests performed in an office setting or performed on a sample collected via DRE.