Metadata Title 乳癌_CDK46給付規定 Version 1.0.0 Status Draft Description 此 Library 為乳癌患者於申請使用 CDK46 之給付檢核條件。 Type logic-library from http://terminology.hl7.org/CodeSystem/library-type Parameters Parameter None Library Content CQL Content //乳癌_CDK46給付規定 library BCCDK46Rule1 version '1.0.0' using FHIR version '4.0.1' include FHIRHelpers version '4.0.1' called FHIRHelpers include BCCodeConcept version '1.0.0' called CodeConcept include BCReusable version '1.0.0' called Reusable context Patient //============================================ // 申請類型判斷 //============================================ define "初次申請": "申請類型" = '初次使用' define "續用申請": "申請類型" = '續用' define "申請類型未知": "申請類型" = '無法判斷申請類型' define "申請類型": case when Reusable."續用註記為1" then '初次使用' when Reusable."續用註記為2" then '續用' else '無法判斷申請類型' end //============================================ // 主要規定一：初次使用條件 //============================================ /*規則1*/ define "ICD代碼檢核_布林值": Reusable."ICD-10使用C50" define "醫令類別為1_布林值":Reusable."醫令類別為1" //條件1:停經後乳癌婦女 //條件1-1 define "條件1-1=簡要病摘含有停經字樣": exists ( [Claim] C where exists ( C.diagnosis D where exists ( D.type.text T where Matches(T.value, '(?i).*(停經|停經前|正在停經\\+).*') ) ) ) //條件1-2 define "條件1-2=女性": Patient.gender = 'female' //條件1-3 define "條件1-3=CDK46抑制劑申請": exists ( [MedicationRequest] MRPlan where MRPlan.intent = 'plan' and exists ( MRPlan.medication.coding Cdg where Cdg in CodeConcept.NHIMedication and Cdg.code in CodeConcept."CDK46抑制劑" ) ) define "條件1-1=停經後乳癌婦女": "ICD代碼檢核_布林值" and "醫令類別為1_布林值" and "條件1-1=簡要病摘含有停經字樣" and "條件1-2=女性" and "條件1-3=CDK46抑制劑申請" //條件2:遠端轉移 //條件2-1 define "ICD腫瘤代碼檢核_布林值": Reusable."ICD-10使用C77、C78、C79" //條件2-2 define "條件2-2=6個月內影像報告": exists ( [DiagnosticReport] O where exists ( O.code.coding Cdg where ( Cdg in CodeConcept.ICD10PCS2023Image or Cdg in CodeConcept.ICD10PCS2014Image ) and Cdg.code in CodeConcept.ImageCodes ) and O.effective is not null and FHIRHelpers.ToDateTime(O.effective) >= Today() - 180 days and FHIRHelpers.ToDateTime(O.effective) <= Today() ) //條件2-3 define "條件2-3=癌症分期分數或結果為M≠0": exists ( [Observation] O where exists ( O.code.coding Cdg where Cdg.code = '399390009' and Cdg in CodeConcept.SNOMED ) and O.value is not null and O.value is FHIR.string and Matches((O.value as FHIR.string).value, '.*M[1-9].*') ) define "條件1-2=遠端轉移": "ICD腫瘤代碼檢核_布林值" or ("條件2-2=6個月內影像報告" and "條件2-3=癌症分期分數或結果為M≠0") //條件3:(1)荷爾蒙接受體為：ER或PR >30%。 //條件3-1 ER define "條件3-1=荷爾蒙受體(HR)陽性(ER>30%)": exists ( [Observation] OBs where exists ( OBs.category C where exists ( C.coding Cdg where Cdg in CodeConcept.NHIPASSupportingInfoType and Cdg.code = 'tests' ) ) and exists ( OBs.code.coding Cdg where Cdg in CodeConcept.LOINC and Cdg.code in CodeConcept.ER ) and OBs.value is Quantity and (OBs.value as Quantity).value > 30 and (OBs.value as Quantity).comparator = '>' and (OBs.value as Quantity).unit = '%' ) //條件3-2 PR define "條件3-2=荷爾蒙受體(HR)陽性(PR>30%)": exists ( [Observation] OBs where exists ( OBs.category C where exists ( C.coding Cdg where Cdg in CodeConcept.NHIPASSupportingInfoType and Cdg.code = 'tests' ) ) and exists ( OBs.code.coding Cdg where Cdg in CodeConcept.LOINC and Cdg.code in CodeConcept.PR ) and OBs.value is Quantity and (OBs.value as Quantity).value > 30 and (OBs.value as Quantity).comparator = '>' and (OBs.value as Quantity).unit = '%' ) define "條件3=(1)荷爾蒙接受體為：ER或PR >30%": "條件3-1=荷爾蒙受體(HR)陽性(ER>30%)" or "條件3-2=荷爾蒙受體(HR)陽性(PR>30%)" //條件4:(2)HER-2 檢測為陰性 define "條件4=(2)HER-2 檢測為陰性": exists ( [Observation] OBs where exists ( OBs.category C where exists ( C.coding Cdg where Cdg in CodeConcept.NHIPASSupportingInfoType and Cdg.code = 'tests' ) ) and exists ( OBs.code.coding Cdg where Cdg in CodeConcept.LOINC and Cdg.code in CodeConcept.HER2 ) and exists ( OBs.interpretation.coding INT where INT in CodeConcept.InterpretationCodes and INT.code in {'NEG', 'ND'} ) ) //條件5:經完整疾病評估後未出現器官轉移危急症狀 (visceral crisis)且無中樞神經系統(CNS)轉移 //條件5-1 define "條件5-1=未出現器官轉移危急症狀 (visceral crisis)": exists ( [DiagnosticReport] O where exists ( O.code.coding Cdg where ( Cdg in CodeConcept.ICD10PCS2023Image or Cdg in CodeConcept.ICD10PCS2014Image ) and Cdg.code in CodeConcept.ImageCodes ) and O.effective is not null and FHIRHelpers.ToDateTime(O.effective) >= Today() - 180 days and FHIRHelpers.ToDateTime(O.effective) <= Today() and O.conclusion is not null and Matches(O.conclusion, '(?i).*(no visceral crisis|\\+).*') ) //條件5-2 define "條件5-2=無中樞神經系統(CNS)轉移": Reusable."ICD-10使用C77、C78、C79但排除C79.3" define "條件5=經完整疾病評估後未出現器官轉移危急症狀 (visceral crisis)且無中樞神經系統(CNS)轉移": "條件5-1=未出現器官轉移危急症狀 (visceral crisis)" or "條件5-2=無中樞神經系統(CNS)轉移" //條件6:骨轉移不可為唯一轉移部位 define "條件6=骨轉移不可為唯一轉移部位": exists ( [DiagnosticReport] O where exists ( O.code.coding Cdg where ( Cdg in CodeConcept.ICD10PCS2023Image or Cdg in CodeConcept.ICD10PCS2014Image ) and Cdg.code in CodeConcept.ImageCodes ) and O.effective is not null and FHIRHelpers.ToDateTime(O.effective) >= Today() - 180 days and FHIRHelpers.ToDateTime(O.effective) <= Today() ) //條件7:且滿足下列條件之一： //Ⅰ.年齡滿55歲。 //II.曾接受雙側卵巢切除術。 //III.FSH及estradiol血液檢測值在停經後數值範圍內。 //條件7-1 define "病患目前未接受卵巢功能抑制治療 (包含GnRH analogue等)": not exists ( [MedicationRequest] MROrder1 where (MROrder1.intent = 'plan' or MROrder1.intent = 'order') and (MROrder1.status is null or MROrder1.status in { 'active', 'completed' }) and exists ( MROrder1.medication.coding Cdg where Cdg in CodeConcept.NHIMedication and Cdg.code in CodeConcept."卵巢功能抑制治療" ) and exists MROrder1.dosageInstruction and MROrder1.dosageInstruction[0].timing.repeat.bounds is Period // 用藥期間與過去180天有重疊 and (MROrder1.dosageInstruction[0].timing.repeat.bounds as Period) overlaps Interval[Today() - 180 days, Today()] ) //條件7-2 define "條件7-2=年齡滿55歲": AgeInYears() >= 55 //條件7-3 define "條件7-3=曾接受雙側卵巢切除術": exists ( [Claim] C where exists ( C.procedure CP where exists ( CP.procedure.coding Pcoding where Pcoding.code.value in CodeConcept.BilateralOvaries ) ) ) or ( exists ( [Claim] C where exists ( C.procedure CP where exists ( CP.procedure.coding Pcoding where Pcoding.code.value in CodeConcept.RightOvary ) ) ) and exists ( [Claim] C where exists ( C.procedure CP where exists ( CP.procedure.coding Pcoding where Pcoding.code.value in CodeConcept.LeftOvary ) ) ) ) //條件7-4:FSH及estradiol血液檢測值在停經後數值範圍內 //條件7-4-1 define "條件7-4-1=FSH血液檢測值在停經後數值範圍內": exists ( [Observation] OBs where exists ( OBs.category C where exists ( C.coding Cdg where Cdg in CodeConcept.NHIPASSupportingInfoType and Cdg.code = 'tests' ) ) and exists ( OBs.code.coding Cdg where Cdg in CodeConcept.LOINC and Cdg.code in CodeConcept.FSH ) and OBs.value is Quantity and (OBs.value as Quantity).value > 30 and (OBs.value as Quantity).comparator = '>' and (OBs.value as Quantity).unit = 'IU/L' ) //條件7-4-2 define "條件7-4-2=Estradiol血液檢測值在停經後數值範圍內": exists ( [Observation] OBs where exists ( OBs.category C where exists ( C.coding Cdg where Cdg in CodeConcept.NHIPASSupportingInfoType and Cdg.code = 'tests' ) ) and exists ( OBs.code.coding Cdg where Cdg in CodeConcept.LOINC and Cdg.code in CodeConcept.Estradiol ) and OBs.value is Quantity and (OBs.value as Quantity).value < 35 and (OBs.value as Quantity).comparator = '<' and (OBs.value as Quantity).unit = 'pg/ml' ) define "條件7-4=FSH及estradiol血液檢測值在停經後數值範圍內": "條件7-4-1=FSH血液檢測值在停經後數值範圍內" and "條件7-4-2=Estradiol血液檢測值在停經後數值範圍內" define "條件7": "病患目前未接受卵巢功能抑制治療 (包含GnRH analogue等)" and ("條件7-2=年齡滿55歲" or "條件7-3=曾接受雙側卵巢切除術" or "條件7-4=FSH及estradiol血液檢測值在停經後數值範圍內") //主要規定一之規則1 define "主要規定一之規則1": "條件1-1=停經後乳癌婦女" and "條件1-2=遠端轉移" and "條件3=(1)荷爾蒙接受體為：ER或PR >30%" and "條件4=(2)HER-2 檢測為陰性" and "條件5=經完整疾病評估後未出現器官轉移危急症狀 (visceral crisis)且無中樞神經系統(CNS)轉移" and "條件6=骨轉移不可為唯一轉移部位" and "條件7" /*規則2*/ //條件1:同規則1的條件1 //條件2:同規則1的條件2 //條件3:與芳香環轉化酶抑制劑及GnRH analogue併用 define "條件3=與芳香環轉化酶抑制劑及GnRH analogue併用": ( // CDK46抑制劑 申請 exists ( [MedicationRequest] MRPlan where MRPlan.intent = 'plan' and exists ( MRPlan.medication.coding Cdg where Cdg in CodeConcept.NHIMedication and Cdg.code in CodeConcept."CDK46抑制劑" ) ) and // 併用芳香環轉化酶抑制劑 (L02BG03, L02BG04, L02BG06) exists ( [MedicationRequest] MROrder1 where MROrder1.intent = 'order' and exists ( MROrder1.medication.coding Cdg where Cdg in CodeConcept.NHIMedication and Cdg.code in CodeConcept.L02BG03 or Cdg.code in CodeConcept.L02BG04 or Cdg.code in CodeConcept.L02BG06 ) and Reusable."HasValidTiming"(MROrder1) ) and // 併用 GnRH analogue (L02AE03, L02AE02, L02AE04) exists ( [MedicationRequest] MROrder2 where MROrder2.intent = 'order' and exists ( MROrder2.medication.coding Cdg where Cdg in CodeConcept.NHIMedication and Cdg.code in CodeConcept.L02AE03 or Cdg.code in CodeConcept.L02AE02 or Cdg.code in CodeConcept.L02AE04 ) and Reusable."HasValidTiming"(MROrder2) ) and Reusable."醫令類別為1" ) //條件4:同規則1的條件3 //條件5:同規則1的條件4 //條件6:同規則1的條件5 //主要規定一之規則2 define "主要規定一之規則2": "條件1-1=停經後乳癌婦女" and "條件1-2=遠端轉移" and "條件3=與芳香環轉化酶抑制劑及GnRH analogue併用" and "條件3=(1)荷爾蒙接受體為：ER或PR >30%" and "條件4=(2)HER-2 檢測為陰性" and "條件5=經完整疾病評估後未出現器官轉移危急症狀 (visceral crisis)且無中樞神經系統(CNS)轉移" and "條件6=骨轉移不可為唯一轉移部位" // 主要規定一 define "主要規定一": "主要規定一之規則1" or "主要規定一之規則2" //============================================ // 主要規定二：續用條件－治療持續給付 //============================================ //條件1:每24週須再次申請並檢附療效評估資料 // 前次申請紀錄（最近一次在今天之前開始的申請） define "前次申請紀錄": Last( [MedicationRequest] MR where MR.intent = 'plan' and exists ( MR.medication.coding Cdg where Cdg in CodeConcept.NHIMedication and Cdg.code in CodeConcept."CDK46抑制劑" ) and MR.dosageInstruction[0].timing.repeat.bounds is Period and FHIRHelpers.ToDateTime((MR.dosageInstruction[0].timing.repeat.bounds as Period).start) < Today() sort by FHIRHelpers.ToDateTime((dosageInstruction[0].timing.repeat.bounds as Period).start) ) // 本次申請紀錄（今天過後之新申請） define "本次申請紀錄": First( [MedicationRequest] MR where MR.intent = 'plan' and exists ( MR.medication.coding Cdg where Cdg in CodeConcept.NHIMedication and Cdg.code in CodeConcept."CDK46抑制劑" ) and MR.dosageInstruction[0].timing.repeat.bounds is Period and FHIRHelpers.ToDateTime((MR.dosageInstruction[0].timing.repeat.bounds as Period).start) >= Today() sort by FHIRHelpers.ToDateTime((dosageInstruction[0].timing.repeat.bounds as Period).start) ) // 檢查24週間隔的邏輯 define "條件1=每24週須再次申請並檢附療效評估資料": Reusable."醫令類別為1" and Reusable."續用註記為2" and "前次申請紀錄" is not null and "本次申請紀錄" is not null and ( // 計算前次申請結束日期到本次申請開始日期的天數差異 difference in days between FHIRHelpers.ToDateTime(("前次申請紀錄".dosageInstruction[0].timing.repeat.bounds as Period).end) and FHIRHelpers.ToDateTime(("本次申請紀錄".dosageInstruction[0].timing.repeat.bounds as Period).start) ) <= 168 // 24週 = 168天 //條件2:疾病有惡化情形須停止使用 // 取得前次治療紀錄（最近一次已完成的治療） define "前次治療紀錄": Last( [MedicationRequest] MR where MR.intent = 'order' and MR.status = 'completed' and exists ( MR.medication.coding Cdg where Cdg in CodeConcept.NHIMedication and Cdg.code in CodeConcept."CDK46抑制劑" ) and (MR.dosageInstruction[0].timing.repeat.bounds as Period).start < Today() sort by (dosageInstruction[0].timing.repeat.bounds as Period).start ) // 前次用藥開始日期 define "前次用藥開始日期": ("前次治療紀錄".dosageInstruction[0].timing.repeat.bounds as Period).start // 規則1-2: 疾病有惡化情形須停止使用(續用須檢附前次治療後影像學報告) define "條件2=疾病有惡化情形須停止使用": exists ( [DiagnosticReport] O where exists ( O.code.coding Cdg where ( Cdg in CodeConcept.ICD10PCS2023Image or Cdg in CodeConcept.ICD10PCS2014Image ) and Cdg.code in CodeConcept.ImageCodes ) and O.effective is not null and FHIRHelpers.ToDateTime(O.effective) >= "前次用藥開始日期" and FHIRHelpers.ToDateTime(O.effective) < Today() ) // 主要規定二 define "主要規定二：續用條件": Reusable."續用註記為2" and "條件1=每24週須再次申請並檢附療效評估資料" and "條件2=疾病有惡化情形須停止使用" //============================================ // 主要規定三：藥品使用規則 //============================================ //條件1:(1)ribociclib每日最多處方3粒 define "條件1=ribociclib每日最多處方3粒": exists ( [MedicationRequest] MR where MR.intent = 'plan' and exists ( MR.medication.coding Cdg where Cdg in CodeConcept.NHIMedication and Cdg.code in CodeConcept.L01EF02 ) and exists ( MR.dosageInstruction DI where exists ( DI.timing.code.coding C where C.code = 'QD' ) and exists ( DI.doseAndRate DR where (DR.dose as FHIR.SimpleQuantity) is not null and (DR.dose as FHIR.SimpleQuantity).value <= 3 and (DR.dose as FHIR.SimpleQuantity).code = '{tbl}' and (DR.dose as FHIR.SimpleQuantity).unit = 'tablets' ) ) ) //條件2:(2)palbociclib每日最多處方1粒 define "條件2=palbociclib每日最多處方1粒": exists ( [MedicationRequest] MR where MR.intent = 'plan' and exists ( MR.medication.coding Cdg where Cdg in CodeConcept.NHIMedication and Cdg.code in CodeConcept.L01EF01 ) and exists ( MR.dosageInstruction DI where exists ( DI.timing.code.coding C where C.code = 'QD' ) and exists ( DI.doseAndRate DR where (DR.dose as FHIR.SimpleQuantity) is not null and (DR.dose as FHIR.SimpleQuantity).value <= 1 and (DR.dose as FHIR.SimpleQuantity).code = '{tbl}' and (DR.dose as FHIR.SimpleQuantity).unit = 'tablets' ) ) ) //條件3:(3)本類藥品僅得擇一使用，唯有在耐受不良時方可轉換使用 //條件3-1:可忍受化療(其副作用)時（一般情況，不另外註記） //條件3-2 define "條件3-2=Ribociclib、Palbociclib二者僅能擇一使用": not ( exists ( [MedicationRequest] M1 where exists ( M1.medication.coding Cdg1 where Cdg1.code in CodeConcept.L01EF01 ) and Reusable."HasValidTiming"(M1) ) and exists ( [MedicationRequest] M2 where exists ( M2.medication.coding Cdg2 where Cdg2.code in CodeConcept.L01EF02 ) and Reusable."HasValidTiming"(M2) ) ) //條件3-3:無法忍受化療(其副作用)時（有註記） define "條件3-3=無法忍受化療(其副作用)時(有註記)": exists ( [Claim] C where exists ( C.diagnosis D where exists ( D.type.text T where Matches(T.value, '(?i).*無法忍受副作用.*') ) ) ) //條件3-4 define "條件3-4=ribociclib、palbociclib二者可轉換": exists ( [MedicationRequest] M1 where exists ( M1.medication.coding Cdg1 where Cdg1.code in CodeConcept.L01EF01 ) and Reusable."HasValidTiming"(M1) ) or exists ( [MedicationRequest] M2 where exists ( M2.medication.coding Cdg2 where Cdg2.code in CodeConcept.L01EF02 ) and Reusable."HasValidTiming"(M2) ) define "條件3=本類藥品僅得擇一使用，唯有在耐受不良時方可轉換使用": if "條件3-3=無法忍受化療(其副作用)時(有註記)" then "條件3-4=ribociclib、palbociclib二者可轉換" else "條件3-2=Ribociclib、Palbociclib二者僅能擇一使用" //條件4 define "條件4=使用總療程合併計算，以每人終生給付24個月為上限": Sum( [MedicationRequest] MRTotal where (MRTotal.intent = 'plan' or MRTotal.intent = 'order') and (MRTotal.status is null or MRTotal.status in { 'active', 'completed', 'on-hold' }) and exists MRTotal.dosageInstruction and MRTotal.dosageInstruction[0].timing.repeat.bounds is Period and (start of (MRTotal.dosageInstruction[0].timing.repeat.bounds as Period)) is not null and (end of (MRTotal.dosageInstruction[0].timing.repeat.bounds as Period)) is not null and exists ( MRTotal.medication.coding Cdg where Cdg in CodeConcept.NHIMedication and Cdg.code in CodeConcept."CDK46抑制劑" ) return days between start of (MRTotal.dosageInstruction[0].timing.repeat.bounds as Period) and end of (MRTotal.dosageInstruction[0].timing.repeat.bounds as Period) ) <= 720 //條件5:everolimus無效，不得再申請CDK4/6抑制劑 define "條件5=未註記everolimus無效": not exists ( [Claim] C where exists ( C.diagnosis D where exists ( D.type.text T where Matches(T.value, '(?i).*everolimus無效.*') ) ) ) //條件6:abemaciclib無效，不得再申請CDK4/6抑制劑 define "條件6=未註記abemaciclib無效": not exists ( [Claim] C where exists ( C.diagnosis D where exists ( D.type.text T where Matches(T.value, '(?i).*abemaciclib無效.*') ) ) ) // 主要規定三 define "主要規定三：藥品使用規則": ("條件1=ribociclib每日最多處方3粒" or "條件2=palbociclib每日最多處方1粒") and "條件3=本類藥品僅得擇一使用，唯有在耐受不良時方可轉換使用" and "條件4=使用總療程合併計算，以每人終生給付24個月為上限" and "條件5=未註記everolimus無效" and "條件6=未註記abemaciclib無效" //============================================ // 列出「符合」項目判斷式 //============================================ define function "符合項目"(): // 主要規定一：初次使用條件 (if "初次申請" and ( "條件1-1=停經後乳癌婦女" or "條件1-2=遠端轉移" or "條件3=(1)荷爾蒙接受體為：ER或PR >30%" or "條件4=(2)HER-2 檢測為陰性" or "條件5=經完整疾病評估後未出現器官轉移危急症狀 (visceral crisis)且無中樞神經系統(CNS)轉移" or "條件6=骨轉移不可為唯一轉移部位" or "條件7" or "主要規定一之規則2" ) then '<主要規定一：初次使用條件>\n' + (if "條件1-1=簡要病摘含有停經字樣" then '● 條件1-1：簡要病摘含有停經字樣\n' else '') + (if "條件1-2=女性" then '● 條件1-2：女性\n' else '') + (if "條件1-3=CDK46抑制劑申請" then '● 條件1-3：CDK46抑制劑申請\n' else '') + (if "ICD腫瘤代碼檢核_布林值" then '● ICD腫瘤代碼檢核：ICD-10使用C77、C78、C79\n' else '') + (if "條件2-2=6個月內影像報告" then '● 條件2-2：6個月內影像報告\n' else '') + (if "條件2-3=癌症分期分數或結果為M≠0" then '● 條件2-3：癌症分期分數或結果為M≠0\n' else '') + (if "條件3-1=荷爾蒙受體(HR)陽性(ER>30%)" then '● 條件3-1：荷爾蒙受體(HR)陽性(ER>30%)\n' else '') + (if "條件3-2=荷爾蒙受體(HR)陽性(PR>30%)" then '● 條件3-2：荷爾蒙受體(HR)陽性(PR>30%)\n' else '') + (if "條件4=(2)HER-2 檢測為陰性" then '● 條件4：HER-2檢測為陰性\n' else '') + (if "條件5-1=未出現器官轉移危急症狀 (visceral crisis)" then '● 條件5-1：未出現器官轉移危急症狀(visceral crisis)\n' else '') + (if "條件5-2=無中樞神經系統(CNS)轉移" then '● 條件5-2：無中樞神經系統(CNS)轉移\n' else '') + (if "條件6=骨轉移不可為唯一轉移部位" then '● 條件6：骨轉移不為唯一轉移部位(已檢附影像報告)\n' else '') + (if "條件7-2=年齡滿55歲" then '● 條件7-2：年齡滿55歲\n' else '') + (if "條件7-3=曾接受雙側卵巢切除術" then '● 條件7-3：曾接受雙側卵巢切除術\n' else '') + (if "條件7-4=FSH及estradiol血液檢測值在停經後數值範圍內" then '● 條件7-4：FSH及estradiol血液檢測值在停經後數值範圍內\n' else '') + (if "條件3=與芳香環轉化酶抑制劑及GnRH analogue併用" then '● 條件3：與芳香環轉化酶抑制劑及GnRH analogue併用\n' else '') + '\n' else '') + // 主要規定二：續用條件 (if "續用申請" and ( "條件1=每24週須再次申請並檢附療效評估資料" or "條件2=疾病有惡化情形須停止使用" ) then '<主要規定二：續用條件－治療持續給付>\n' + (if "條件1=每24週須再次申請並檢附療效評估資料" then '● 續用條件1：於24週內再次申請並檢附療效評估資料\n' else '') + (if "條件2=疾病有惡化情形須停止使用" then '● 續用條件2：已檢附前次治療後影像學報告，確認無惡化\n' else '') + '\n' else '') + // 主要規定三：藥品使用規則 (if "條件1=ribociclib每日最多處方3粒" or "條件2=palbociclib每日最多處方1粒" or "條件3=本類藥品僅得擇一使用，唯有在耐受不良時方可轉換使用" or "條件4=使用總療程合併計算，以每人終生給付24個月為上限" or "條件5=未註記everolimus無效" or "條件6=未註記abemaciclib無效" then '<主要規定三：藥品使用規則>\n' + // 只顯示實際申請的藥品劑量規定 (if "條件1=ribociclib每日最多處方3粒" then '● 條件1：ribociclib每日劑量≤3粒\n' else if "條件2=palbociclib每日最多處方1粒" then '● 條件2：palbociclib每日劑量≤1粒\n' else '') + (if "條件3=本類藥品僅得擇一使用，唯有在耐受不良時方可轉換使用" then '● 條件3：藥品擇一使用或符合轉換條件\n' else '') + (if "條件4=使用總療程合併計算，以每人終生給付24個月為上限" then '● 條件4：使用總療程≤24個月(720天)\n' else '') + (if "條件5=未註記everolimus無效" then '● 條件5：未註記everolimus無效\n' else '') + (if "條件6=未註記abemaciclib無效" then '● 條件6：未註記abemaciclib無效\n' else '') else '') //============================================ // 列出「不符合」項目判斷式 - 代碼或條件不符 //============================================ define function "不符合項目_代碼或條件不符"(): // 主要規定一：初次使用條件 - 代碼條件不符 (if "初次申請" and ( not Reusable."ICD-10使用C50" or not "條件1-2=女性" ) then '<主要規定一：初次使用條件>\n' + (if not Reusable."ICD-10使用C50" then '▲ ICD代碼檢核：主要疾病之ICD代碼未使用C50\n' else '') + (if not "條件1-2=女性" then '▲ 條件1-2：非女性\n' else '') + '\n' else '') + // 主要規定三：藥品使用規則 - 代碼條件不符 (if (not "條件1=ribociclib每日最多處方3粒" and not "條件2=palbociclib每日最多處方1粒") or not "條件3=本類藥品僅得擇一使用，唯有在耐受不良時方可轉換使用" or not "條件4=使用總療程合併計算，以每人終生給付24個月為上限" or not "條件5=未註記everolimus無效" or not "條件6=未註記abemaciclib無效" then '<主要規定三：藥品使用規則>\n' + // 只有當兩個劑量規定都不符合時才顯示錯誤（表示沒有申請或劑量都超標） (if not "條件1=ribociclib每日最多處方3粒" and not "條件2=palbociclib每日最多處方1粒" then '▲ 條件1/2：未申請CDK46抑制劑或劑量超標\n' else '') + (if not "條件3=本類藥品僅得擇一使用，唯有在耐受不良時方可轉換使用" then '▲ 條件：藥品使用不符規定(本類藥品僅得擇一使用，唯有在耐受不良時方可轉換使用)\n' else '') + (if not "條件4=使用總療程合併計算，以每人終生給付24個月為上限" then '▲ 條件4：使用總療程超過24個月(720天)\n' else '') + (if not "條件5=未註記everolimus無效" then '▲ 條件5：病歷註記everolimus無效\n' else '') + (if not "條件6=未註記abemaciclib無效" then '▲ 條件6：病歷註記abemaciclib無效\n' else '') else '') //============================================ // 列出「不符合」項目判斷式 - 必要資料未填寫 //============================================ define function "不符合項目_必要資料未填寫"(): // 主要規定一：初次使用條件 - 必要資料未填寫 (if "初次申請" and ( not "條件1-1=簡要病摘含有停經字樣" or not "條件1-3=CDK46抑制劑申請" or not "條件1-2=遠端轉移" or not "條件3=(1)荷爾蒙接受體為：ER或PR >30%" or not "條件4=(2)HER-2 檢測為陰性" or not "條件5=經完整疾病評估後未出現器官轉移危急症狀 (visceral crisis)且無中樞神經系統(CNS)轉移" or not "條件6=骨轉移不可為唯一轉移部位" or not "條件7" ) then '<主要規定一：初次使用條件>\n' + (if not "條件1-1=簡要病摘含有停經字樣" then '▲ 條件1-1：簡要病摘未含有停經字樣\n' else '') + (if not "條件1-3=CDK46抑制劑申請" then '▲ 條件1-3：未提供CDK46抑制劑申請資料\n' else '') + (if not "條件1-2=遠端轉移" then '▲ 條件1-2：未提供遠端轉移證據(缺少ICD腫瘤代碼或影像報告、分期資料)\n' else '') + (if not "條件3=(1)荷爾蒙接受體為：ER或PR >30%" then '▲ 條件3：未提供荷爾蒙受體(HR)檢測資料或未達陽性標準(ER或PR>30%)\n' else '') + (if not "條件4=(2)HER-2 檢測為陰性" then '▲ 條件4：未提供HER-2檢測資料或HER-2非陰性\n' else '') + (if not "條件5=經完整疾病評估後未出現器官轉移危急症狀 (visceral crisis)且無中樞神經系統(CNS)轉移" then '▲ 條件5：未提供完整疾病評估資料或有visceral crisis或CNS轉移\n' else '') + (if not "條件6=骨轉移不可為唯一轉移部位" then '▲ 條件6：未提供影像報告證明骨轉移非唯一轉移部位\n' else '') + (if not "條件7" then '▲ 條件7：病患目前接受卵巢功能抑制治療或未滿足停經條件(需符合≥55歲/雙側卵巢切除/FSH及Estradiol檢測之一)\n' else '') + '\n' else '') + // 主要規定二：續用條件 - 必要資料未填寫 (if "續用申請" and ( not "條件1=每24週須再次申請並檢附療效評估資料" or not "條件2=疾病有惡化情形須停止使用" ) then '<主要規定二：續用條件－治療持續給付>\n' + (if not "條件1=每24週須再次申請並檢附療效評估資料" then '▲ 續用條件1：未於24週內再次申請或未檢附療效評估資料\n' else '') + (if not "條件2=疾病有惡化情形須停止使用" then '▲ 續用條件2：未提供前次治療後影像學報告或顯示疾病惡化\n' else '') + '\n' else '') //============================================ // 審核結果 //============================================ define "乳癌CDK46抑制劑申請結果_布林": case when "初次申請" then ( "主要規定一" and "主要規定三：藥品使用規則" ) when "續用申請" then ( "主要規定二：續用條件" and "主要規定三：藥品使用規則" ) else false end define "乳癌CDK46抑制劑申請之CQL檢核結果": if ( "初次申請" and "主要規定一" and "主要規定三：藥品使用規則" ) then '✓通過：初次使用－乳癌CDK46抑制劑用藥申請' else if ( "續用申請" and "主要規定二：續用條件" and "主要規定三：藥品使用規則" ) then '✓通過：續用－乳癌 CDK46抑制劑 用藥申請' else if "初次申請" then '✖不通過：初次使用－乳癌 CDK46抑制劑 用藥申請' else if "續用申請" then '✖不通過：續用－乳癌 CDK46抑制劑 用藥申請' else '✖不通過：無法判定申請類型－乳癌 CDK46抑制劑 用藥申請' //============================================ // 報告總結 //============================================ define "報告總結": '\n=== 乳癌之CDK46抑制劑申請審核報告 ===\n' + '\n【申請類型】' + "申請類型" + '\n' + '\n【●符合項目】\n' + (if "符合項目"() = '' then '無\n' else "符合項目"()) + '\n【▲不符合項目 - 代碼或條件不符】\n' + (if "不符合項目_代碼或條件不符"() = '' then '無\n' else "不符合項目_代碼或條件不符"()) + '\n【▲不符合項目 - 必要資料未填寫】\n' + (if "不符合項目_必要資料未填寫"() = '' then '無\n' else "不符合項目_必要資料未填寫"()) + '\n【申請結果】\n' + "乳癌CDK46抑制劑申請之CQL檢核結果" + '\n===============================================\n' ELM XML Content Encoded data ELM JSON Content Encoded data Generated using version 0.5.3-cibuild of the sample-content-ig Liquid templates
此 Library 為乳癌患者於申請使用 CDK46 之給付檢核條件。