Metadata Title Controlling High Blood PressureFHIR Version 0.1.000 Short Name CMS165FHIR GUID (Version Independent) urn:uuid:9017d914-6748-45a9-bff1-8392ed644a7b GUID (Version Specific) urn:uuid:f573fb8f-4907-4ed7-bc04-09d9a3f36268 CMS Identifier 165FHIR Effective Period 2025-01-01 through 2025-12-31 Status Draft Steward (Publisher) National Committee for Quality Assurance Developer National Committee for Quality Assurance Description Percentage of patients 18-85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period, and whose most recent blood pressure was adequately controlled (<140/90 mmHg) during the measurement period Copyright This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. 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NLM is not responsible for the measures and does not endorse or recommend this or any other product. “HL7” is the registered trademark of Health Level Seven International. 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 Scoring Proportion Rationale High blood pressure (HBP), also known as hypertension, is when the pressure in blood vessels is higher than normal (Centers for Disease Control and Prevention [CDC], 2023). The causes of hypertension are multiple and multifaceted and can be based on genetic predisposition, environmental risk factors, being overweight and obese, sodium intake, potassium intake, physical activity, and alcohol use. High blood pressure is common; according to the American Heart Association, between 2013-2016, approximately 121.5 million US adults >= 20 years of age had HBP and the prevalence of hypertension among US adults 65 and older was 77.0 percent (Virani et al., 2021). In an analysis of adults with hypertension in National Health and Nutrition Examination Survey (NHANES), the estimated age-adjusted proportion with controlled blood pressure (BP) increased from 31.8 percent in 1999 to 53.8 percent in 2014. However, that proportion declined to 43.7 percent in 2017 to 2018 (Tsao et al., 2022). HBP increases risks of heart disease and stroke which are two of the leading causes of death in the US (CDC, 2023). A person who has HBP is four times more likely to die from a stroke and three times more likely to die from heart disease (CDC, 2021). The National Center for Health Statistics reported that in 2020 there were over 670,000 deaths with HBP as a primary or contributing cause (CDC, 2022). Between 2009 and 2019 the number of deaths due to HBP rose by 65.3 percent (Tsao et al., 2022). Managing and treating HBP would reduce cardiovascular disease mortality for males and females by 30.4 percent and 38.0 percent, respectively (Patel et al., 2015). Age-adjusted death rates attributable to HBP in 2019 were more than twice as high in non-Hispanic Black males (56.7 percent) when compared to rates for non-Hispanic White males (25.7 percent) (Tsao et al., 2022). HBP costs the U.S. approximately 131 billion dollars each year, averaged over 12 years from 2003 to 2014 (Kirkland et al., 2018). A study on cost-effectiveness on treating hypertension found that controlling HBP in patients with cardiovascular disease and systolic blood pressures (SBP) of >= 160 mmHg could be effective and cost-saving (Moran et al., 2015). Many studies have shown that controlling high blood pressure reduces cardiovascular events and mortality. The Systolic Blood Pressure Intervention Trial (SPRINT) investigated the impact of obtaining a SBP goal of <120 mmHg compared to a SBP goal of <140 mmHg among patients 50 and older with established cardiovascular disease and found that the patients with the former goal had reduced cardiovascular events and mortality (SPRINT Research Group et al., 2015). Controlling HBP will significantly reduce the risks of cardiovascular disease mortality and lead to better health outcomes like reduction of heart attacks, stroke, and kidney disease (James et al., 2014). Thus, the relationship between the measure (control of hypertension) and the long-term clinical outcomes listed is well established. Clinical Recommendation Statement U.S. Preventive Services Task Force (USPSTF) (2021): The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement (OBPM). The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. This is a grade A recommendation. American College of Cardiology/American Heart Association (2017): For adults with confirmed hypertension and known cardiovascular disease (CVD) or 10-year atherosclerotic cardiovascular disease (ASCVD) event risk of 10 percent or higher, a blood pressure target of less than 130/80 mmHg is recommended (Level of evidence: B-R (for systolic blood pressures), Level of evidence: C-EO (for diastolic blood pressure)) For adults with confirmed hypertension, without additional markers of increased CVD risk, a blood pressure target of less than 130/80 mmHg may be reasonable (Note: clinical trial evidence is strongest for a target blood pressure of 140/90 mmHg in this population. However, observational studies suggest that these individuals often have a high lifetime risk and would benefit from blood pressure control earlier in life) (Level of evidence: B-NR (for systolic blood pressure), Level of evidence: C-EO (for diastolic blood pressure)). American Academy of Family Physicians (2022): Treat adults who have hypertension to a standard blood pressure target (less than 140/90 mm Hg) to reduce the risk of all-cause and cardiovascular mortality (strong recommendation; high-quality evidence). Treating to a lower blood pressure target (less than 135/85 mm Hg) does not provide additional benefit at preventing mortality; however, a lower blood pressure target could be considered based on patient preferences and values. (Grade: strong recommendation, Quality of evidence: high) Consider treating adults who have hypertension to a lower blood pressure target (less than 135/85 mm Hg) to reduce risk of myocardial infarction (weak recommendation; moderate-quality evidence). Although treatment to a standard blood pressure target (less than 140/90 mm Hg) reduced the risk of myocardial infarction, there was a small additional benefit observed with a lower blood pressure target. There was no observed additional benefit in preventing stroke with the lower blood pressure target. (Grade: weak recommendation, Quality of evidence: low) American Diabetes Association (2022): For individuals with diabetes and hypertension at higher cardiovascular risk (existing atherosclerotic cardiovascular disease or 10-year atherosclerotic cardiovascular disease risk >=15 percent), a blood pressure target of <130/80 mmHg may be appropriate, if it can be safely attained (Level of evidence: B) For individuals with diabetes and hypertension at lower risk for cardiovascular disease (10-year atherosclerotic cardiovascular disease risk <15 percent), treat to a blood pressure target of <140/90 mmHg (Level of evidence: A) Guidance (Usage) In reference to the numerator element, only blood pressure readings performed by a clinician or an automated blood pressure monitor or device are acceptable for numerator compliance with this measure. This includes blood pressures taken in person by a clinician and blood pressures measured remotely by electronic monitoring devices capable of transmitting the blood pressure data to the clinician. Blood pressure readings taken by an automated blood pressure monitor or device and conveyed by the patient to the clinician are also acceptable. It is the clinician’s responsibility and discretion to confirm the automated blood pressure monitor or device used to obtain the blood pressure is considered acceptable and reliable and whether the blood pressure reading is considered accurate before documenting it in the patient’s medical record. Do not include BP readings taken during an acute inpatient stay or an emergency department (ED) visit. If no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed "not controlled". If there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading. Ranges and thresholds do not meet criteria for this measure. A distinct numeric result for both the systolic and diastolic BP reading is required for numerator compliance. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS165v13. Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html). Measure Group (Rate) (ID: 650b4f94da013638e7b3dd9a) Basis boolean Scoring Proportion Improvement Notation increase Type Outcome Rate Aggregation None Initial Population ID: DB8494F3-F2F2-4493-A9F6-8793D5F77F41 Description: Patients 18-85 years of age by the end of the measurement period who had a visit during the measurement period and diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period Criteria: Initial Population Denominator ID: 47151B22-36FA-413F-8F3A-665071CB2E83 Description: Equals Initial Population Criteria: Denominator Denominator Exclusion ID: cc61a60b-d556-4368-9651-a1577003ae68 Description: Exclude patients who are in hospice care for any part of the measurement period. Patients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period. Also exclude patients with a diagnosis of pregnancy during the measurement period. Exclude patients 66-80 by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness diagnosis during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients 81 and older by the end of the measurement period with an indication of frailty for any part of the measurement period. Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients receiving palliative care for any part of the measurement period. Criteria: Denominator Exclusions Numerator ID: D4F113F9-F280-45AC-ACDA-88CD87C42EB6 Description: Patients whose most recent blood pressure is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement period Criteria: Numerator Stratifier ID: 863b910a-a4b5-4493-8e8e-3c94a4560d7b Stratifier ID: 33cce73e-b08d-4304-b3c6-f25eb0da594b Supplemental Data Elements Supplemental Data Element ID: sde-sex Usage Code: Supplemental Data Description: SDE Sex Logic Definition: SDE Sex Supplemental Data Element ID: sde-race Usage Code: Supplemental Data Description: SDE Race Logic Definition: SDE Race Supplemental Data Element ID: sde-payer Usage Code: Supplemental Data Description: SDE Payer Logic Definition: SDE Payer Supplemental Data Element ID: sde-ethnicity Usage Code: Supplemental Data Description: SDE Ethnicity Logic Definition: SDE Ethnicity Measure Logic Primary Library Controlling High Blood Pressure FHIR Contents Population Criteria Logic Definitions Terminology Dependencies Data Requirements Parameters Population Criteria Measure Group (Rate) (ID: 650b4f94da013638e7b3dd9a) Initial Population define "Initial Population": AgeInYearsAt(date from end of "Measurement Period" ) in Interval[18, 85] and exists "Essential Hypertension Diagnosis" and exists AdultOutpatientEncounters."Qualifying Encounters" Definition Denominator define "Denominator": "Initial Population" Definition Denominator Exclusion define "Denominator Exclusions": Hospice."Has Hospice Services" or exists ( "Pregnancy or Renal Diagnosis" ) or exists ( "End Stage Renal Disease Procedures" ) or exists ( "End Stage Renal Disease Encounter" ) or AIFrailLTCF."Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty" or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home" or PalliativeCare."Has Palliative Care in the Measurement Period" Definition Numerator define "Numerator": "Has Systolic Blood Pressure Less Than 140" and "Has Diastolic Blood Pressure Less Than 90" 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"] union [Encounter: "Virtual Encounter"] union [Encounter: "Telephone Visits"] ).isEncounterPerformed() ) ValidEncounter where ValidEncounter.period.toInterval() during day of "Measurement Period" Logic Definition Library Name: Hospice define "Has Hospice Services": exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)" or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)" ) and InpatientEncounter.period.toInterval() ends during day of "Measurement Period" ) or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter where HospiceEncounter.period.toInterval() overlaps day of "Measurement Period" ) or exists ((([Observation: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment where HospiceAssessment.value ~ "Yes (qualifier value)" and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period" ) or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder where HospiceOrder.authoredOn.toInterval() during day of "Measurement Period" // and HospiceOrder.doNotPerform is not true // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447 ) or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period" ) or exists (([Condition: "Hospice Diagnosis"]) HospiceCareDiagnosis where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" ) Logic Definition Library Name: AdvancedIllnessandFrailty define "Has Criteria Indicating Frailty": exists ( (([DeviceRequest: "Frailty Device"]).isDeviceOrder()) FrailtyDeviceOrder where FrailtyDeviceOrder.doNotPerform() is not true and FrailtyDeviceOrder.authoredOn.toInterval() during day of "Measurement Period" ) or exists ( (([Observation: "Medical equipment used"]).isAssessmentPerformed()) EquipmentUsed where EquipmentUsed.value as Concept in "Frailty Device" and EquipmentUsed.effective.toInterval() ends during day of "Measurement Period" ) or exists ( ([Condition: "Frailty Diagnosis"]) FrailtyDiagnosis where FrailtyDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" ) or exists ( (([Encounter: "Frailty Encounter"]).isEncounterPerformed()) FrailtyEncounter where FrailtyEncounter.period.toInterval() overlaps day of "Measurement Period" ) or exists ( (([Observation: "Frailty Symptom"]).isSymptom()) FrailtySymptom where FrailtySymptom.effective.toInterval() overlaps day of "Measurement Period" ) Logic Definition Library Name: AdvancedIllnessandFrailty define "Has Advanced Illness in Year Before or During Measurement Period": exists ([Condition: "Advanced Illness"] AdvancedIllnessDiagnosis where AdvancedIllnessDiagnosis.prevalenceInterval() starts during day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"]) Logic Definition Library Name: AdvancedIllnessandFrailty define "Has Dementia Medications in Year Before or During Measurement Period": exists (( ([MedicationRequest: medication in "Dementia Medications"]).isMedicationActive()) DementiaMedication // https://oncprojectracking.healthit.gov/support/browse/CQLIT-449 where DementiaMedication.medicationRequestPeriod() overlaps day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"] // and DementiaMedication.doNotPerform is not true // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447 ) Logic Definition Library Name: AdvancedIllnessandFrailty define "Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty": ( AgeInYearsAt(date from end of "Measurement Period")in Interval[66, 80] and "Has Criteria Indicating Frailty" and ( "Has Advanced Illness in Year Before or During Measurement Period" or "Has Dementia Medications in Year Before or During Measurement Period" ) ) or ( AgeInYearsAt(date from end of "Measurement Period")>= 81 and "Has Criteria Indicating Frailty" ) Logic Definition Library Name: AdvancedIllnessandFrailty define "Is Age 66 or Older Living Long Term in a Nursing Home": AgeInYearsAt(date from end of "Measurement Period" )>= 66 and ( ( Last( (([Observation: "Housing status"]).isAssessmentPerformed()) HousingStatus where HousingStatus.effective.toInterval() ends on or before day of end of "Measurement Period" sort by end of effective.toInterval() asc )) LastHousingStatus where LastHousingStatus.value ~ "Lives in a nursing home (finding)" ) is not null Logic Definition Library Name: PalliativeCare define "Has Palliative Care in the Measurement Period": exists ((([Observation: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"]).isAssessmentPerformed()) PalliativeAssessment where PalliativeAssessment.effective.toInterval() overlaps day of "Measurement Period" ) or exists ([Condition: "Palliative Care Diagnosis"] PalliativeDiagnosis where PalliativeDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" ) or exists ((([Encounter: "Palliative Care Encounter"]).isEncounterPerformed()) PalliativeEncounter where PalliativeEncounter.period.toInterval() overlaps day of "Measurement Period" ) or exists ((([Procedure: "Palliative Care Intervention"]).isInterventionPerformed()) PalliativeIntervention where PalliativeIntervention.performed.toInterval() overlaps day of "Measurement Period" ) Logic Definition Library Name: SupplementalDataElements define "SDE Sex": case when Patient.gender = 'male' then "M" when Patient.gender = 'female' then "F" else null end Logic Definition Library Name: SupplementalDataElements define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period } Logic Definition Library Name: SupplementalDataElements define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text } Logic Definition Library Name: SupplementalDataElements define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text } Logic Definition Library Name: ControllingHighBloodPressureFHIR define "SDE Sex": SDE."SDE Sex" Logic Definition Library Name: ControllingHighBloodPressureFHIR define "Qualifying Systolic Blood Pressure Reading": ( ( ["observation-bp"] ).isObservationBP ( ) ) BloodPressure where ( not ( ( BloodPressure.encounter.getEncounter ( ) ).class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS' } ) ) and BloodPressure.effective.latest ( ) during day of "Measurement Period" Logic Definition Library Name: ControllingHighBloodPressureFHIR define "Qualifying Diastolic Blood Pressure Reading": ( ( ["observation-bp"] ).isObservationBP ( ) ) BloodPressure where ( not ( ( BloodPressure.encounter.getEncounter ( ) ).class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS' } ) ) and BloodPressure.effective.latest ( ) during day of "Measurement Period" Logic Definition Library Name: ControllingHighBloodPressureFHIR define "Blood Pressure Days": ( "Qualifying Diastolic Blood Pressure Reading" DBPExam return date from DBPExam.effective.latest ( ) ) intersect ( "Qualifying Systolic Blood Pressure Reading" SBPExam return date from SBPExam.effective.latest ( ) ) Logic Definition Library Name: ControllingHighBloodPressureFHIR define "Most Recent Blood Pressure Day": Last("Blood Pressure Days" BPDays sort asc ) Logic Definition Library Name: ControllingHighBloodPressureFHIR define "Lowest Systolic Reading on Most Recent Blood Pressure Day": First("Qualifying Systolic Blood Pressure Reading" SBPReading where SBPReading.effective.latest() same day as "Most Recent Blood Pressure Day" return singleton from(SBPReading.component SBPComponent where SBPComponent.code ~ "Systolic blood pressure" return SBPComponent.value as Quantity ) sort asc ) Logic Definition Library Name: ControllingHighBloodPressureFHIR define "Has Systolic Blood Pressure Less Than 140": "Lowest Systolic Reading on Most Recent Blood Pressure Day" < 140 'mm[Hg]' Logic Definition Library Name: ControllingHighBloodPressureFHIR define "Lowest Diastolic Reading on Most Recent Blood Pressure Day": First("Qualifying Diastolic Blood Pressure Reading" DBPReading where DBPReading.effective.latest() same day as "Most Recent Blood Pressure Day" return singleton from(DBPReading.component DBPComponent where DBPComponent.code ~ "Diastolic blood pressure" return DBPComponent.value as Quantity ) sort asc ) Logic Definition Library Name: ControllingHighBloodPressureFHIR define "Has Diastolic Blood Pressure Less Than 90": "Lowest Diastolic Reading on Most Recent Blood Pressure Day" < 90 'mm[Hg]' Logic Definition Library Name: ControllingHighBloodPressureFHIR define "Numerator": "Has Systolic Blood Pressure Less Than 140" and "Has Diastolic Blood Pressure Less Than 90" Logic Definition Library Name: ControllingHighBloodPressureFHIR define "Essential Hypertension Diagnosis": ( [Condition: "Essential Hypertension"] ) Hypertension where Hypertension.prevalenceInterval ( ) overlaps Interval[start of "Measurement Period", start of "Measurement Period" + 6 months ) Logic Definition Library Name: ControllingHighBloodPressureFHIR define "Initial Population": AgeInYearsAt(date from end of "Measurement Period" ) in Interval[18, 85] and exists "Essential Hypertension Diagnosis" and exists AdultOutpatientEncounters."Qualifying Encounters" Logic Definition Library Name: ControllingHighBloodPressureFHIR define "Denominator": "Initial Population" Logic Definition Library Name: ControllingHighBloodPressureFHIR define "SDE Payer": SDE."SDE Payer" Logic Definition Library Name: ControllingHighBloodPressureFHIR define "SDE Ethnicity": SDE."SDE Ethnicity" Logic Definition Library Name: ControllingHighBloodPressureFHIR define "Pregnancy or Renal Diagnosis": ( [Condition: "Pregnancy"] union [Condition: "End Stage Renal Disease"] union [Condition: "Kidney Transplant Recipient"] union [Condition: "Chronic Kidney Disease, Stage 5"] ) PregnancyESRDDiagnosis where PregnancyESRDDiagnosis.prevalenceInterval ( ) overlaps "Measurement Period" Logic Definition Library Name: ControllingHighBloodPressureFHIR define "End Stage Renal Disease Procedures": ( ( [Procedure: "Kidney Transplant"] union [Procedure: "Dialysis Services"] ).isProcedurePerformed ( ) ) ESRDProcedure where ESRDProcedure.performed.toInterval ( ) ends on or before end of "Measurement Period" Logic Definition Library Name: ControllingHighBloodPressureFHIR define "End Stage Renal Disease Encounter": ( ( [Encounter: "ESRD Monthly Outpatient Services"] ).isEncounterPerformed ( ) ) ESRDEncounter where ESRDEncounter.period.toInterval ( ) starts on or before end of "Measurement Period" Logic Definition Library Name: ControllingHighBloodPressureFHIR define "Denominator Exclusions": Hospice."Has Hospice Services" or exists ( "Pregnancy or Renal Diagnosis" ) or exists ( "End Stage Renal Disease Procedures" ) or exists ( "End Stage Renal Disease Encounter" ) or AIFrailLTCF."Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty" or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home" or PalliativeCare."Has Palliative Care in the Measurement Period" Logic Definition Library Name: ControllingHighBloodPressureFHIR define "SDE Race": SDE."SDE Race" Logic Definition Library Name: ControllingHighBloodPressureFHIR define fluent function getEncounter(reference Reference): singleton from ( [Encounter] E where E.id = reference.reference.getId ( ) ) 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 uri): value.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 /* @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: QICoreCommon /* @description: Returns the tail of the given uri (i.e. everything after the last slash in the URI). @comment: This function can be used to determine the logical id of a given resource. It can be used in a single-server environment to trace references. However, this function does not attempt to resolve or distinguish the base of the given url, and so cannot be used safely in multi-server environments. */ define fluent function getId(uri String): Last(Split(uri, '/')) Logic Definition Library Name: QICoreCommon /* @description: Returns an interval representing the normalized prevalence period of a given Condition. @comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary. */ define fluent function prevalenceInterval(condition Condition): if condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse" then Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()] else (end of condition.abatementInterval()) abatementDate return if abatementDate is null then Interval[start of condition.onset.toInterval(), abatementDate) else Interval[start of condition.onset.toInterval(), abatementDate] Logic Definition Library Name: QICoreCommon /* @description: Returns an interval representing the normalized abatement of a given Condition. @comment: If the abatement element of the Condition is represented as a DateTime, the result is an interval beginning and ending on that DateTime. If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The result is an interval from the date the patient turned that age to immediately before one year later. If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately before one year later than the date the patient turned the ending age of the quantity interval. */ define fluent function abatementInterval(condition Condition): if condition.abatement is DateTime then Interval[condition.abatement as DateTime, condition.abatement as DateTime] else if condition.abatement is Quantity then Interval[Patient.birthDate + (condition.abatement as Quantity), Patient.birthDate + (condition.abatement as Quantity) + 1 year) else if condition.abatement is Interval<Quantity> then Interval[Patient.birthDate + (condition.abatement.low as Quantity), Patient.birthDate + (condition.abatement.high as Quantity) + 1 year) else if condition.abatement is Interval<DateTime> then Interval[condition.abatement.low, condition.abatement.high) else null as Interval<DateTime> Logic Definition Library Name: QICoreCommon /* @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval @comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible representations for timing-valued elements in QICore, allowing this function to be used across any resource. The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>. The intent of this function is to provide a clear and concise mechanism to treat single elements that have multiple possible representations as intervals so that logic doesn't have to account for the variability. More complex calculations (such as medication request period or dispense period calculation) need specific guidance and consideration. That guidance may make use of this function, but the focus of this function is on single element calculations where the semantics are unambiguous. If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime. If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age, and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later. If the input is a DateTime Interval, the result is the input. If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending immediately before one year later than the date the patient turned the age given as the end of the quantity interval. If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval */ define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>): case when choice is DateTime then Interval[choice as DateTime, choice as DateTime] when choice is Interval<DateTime> then choice as Interval<DateTime> when choice is Quantity then Interval[Patient.birthDate + (choice as Quantity), Patient.birthDate + (choice as Quantity) + 1 year) when choice is Interval<Quantity> then Interval[Patient.birthDate + (choice.low as Quantity), Patient.birthDate + (choice.high as Quantity) + 1 year) when choice is Timing then Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime> else null as Interval<DateTime> end Logic Definition Library Name: QICoreCommon /* @description: Returns true if the given DeviceRequest is a negation (i.e. do not perform this order) */ define fluent function doNotPerform(deviceRequest DeviceRequest): singleton from ( deviceRequest.modifierExtension E where E.url = 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-doNotPerform' return E.value as Boolean ) Logic Definition Library Name: Status //Observation Vital Signs define fluent function isObservationBP(Obs List<"QICore.observation-bp">): Obs O where O.status in { 'final', 'amended', 'corrected' } Logic Definition Library Name: Status //Encounter, Performed //General usage unless required otherwise by measure intent (e.g., follow-up encounters) define fluent function isEncounterPerformed(Enc List<Encounter>): Enc E where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'} Logic Definition Library Name: Status //This library contains functions that are based on QDM 5.6 to QICore 4.1.1 March 2023 (https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1). The functions may appear similar to some QICoreCommon functions but different in that they have constraints that are relevant for measures authored by NCQA. //Assessment, Performed define fluent function isAssessmentPerformed(Obs List<Observation>): Obs O where O.status in { 'final', 'amended', 'corrected' } and exists ( O.category ObservationCategory where ( ObservationCategory ) ~ "survey" ) Logic Definition Library Name: Status //Intervention, Order: active and completed only define fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>): ServiceRequest S where S.status in { 'active', 'completed' } and S.intent = 'order' Logic Definition Library Name: Status //Intervention, Performed define fluent function isInterventionPerformed(Proc List<Procedure>): Proc P where P.status ~ 'completed' Logic Definition Library Name: Status //Procedure, Performed define fluent function isProcedurePerformed(Proc List<Procedure>): Proc P where P.status ~ 'completed' Logic Definition Library Name: Status //Device, Order - Personal Use Devices: active and completed only define fluent function isDeviceOrder(DeviceRequest List<DeviceRequest>): DeviceRequest D where D.status in { 'active', 'completed' } and D.intent = 'order' Logic Definition Library Name: Status //Symptom define fluent function isSymptom(Obs List<Observation>): Obs O where O.status in { 'preliminary', 'final', 'amended', 'corrected' } Logic Definition Library Name: Status //Medication, Active define fluent function isMedicationActive(MedicationRequest List<MedicationRequest>): MedicationRequest M where M.status = 'active' and M.intent = 'order' Logic Definition Library Name: CumulativeMedicationDuration define fluent function medicationRequestPeriod(Request "MedicationRequest"): Request R let dosage: singleton from R.dosageInstruction, doseAndRate: singleton from dosage.doseAndRate, timing: dosage.timing, frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency), period: Quantity(timing.repeat.period, timing.repeat.periodUnit), doseRange: doseAndRate.dose, doseQuantity: doseAndRate.dose, dose: Coalesce(end of doseRange, doseQuantity), dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0), boundsPeriod: timing.repeat.bounds as Interval<DateTime>, daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).value, quantity: R.dispenseRequest.quantity, refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0), startDate: Coalesce( date from start of boundsPeriod, date from R.authoredOn, date from start of R.dispenseRequest.validityPeriod ), totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills) return if startDate is not null and totalDaysSupplied is not null then Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ] else if startDate is not null and boundsPeriod."high" is not null then Interval[startDate, date from end of boundsPeriod] else null Logic Definition Library Name: CumulativeMedicationDuration /**********************************************************************/ /* Functions in this region are copied from opioid-mme-r4 */ /**********************************************************************/ define function Quantity(value Decimal, unit String): if value is not null then System.Quantity { value: value, unit: unit } else null Logic Definition Library Name: CumulativeMedicationDuration /* Goal is to get to number of days Two broad approaches to the calculation: 1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered 2) Based on relevant period, determine a covered interval and calculate the length of that interval in days This topic covers several use cases and illustrates how to calculate Cumulative Medication Duration for each type of medication resource using the supply and frequency approach. */ /* For the first approach, we need to get from frequency to a frequency/day So we define ToDaily */ /* Calculates daily frequency given frequency within a period */ define function ToDaily(frequency System.Integer, period System.Quantity): case period.unit when 'h' then frequency * (24.0 / period.value) when 'min' then frequency * (24.0 / period.value) * 60 when 's' then frequency * (24.0 / period.value) * 60 * 60 when 'd' then frequency * (24.0 / period.value) / 24 when 'wk' then frequency * (24.0 / period.value) / (24 * 7) when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ when 'hour' then frequency * (24.0 / period.value) when 'minute' then frequency * (24.0 / period.value) * 60 when 'second' then frequency * (24.0 / period.value) * 60 * 60 when 'day' then frequency * (24.0 / period.value) / 24 when 'week' then frequency * (24.0 / period.value) / (24 * 7) when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ when 'hours' then frequency * (24.0 / period.value) when 'minutes' then frequency * (24.0 / period.value) * 60 when 'seconds' then frequency * (24.0 / period.value) * 60 * 60 when 'days' then frequency * (24.0 / period.value) / 24 when 'weeks' then frequency * (24.0 / period.value) / (24 * 7) when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit) end Terminology Code System Description: Code system AdministrativeGender Resource: AdministrativeGender Canonical URL: http://hl7.org/fhir/administrative-gender Code System Description: Code system LOINC Resource: Logical Observation Identifiers, Names and Codes (LOINC) Canonical URL: http://loinc.org Code System Description: Code system ConditionClinicalStatusCodes Resource: Condition Clinical Status Codes Canonical URL: http://terminology.hl7.org/CodeSystem/condition-clinical Code System Description: Code system SNOMEDCT Resource: SNOMED CT (all versions) Canonical URL: http://snomed.info/sct Code System Description: Code system ObservationCategoryCodes Resource: Observation Category Codes Canonical URL: http://terminology.hl7.org/CodeSystem/observation-category Value Set Description: Value set Essential Hypertension Resource: Essential Hypertension Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.104.12.1011 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 Virtual Encounter Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089 Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089 Value Set Description: Value set Telephone Visits Resource: Telephone Visits Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080 Value Set Description: Value set Payer Type Resource: Payer 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 Encounter Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003 Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003 Value Set Description: Value set Hospice Care Ambulatory Resource: Hospice Care Ambulatory Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584 Value Set Description: Value set Hospice Diagnosis Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165 Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165 Value Set Description: Value set Pregnancy Resource: Pregnancy Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.378 Value Set Description: Value set End Stage Renal Disease Resource: End Stage Renal Disease Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.353 Value Set Description: Value set Kidney Transplant Recipient Resource: Kidney Transplant Recipient Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1029 Value Set Description: Value set Chronic Kidney Disease, Stage 5 Resource: Chronic Kidney Disease, Stage 5 Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1002 Value Set Description: Value set Kidney Transplant Resource: Kidney Transplant Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1012 Value Set Description: Value set Dialysis Services Resource: Dialysis Services Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1013 Value Set Description: Value set ESRD Monthly Outpatient Services Resource: ESRD Monthly Outpatient Services Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1014 Value Set Description: Value set Frailty Device Resource: Frailty Device Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.118.12.1300 Value Set Description: Value set Frailty Diagnosis Resource: Frailty Diagnosis Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1074 Value Set Description: Value set Frailty Encounter Resource: Frailty Encounter Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1088 Value Set Description: Value set Frailty Symptom Resource: Frailty Symptom Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1075 Value Set Description: Value set Advanced Illness Resource: Advanced Illness Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1082 Value Set Description: Value set Dementia Medications Resource: Dementia Medications Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1510 Value Set Description: Value set Palliative Care Diagnosis Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167 Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167 Value Set Description: Value set Palliative Care Encounter Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090 Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090 Value Set Description: Value set Palliative Care Intervention Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135 Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135 Direct Reference Code Display: Male Code: M System: http://hl7.org/fhir/administrative-gender Direct Reference Code Display: Female Code: F System: http://hl7.org/fhir/administrative-gender Direct Reference Code Display: Systolic blood pressure Code: 8480-6 System: http://loinc.org Direct Reference Code Display: Diastolic blood pressure Code: 8462-4 System: http://loinc.org Direct Reference Code Display: Active Code: active System: http://terminology.hl7.org/CodeSystem/condition-clinical Direct Reference Code Display: Recurrence Code: recurrence System: http://terminology.hl7.org/CodeSystem/condition-clinical Direct Reference Code Display: Relapse Code: relapse System: http://terminology.hl7.org/CodeSystem/condition-clinical 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: survey Code: survey System: http://terminology.hl7.org/CodeSystem/observation-category Direct Reference Code Display: Yes (qualifier value) Code: 373066001 System: http://snomed.info/sct Direct Reference Code Display: Hospice care [Minimum Data Set] Code: 45755-6 System: http://loinc.org Direct Reference Code Display: Medical equipment used Code: 98181-1 System: http://loinc.org Direct Reference Code Display: Housing status Code: 71802-3 System: http://loinc.org Direct Reference Code Display: Lives in a nursing home (finding) Code: 160734000 System: http://snomed.info/sct Direct Reference Code Display: Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal) Code: 71007-9 System: http://loinc.org Dependencies Dependency Description: QICore model information Resource: http://hl7.org/fhir/us/qicore/Library/QICore-ModelInfo|4.1.1 Canonical URL: http://hl7.org/fhir/us/qicore/Library/QICore-ModelInfo|4.1.1 Dependency Description: Library SDE Resource: SupplementalDataElementsversion: null3.5.000) Canonical URL: https://madie.cms.gov/Library/SupplementalDataElements|3.5.000 Dependency Description: Library Status Resource: Statusversion: null1.8.000) Canonical URL: https://madie.cms.gov/Library/Status|1.8.000 Dependency Description: Library FHIRHelpers Resource: FHIRHelpersversion: null4.4.000) Canonical URL: https://madie.cms.gov/Library/FHIRHelpers|4.4.000 Dependency Description: Library QICoreCommon Resource: QICoreCommonversion: null2.1.000) Canonical URL: https://madie.cms.gov/Library/QICoreCommon|2.1.000 Dependency Description: Library AdultOutpatientEncounters Resource: AdultOutpatientEncountersversion: null4.11.000) Canonical URL: https://madie.cms.gov/Library/AdultOutpatientEncounters|4.11.000 Dependency Description: Library Hospice Resource: Hospiceversion: null6.12.000) Canonical URL: https://madie.cms.gov/Library/Hospice|6.12.000 Dependency Description: Library AIFrailLTCF Resource: AdvancedIllnessandFrailtyversion: null1.16.000) Canonical URL: https://madie.cms.gov/Library/AdvancedIllnessandFrailty|1.16.000 Dependency Description: Library CMD Resource: CumulativeMedicationDurationversion: null4.1.000) Canonical URL: https://madie.cms.gov/Library/CumulativeMedicationDuration|4.1.000 Dependency Description: Library PalliativeCare Resource: PalliativeCareversion: null1.11.000) Canonical URL: https://madie.cms.gov/Library/PalliativeCare|1.11.000 Data Requirements Data Requirement Type: Patient Profile(s): QICorePatient Must Support Elements: ethnicity, race Data Requirement Type: Encounter Profile(s): QICoreEncounter Must Support Elements: id, id.value, status, status.value, period Data Requirement Type: Encounter Profile(s): QICoreEncounter Must Support Elements: type, status, status.value, period Code Filter(s): Path: type ValueSet: Office Visit Data Requirement Type: Encounter Profile(s): QICoreEncounter Must Support Elements: type, status, status.value, period Code Filter(s): Path: type ValueSet: Annual Wellness Visit Data Requirement Type: Encounter Profile(s): QICoreEncounter Must Support Elements: type, status, status.value, period Code Filter(s): Path: type ValueSet: Preventive Care Services - Established Office Visit, 18 and Up Data Requirement Type: Encounter Profile(s): QICoreEncounter Must Support Elements: type, status, status.value, period Code Filter(s): Path: type ValueSet: Preventive Care Services-Initial Office Visit, 18 and Up Data Requirement Type: Encounter Profile(s): QICoreEncounter Must Support Elements: type, status, status.value, period Code Filter(s): Path: type ValueSet: Home Healthcare Services Data Requirement Type: Encounter Profile(s): QICoreEncounter Must Support Elements: type, status, status.value, period Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089 Data Requirement Type: Encounter Profile(s): QICoreEncounter Must Support Elements: type, status, status.value, period Code Filter(s): Path: type ValueSet: Telephone Visits Data Requirement Type: Encounter Profile(s): QICoreEncounter Must Support Elements: type, hospitalization, hospitalization.dischargeDisposition, period, status, status.value Code Filter(s): Path: type ValueSet: Encounter Inpatient Data Requirement Type: Encounter Profile(s): QICoreEncounter Must Support Elements: type, period, status, status.value Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003 Data Requirement Type: Encounter Profile(s): QICoreEncounter Must Support Elements: type, period, status, status.value Code Filter(s): Path: type ValueSet: ESRD Monthly Outpatient Services Data Requirement Type: Encounter Profile(s): QICoreEncounter Must Support Elements: type, period, status, status.value Code Filter(s): Path: type ValueSet: Frailty Encounter Data Requirement Type: Encounter Profile(s): QICoreEncounter Must Support Elements: type, period, status, status.value Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090 Data Requirement Type: Observation Profile(s): Observation Blood Pressure Profile Must Support Elements: encounter, encounter.class, encounter.class.code, effective, status, status.value, component Data Requirement Type: Condition Profile(s): QICoreCondition Must Support Elements: code Code Filter(s): Path: code ValueSet: Essential Hypertension Data Requirement Type: Condition Profile(s): QICoreCondition Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165 Data Requirement Type: Condition Profile(s): QICoreCondition Must Support Elements: code Code Filter(s): Path: code ValueSet: Pregnancy Data Requirement Type: Condition Profile(s): QICoreCondition Must Support Elements: code Code Filter(s): Path: code ValueSet: End Stage Renal Disease Data Requirement Type: Condition Profile(s): QICoreCondition Must Support Elements: code Code Filter(s): Path: code ValueSet: Kidney Transplant Recipient Data Requirement Type: Condition Profile(s): QICoreCondition Must Support Elements: code Code Filter(s): Path: code ValueSet: Chronic Kidney Disease, Stage 5 Data Requirement Type: Condition Profile(s): QICoreCondition Must Support Elements: code Code Filter(s): Path: code ValueSet: Frailty Diagnosis Data Requirement Type: Condition Profile(s): QICoreCondition Must Support Elements: code Code Filter(s): Path: code ValueSet: Advanced Illness Data Requirement Type: Condition Profile(s): QICoreCondition Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167 Data Requirement Type: Coverage Profile(s): QICoreCoverage Must Support Elements: type, period Code Filter(s): Path: type ValueSet: Payer Data Requirement Type: Observation Profile(s): QICoreObservation Must Support Elements: code, value, effective, status, status.value, category Code Filter(s): Path: code Code(s): LOINC: 45755-6 (Hospice care [Minimum Data Set]) Path: value Data Requirement Type: Observation Profile(s): QICoreObservation Must Support Elements: code, value, effective, status, status.value, category Code Filter(s): Path: code Code(s): LOINC: 98181-1 (Medical equipment used) Path: value ValueSet: Frailty Device Data Requirement Type: Observation Profile(s): QICoreObservation Must Support Elements: code, effective, status, status.value, category Code Filter(s): Path: code ValueSet: Frailty Symptom Data Requirement Type: Observation Profile(s): QICoreObservation Must Support Elements: code, effective, status, status.value, category Code Filter(s): Path: code Code(s): LOINC: 71802-3 (Housing status) Data Requirement Type: Observation Profile(s): QICoreObservation Must Support Elements: code, effective, value, status, status.value, category Code Filter(s): Path: code Code(s): LOINC: 71802-3 (Housing status) Path: value Data Requirement Type: Observation Profile(s): QICoreObservation Must Support Elements: code, effective, status, status.value, category Code Filter(s): Path: code Code(s): LOINC: 71007-9 (Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)) Data Requirement Type: ServiceRequest Profile(s): QICoreServiceRequest Must Support Elements: code, authoredOn, authoredOn.value, status, status.value, intent, intent.value Code Filter(s): Path: code ValueSet: Hospice Care Ambulatory Data Requirement Type: Procedure Profile(s): QICoreProcedure Must Support Elements: code, performed, status, status.value Code Filter(s): Path: code ValueSet: Hospice Care Ambulatory Data Requirement Type: Procedure Profile(s): QICoreProcedure Must Support Elements: code, status, status.value, performed Code Filter(s): Path: code ValueSet: Kidney Transplant Data Requirement Type: Procedure Profile(s): QICoreProcedure Must Support Elements: code, status, status.value, performed Code Filter(s): Path: code ValueSet: Dialysis Services Data Requirement Type: Procedure Profile(s): QICoreProcedure Must Support Elements: code, performed, status, status.value Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135 Data Requirement Type: DeviceRequest Profile(s): QICoreDeviceRequest Must Support Elements: code, status, status.value, intent, intent.value, url, url.value, value, authoredOn, authoredOn.value Code Filter(s): Path: code ValueSet: Frailty Device Data Requirement Type: MedicationRequest Profile(s): QICoreMedicationRequest Must Support Elements: medication, status, status.value, intent, intent.value, dosageInstruction, dispenseRequest, dispenseRequest.expectedSupplyDuration, dispenseRequest.quantity, dispenseRequest.numberOfRepeatsAllowed, dispenseRequest.numberOfRepeatsAllowed.value, authoredOn, authoredOn.value, dispenseRequest.validityPeriod Code Filter(s): Path: medication ValueSet: Dementia Medications Parameters Name Use Card. Type Documentation Measurement Period In 0..1 Period ErrorLevel In 0..1 string SDE Sex Out 0..1 Coding Numerator Out 0..1 boolean Denominator Out 0..1 boolean SDE Payer Out 0..* Resource Initial Population Out 0..1 boolean SDE Ethnicity Out 0..1 Resource Denominator Exclusions Out 0..1 boolean SDE Race Out 0..1 Resource Generated using version 0.5.4-cibuild of the sample-content-ig Liquid templates
Discharge to home for hospice care (procedure)
Discharge to healthcare facility for hospice care (procedure)
Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)
define "SDE Sex": case when Patient.gender = 'male' then "M" when Patient.gender = 'female' then "F" else null end
Qualifying Systolic Blood Pressure Reading
define "Qualifying Systolic Blood Pressure Reading": ( ( ["observation-bp"] ).isObservationBP ( ) ) BloodPressure where ( not ( ( BloodPressure.encounter.getEncounter ( ) ).class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS' } ) ) and BloodPressure.effective.latest ( ) during day of "Measurement Period"
Qualifying Diastolic Blood Pressure Reading
define "Qualifying Diastolic Blood Pressure Reading": ( ( ["observation-bp"] ).isObservationBP ( ) ) BloodPressure where ( not ( ( BloodPressure.encounter.getEncounter ( ) ).class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS' } ) ) and BloodPressure.effective.latest ( ) during day of "Measurement Period"
define "Blood Pressure Days": ( "Qualifying Diastolic Blood Pressure Reading" DBPExam return date from DBPExam.effective.latest ( ) ) intersect ( "Qualifying Systolic Blood Pressure Reading" SBPExam return date from SBPExam.effective.latest ( ) )
define "Most Recent Blood Pressure Day": Last("Blood Pressure Days" BPDays sort asc )
Lowest Systolic Reading on Most Recent Blood Pressure Day
define "Lowest Systolic Reading on Most Recent Blood Pressure Day": First("Qualifying Systolic Blood Pressure Reading" SBPReading where SBPReading.effective.latest() same day as "Most Recent Blood Pressure Day" return singleton from(SBPReading.component SBPComponent where SBPComponent.code ~ "Systolic blood pressure" return SBPComponent.value as Quantity ) sort asc )
Has Systolic Blood Pressure Less Than 140
define "Has Systolic Blood Pressure Less Than 140": "Lowest Systolic Reading on Most Recent Blood Pressure Day" < 140 'mm[Hg]'
Lowest Diastolic Reading on Most Recent Blood Pressure Day
define "Lowest Diastolic Reading on Most Recent Blood Pressure Day": First("Qualifying Diastolic Blood Pressure Reading" DBPReading where DBPReading.effective.latest() same day as "Most Recent Blood Pressure Day" return singleton from(DBPReading.component DBPComponent where DBPComponent.code ~ "Diastolic blood pressure" return DBPComponent.value as Quantity ) sort asc )
Has Diastolic Blood Pressure Less Than 90
define "Has Diastolic Blood Pressure Less Than 90": "Lowest Diastolic Reading on Most Recent Blood Pressure Day" < 90 'mm[Hg]'
define "Numerator": "Has Systolic Blood Pressure Less Than 140" and "Has Diastolic Blood Pressure Less Than 90"
define "Essential Hypertension Diagnosis": ( [Condition: "Essential Hypertension"] ) Hypertension where Hypertension.prevalenceInterval ( ) overlaps Interval[start of "Measurement Period", start of "Measurement Period" + 6 months )
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"] union [Encounter: "Virtual Encounter"] union [Encounter: "Telephone Visits"] ).isEncounterPerformed() ) ValidEncounter where ValidEncounter.period.toInterval() during day of "Measurement Period"
define "Initial Population": AgeInYearsAt(date from end of "Measurement Period" ) in Interval[18, 85] and exists "Essential Hypertension Diagnosis" and exists AdultOutpatientEncounters."Qualifying Encounters"
define "Denominator": "Initial Population"
define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period }
define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text }
define "SDE Ethnicity": SDE."SDE Ethnicity"
define "Has Hospice Services": exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)" or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)" ) and InpatientEncounter.period.toInterval() ends during day of "Measurement Period" ) or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter where HospiceEncounter.period.toInterval() overlaps day of "Measurement Period" ) or exists ((([Observation: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment where HospiceAssessment.value ~ "Yes (qualifier value)" and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period" ) or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder where HospiceOrder.authoredOn.toInterval() during day of "Measurement Period" // and HospiceOrder.doNotPerform is not true // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447 ) or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period" ) or exists (([Condition: "Hospice Diagnosis"]) HospiceCareDiagnosis where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" )
define "Pregnancy or Renal Diagnosis": ( [Condition: "Pregnancy"] union [Condition: "End Stage Renal Disease"] union [Condition: "Kidney Transplant Recipient"] union [Condition: "Chronic Kidney Disease, Stage 5"] ) PregnancyESRDDiagnosis where PregnancyESRDDiagnosis.prevalenceInterval ( ) overlaps "Measurement Period"
define "End Stage Renal Disease Procedures": ( ( [Procedure: "Kidney Transplant"] union [Procedure: "Dialysis Services"] ).isProcedurePerformed ( ) ) ESRDProcedure where ESRDProcedure.performed.toInterval ( ) ends on or before end of "Measurement Period"
define "End Stage Renal Disease Encounter": ( ( [Encounter: "ESRD Monthly Outpatient Services"] ).isEncounterPerformed ( ) ) ESRDEncounter where ESRDEncounter.period.toInterval ( ) starts on or before end of "Measurement Period"
define "Has Criteria Indicating Frailty": exists ( (([DeviceRequest: "Frailty Device"]).isDeviceOrder()) FrailtyDeviceOrder where FrailtyDeviceOrder.doNotPerform() is not true and FrailtyDeviceOrder.authoredOn.toInterval() during day of "Measurement Period" ) or exists ( (([Observation: "Medical equipment used"]).isAssessmentPerformed()) EquipmentUsed where EquipmentUsed.value as Concept in "Frailty Device" and EquipmentUsed.effective.toInterval() ends during day of "Measurement Period" ) or exists ( ([Condition: "Frailty Diagnosis"]) FrailtyDiagnosis where FrailtyDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" ) or exists ( (([Encounter: "Frailty Encounter"]).isEncounterPerformed()) FrailtyEncounter where FrailtyEncounter.period.toInterval() overlaps day of "Measurement Period" ) or exists ( (([Observation: "Frailty Symptom"]).isSymptom()) FrailtySymptom where FrailtySymptom.effective.toInterval() overlaps day of "Measurement Period" )
Has Advanced Illness in Year Before or During Measurement Period
define "Has Advanced Illness in Year Before or During Measurement Period": exists ([Condition: "Advanced Illness"] AdvancedIllnessDiagnosis where AdvancedIllnessDiagnosis.prevalenceInterval() starts during day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"])
Has Dementia Medications in Year Before or During Measurement Period
define "Has Dementia Medications in Year Before or During Measurement Period": exists (( ([MedicationRequest: medication in "Dementia Medications"]).isMedicationActive()) DementiaMedication // https://oncprojectracking.healthit.gov/support/browse/CQLIT-449 where DementiaMedication.medicationRequestPeriod() overlaps day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"] // and DementiaMedication.doNotPerform is not true // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447 )
Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty
define "Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty": ( AgeInYearsAt(date from end of "Measurement Period")in Interval[66, 80] and "Has Criteria Indicating Frailty" and ( "Has Advanced Illness in Year Before or During Measurement Period" or "Has Dementia Medications in Year Before or During Measurement Period" ) ) or ( AgeInYearsAt(date from end of "Measurement Period")>= 81 and "Has Criteria Indicating Frailty" )
Is Age 66 or Older Living Long Term in a Nursing Home
define "Is Age 66 or Older Living Long Term in a Nursing Home": AgeInYearsAt(date from end of "Measurement Period" )>= 66 and ( ( Last( (([Observation: "Housing status"]).isAssessmentPerformed()) HousingStatus where HousingStatus.effective.toInterval() ends on or before day of end of "Measurement Period" sort by end of effective.toInterval() asc )) LastHousingStatus where LastHousingStatus.value ~ "Lives in a nursing home (finding)" ) is not null
Has Palliative Care in the Measurement Period
define "Has Palliative Care in the Measurement Period": exists ((([Observation: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"]).isAssessmentPerformed()) PalliativeAssessment where PalliativeAssessment.effective.toInterval() overlaps day of "Measurement Period" ) or exists ([Condition: "Palliative Care Diagnosis"] PalliativeDiagnosis where PalliativeDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" ) or exists ((([Encounter: "Palliative Care Encounter"]).isEncounterPerformed()) PalliativeEncounter where PalliativeEncounter.period.toInterval() overlaps day of "Measurement Period" ) or exists ((([Procedure: "Palliative Care Intervention"]).isInterventionPerformed()) PalliativeIntervention where PalliativeIntervention.performed.toInterval() overlaps day of "Measurement Period" )
define "Denominator Exclusions": Hospice."Has Hospice Services" or exists ( "Pregnancy or Renal Diagnosis" ) or exists ( "End Stage Renal Disease Procedures" ) or exists ( "End Stage Renal Disease Encounter" ) or AIFrailLTCF."Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty" or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home" or PalliativeCare."Has Palliative Care in the Measurement Period"
define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text }
//Observation Vital Signs define fluent function isObservationBP(Obs List<"QICore.observation-bp">): Obs O where O.status in { 'final', 'amended', 'corrected' }
define fluent function getEncounter(reference Reference): singleton from ( [Encounter] E where E.id = reference.reference.getId ( ) )
/* @description: Returns the tail of the given uri (i.e. everything after the last slash in the URI). @comment: This function can be used to determine the logical id of a given resource. It can be used in a single-server environment to trace references. However, this function does not attempt to resolve or distinguish the base of the given url, and so cannot be used safely in multi-server environments. */ define fluent function getId(uri String): Last(Split(uri, '/'))
/* @description: Returns an interval representing the normalized prevalence period of a given Condition. @comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary. */ define fluent function prevalenceInterval(condition Condition): if condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse" then Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()] else (end of condition.abatementInterval()) abatementDate return if abatementDate is null then Interval[start of condition.onset.toInterval(), abatementDate) else Interval[start of condition.onset.toInterval(), abatementDate]
/* @description: Returns an interval representing the normalized abatement of a given Condition. @comment: If the abatement element of the Condition is represented as a DateTime, the result is an interval beginning and ending on that DateTime. If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The result is an interval from the date the patient turned that age to immediately before one year later. If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately before one year later than the date the patient turned the ending age of the quantity interval. */ define fluent function abatementInterval(condition Condition): if condition.abatement is DateTime then Interval[condition.abatement as DateTime, condition.abatement as DateTime] else if condition.abatement is Quantity then Interval[Patient.birthDate + (condition.abatement as Quantity), Patient.birthDate + (condition.abatement as Quantity) + 1 year) else if condition.abatement is Interval<Quantity> then Interval[Patient.birthDate + (condition.abatement.low as Quantity), Patient.birthDate + (condition.abatement.high as Quantity) + 1 year) else if condition.abatement is Interval<DateTime> then Interval[condition.abatement.low, condition.abatement.high) else null as Interval<DateTime>
//Encounter, Performed //General usage unless required otherwise by measure intent (e.g., follow-up encounters) define fluent function isEncounterPerformed(Enc List<Encounter>): Enc E where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}
/* @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval @comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible representations for timing-valued elements in QICore, allowing this function to be used across any resource. The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>. The intent of this function is to provide a clear and concise mechanism to treat single elements that have multiple possible representations as intervals so that logic doesn't have to account for the variability. More complex calculations (such as medication request period or dispense period calculation) need specific guidance and consideration. That guidance may make use of this function, but the focus of this function is on single element calculations where the semantics are unambiguous. If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime. If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age, and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later. If the input is a DateTime Interval, the result is the input. If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending immediately before one year later than the date the patient turned the age given as the end of the quantity interval. If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval */ define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>): case when choice is DateTime then Interval[choice as DateTime, choice as DateTime] when choice is Interval<DateTime> then choice as Interval<DateTime> when choice is Quantity then Interval[Patient.birthDate + (choice as Quantity), Patient.birthDate + (choice as Quantity) + 1 year) when choice is Interval<Quantity> then Interval[Patient.birthDate + (choice.low as Quantity), Patient.birthDate + (choice.high as Quantity) + 1 year) when choice is Timing then Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime> else null as Interval<DateTime> end
/* @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 uri): value.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 }
//This library contains functions that are based on QDM 5.6 to QICore 4.1.1 March 2023 (https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1). The functions may appear similar to some QICoreCommon functions but different in that they have constraints that are relevant for measures authored by NCQA. //Assessment, Performed define fluent function isAssessmentPerformed(Obs List<Observation>): Obs O where O.status in { 'final', 'amended', 'corrected' } and exists ( O.category ObservationCategory where ( ObservationCategory ) ~ "survey" )
/* @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 }
//Intervention, Order: active and completed only define fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>): ServiceRequest S where S.status in { 'active', 'completed' } and S.intent = 'order'
//Intervention, Performed define fluent function isInterventionPerformed(Proc List<Procedure>): Proc P where P.status ~ 'completed'
//Procedure, Performed define fluent function isProcedurePerformed(Proc List<Procedure>): Proc P where P.status ~ 'completed'
//Device, Order - Personal Use Devices: active and completed only define fluent function isDeviceOrder(DeviceRequest List<DeviceRequest>): DeviceRequest D where D.status in { 'active', 'completed' } and D.intent = 'order'
/* @description: Returns true if the given DeviceRequest is a negation (i.e. do not perform this order) */ define fluent function doNotPerform(deviceRequest DeviceRequest): singleton from ( deviceRequest.modifierExtension E where E.url = 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-doNotPerform' return E.value as Boolean )
//Symptom define fluent function isSymptom(Obs List<Observation>): Obs O where O.status in { 'preliminary', 'final', 'amended', 'corrected' }
//Medication, Active define fluent function isMedicationActive(MedicationRequest List<MedicationRequest>): MedicationRequest M where M.status = 'active' and M.intent = 'order'
define fluent function medicationRequestPeriod(Request "MedicationRequest"): Request R let dosage: singleton from R.dosageInstruction, doseAndRate: singleton from dosage.doseAndRate, timing: dosage.timing, frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency), period: Quantity(timing.repeat.period, timing.repeat.periodUnit), doseRange: doseAndRate.dose, doseQuantity: doseAndRate.dose, dose: Coalesce(end of doseRange, doseQuantity), dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0), boundsPeriod: timing.repeat.bounds as Interval<DateTime>, daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).value, quantity: R.dispenseRequest.quantity, refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0), startDate: Coalesce( date from start of boundsPeriod, date from R.authoredOn, date from start of R.dispenseRequest.validityPeriod ), totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills) return if startDate is not null and totalDaysSupplied is not null then Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ] else if startDate is not null and boundsPeriod."high" is not null then Interval[startDate, date from end of boundsPeriod] else null
/* Goal is to get to number of days Two broad approaches to the calculation: 1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered 2) Based on relevant period, determine a covered interval and calculate the length of that interval in days This topic covers several use cases and illustrates how to calculate Cumulative Medication Duration for each type of medication resource using the supply and frequency approach. */ /* For the first approach, we need to get from frequency to a frequency/day So we define ToDaily */ /* Calculates daily frequency given frequency within a period */ define function ToDaily(frequency System.Integer, period System.Quantity): case period.unit when 'h' then frequency * (24.0 / period.value) when 'min' then frequency * (24.0 / period.value) * 60 when 's' then frequency * (24.0 / period.value) * 60 * 60 when 'd' then frequency * (24.0 / period.value) / 24 when 'wk' then frequency * (24.0 / period.value) / (24 * 7) when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ when 'hour' then frequency * (24.0 / period.value) when 'minute' then frequency * (24.0 / period.value) * 60 when 'second' then frequency * (24.0 / period.value) * 60 * 60 when 'day' then frequency * (24.0 / period.value) / 24 when 'week' then frequency * (24.0 / period.value) / (24 * 7) when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ when 'hours' then frequency * (24.0 / period.value) when 'minutes' then frequency * (24.0 / period.value) * 60 when 'seconds' then frequency * (24.0 / period.value) * 60 * 60 when 'days' then frequency * (24.0 / period.value) / 24 when 'weeks' then frequency * (24.0 / period.value) / (24 * 7) when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit) end
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 Chronic Kidney Disease, Stage 5
Value set ESRD Monthly Outpatient Services
National Committee for Quality Assurance
Percentage of patients 18-85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period, and whose most recent blood pressure was adequately controlled (<140/90 mmHg) during the measurement period
In reference to the numerator element, only blood pressure readings performed by a clinician or an automated blood pressure monitor or device are acceptable for numerator compliance with this measure. This includes blood pressures taken in person by a clinician and blood pressures measured remotely by electronic monitoring devices capable of transmitting the blood pressure data to the clinician. Blood pressure readings taken by an automated blood pressure monitor or device and conveyed by the patient to the clinician are also acceptable. It is the clinician’s responsibility and discretion to confirm the automated blood pressure monitor or device used to obtain the blood pressure is considered acceptable and reliable and whether the blood pressure reading is considered accurate before documenting it in the patient’s medical record. Do not include BP readings taken during an acute inpatient stay or an emergency department (ED) visit. If no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed "not controlled". If there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading. Ranges and thresholds do not meet criteria for this measure. A distinct numeric result for both the systolic and diastolic BP reading is required for numerator compliance. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS165v13. Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).
This Physician Performance Measure (Measure) and related data specifications are owned and 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 (e.g., 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) 2012-2024 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) codes, descriptions and other data are copyright 2024. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use. Some measure specifications contain coding from LOINC(R) (http://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2024 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at http://loinc.org/terms-of-use. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2024 World Health Organization. All Rights Reserved. Some measures use RxNorm, a standardized nomenclature and coding for clinical drugs and drug delivery devices, which is made publicly available courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services. NLM is not responsible for the measures and does not endorse or recommend this or any other product. “HL7” is the registered trademark of Health Level Seven International.
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].
High blood pressure (HBP), also known as hypertension, is when the pressure in blood vessels is higher than normal (Centers for Disease Control and Prevention [CDC], 2023). The causes of hypertension are multiple and multifaceted and can be based on genetic predisposition, environmental risk factors, being overweight and obese, sodium intake, potassium intake, physical activity, and alcohol use. High blood pressure is common; according to the American Heart Association, between 2013-2016, approximately 121.5 million US adults >= 20 years of age had HBP and the prevalence of hypertension among US adults 65 and older was 77.0 percent (Virani et al., 2021). In an analysis of adults with hypertension in National Health and Nutrition Examination Survey (NHANES), the estimated age-adjusted proportion with controlled blood pressure (BP) increased from 31.8 percent in 1999 to 53.8 percent in 2014. However, that proportion declined to 43.7 percent in 2017 to 2018 (Tsao et al., 2022). HBP increases risks of heart disease and stroke which are two of the leading causes of death in the US (CDC, 2023). A person who has HBP is four times more likely to die from a stroke and three times more likely to die from heart disease (CDC, 2021). The National Center for Health Statistics reported that in 2020 there were over 670,000 deaths with HBP as a primary or contributing cause (CDC, 2022). Between 2009 and 2019 the number of deaths due to HBP rose by 65.3 percent (Tsao et al., 2022). Managing and treating HBP would reduce cardiovascular disease mortality for males and females by 30.4 percent and 38.0 percent, respectively (Patel et al., 2015). Age-adjusted death rates attributable to HBP in 2019 were more than twice as high in non-Hispanic Black males (56.7 percent) when compared to rates for non-Hispanic White males (25.7 percent) (Tsao et al., 2022). HBP costs the U.S. approximately 131 billion dollars each year, averaged over 12 years from 2003 to 2014 (Kirkland et al., 2018). A study on cost-effectiveness on treating hypertension found that controlling HBP in patients with cardiovascular disease and systolic blood pressures (SBP) of >= 160 mmHg could be effective and cost-saving (Moran et al., 2015). Many studies have shown that controlling high blood pressure reduces cardiovascular events and mortality. The Systolic Blood Pressure Intervention Trial (SPRINT) investigated the impact of obtaining a SBP goal of <120 mmHg compared to a SBP goal of <140 mmHg among patients 50 and older with established cardiovascular disease and found that the patients with the former goal had reduced cardiovascular events and mortality (SPRINT Research Group et al., 2015). Controlling HBP will significantly reduce the risks of cardiovascular disease mortality and lead to better health outcomes like reduction of heart attacks, stroke, and kidney disease (James et al., 2014). Thus, the relationship between the measure (control of hypertension) and the long-term clinical outcomes listed is well established.
U.S. Preventive Services Task Force (USPSTF) (2021): - The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement (OBPM). The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. This is a grade A recommendation. American College of Cardiology/American Heart Association (2017): - For adults with confirmed hypertension and known cardiovascular disease (CVD) or 10-year atherosclerotic cardiovascular disease (ASCVD) event risk of 10 percent or higher, a blood pressure target of less than 130/80 mmHg is recommended (Level of evidence: B-R (for systolic blood pressures), Level of evidence: C-EO (for diastolic blood pressure)) - For adults with confirmed hypertension, without additional markers of increased CVD risk, a blood pressure target of less than 130/80 mmHg may be reasonable (Note: clinical trial evidence is strongest for a target blood pressure of 140/90 mmHg in this population. However, observational studies suggest that these individuals often have a high lifetime risk and would benefit from blood pressure control earlier in life) (Level of evidence: B-NR (for systolic blood pressure), Level of evidence: C-EO (for diastolic blood pressure)). American Academy of Family Physicians (2022): - Treat adults who have hypertension to a standard blood pressure target (less than 140/90 mm Hg) to reduce the risk of all-cause and cardiovascular mortality (strong recommendation; high-quality evidence). Treating to a lower blood pressure target (less than 135/85 mm Hg) does not provide additional benefit at preventing mortality; however, a lower blood pressure target could be considered based on patient preferences and values. (Grade: strong recommendation, Quality of evidence: high) - Consider treating adults who have hypertension to a lower blood pressure target (less than 135/85 mm Hg) to reduce risk of myocardial infarction (weak recommendation; moderate-quality evidence). Although treatment to a standard blood pressure target (less than 140/90 mm Hg) reduced the risk of myocardial infarction, there was a small additional benefit observed with a lower blood pressure target. There was no observed additional benefit in preventing stroke with the lower blood pressure target. (Grade: weak recommendation, Quality of evidence: low) American Diabetes Association (2022): - For individuals with diabetes and hypertension at higher cardiovascular risk (existing atherosclerotic cardiovascular disease or 10-year atherosclerotic cardiovascular disease risk >=15 percent), a blood pressure target of <130/80 mmHg may be appropriate, if it can be safely attained (Level of evidence: B) - For individuals with diabetes and hypertension at lower risk for cardiovascular disease (10-year atherosclerotic cardiovascular disease risk <15 percent), treat to a blood pressure target of <140/90 mmHg (Level of evidence: A)
Patients 18-85 years of age by the end of the measurement period who had a visit during the measurement period and diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period
Exclude patients who are in hospice care for any part of the measurement period. Patients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period. Also exclude patients with a diagnosis of pregnancy during the measurement period. Exclude patients 66-80 by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness diagnosis during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients 81 and older by the end of the measurement period with an indication of frailty for any part of the measurement period. Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients receiving palliative care for any part of the measurement period.
Patients whose most recent blood pressure is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement period