library CMS104FHIRSTKDCAntithrombotic version '0.9.002'

/* 2025 AU */


using QICore version '4.1.1'

include FHIRHelpers version '4.4.000' called FHIRHelpers
include CQMCommon version '2.2.000' called CQMCommon
include QICoreCommon version '2.1.000' called QICoreCommon
include SupplementalDataElements version '3.5.000' called SDE
include TJCOverall version '8.15.000' called TJC

valueset "Antithrombotic Therapy for Ischemic Stroke": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62'
valueset "Medical Reason For Not Providing Treatment": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.473'
valueset "Patient Refusal": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93'
valueset "Pharmacological Contraindications For Antithrombotic Therapy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52'

parameter "Measurement Period" Interval<DateTime>

context Patient

define "Initial Population":
  TJC."Ischemic Stroke Encounter"

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  TJC."Ischemic Stroke Encounters With Discharge Disposition"
    union "Encounter With Comfort Measures During Hospitalization For Patients With Documented Ischemic Stroke"

define "Encounter With Comfort Measures During Hospitalization For Patients With Documented Ischemic Stroke":
  "Denominator" Encounter
    with TJC."Intervention Comfort Measures" ComfortMeasure
      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during Encounter.hospitalizationWithObservation ( )

define "Numerator":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with ["MedicationRequest": medication in "Antithrombotic Therapy for Ischemic Stroke"] DischargeAntithrombotic
      such that DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period

define "Antithrombotic Therapy At Discharge":
  ["MedicationRequest": medication in "Antithrombotic Therapy for Ischemic Stroke"] Antithrombotic
    where ( Antithrombotic.isCommunity ( )
        or Antithrombotic.isDischarge ( )
    )
      and Antithrombotic.status in { 'active', 'completed' }
      and Antithrombotic.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }

define "Denominator Exceptions":
  "Encounter With Documented Reason For No Antithrombotic At Discharge"
    union "Encounter With Pharmacological Contraindications For Antithrombotic Therapy At Discharge"

define "Encounter With Documented Reason For No Antithrombotic At Discharge":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with "Reason For Not Giving Antithrombotic At Discharge" NoDischargeAntithrombotic
      such that NoDischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period

define "Reason For Not Giving Antithrombotic At Discharge":
  ["MedicationNotRequested": "Antithrombotic Therapy for Ischemic Stroke"] NoAntithromboticDischarge
    where ( NoAntithromboticDischarge.reasonCode in "Medical Reason For Not Providing Treatment"
        or NoAntithromboticDischarge.reasonCode in "Patient Refusal"
    )
      and ( NoAntithromboticDischarge.isCommunity ( )
          or NoAntithromboticDischarge.isDischarge ( )
      )
      //BONNIEMAT-1617-Since there is an anticipated resolution for STU 5 for Medication.Discharge which leaves one blockers on coverage, will leave the assertion logic as is and update the test cases for coverage.


define "Encounter With Pharmacological Contraindications For Antithrombotic Therapy At Discharge":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with "Pharmacological Contraindications For Antithrombotic Therapy At Discharge" DischargePharmacological
      such that DischargePharmacological.authoredOn during IschemicStrokeEncounter.period

define "Pharmacological Contraindications For Antithrombotic Therapy At Discharge":
  ["MedicationRequest": medication in "Pharmacological Contraindications For Antithrombotic Therapy"] PharmacologicalContraindications
    where ( PharmacologicalContraindications.isCommunity ( )
        or PharmacologicalContraindications.isDischarge ( )
    )
      and PharmacologicalContraindications.status in { 'active', 'completed' }
      and PharmacologicalContraindications.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }

define "SDE Ethnicity":
  SDE."SDE Ethnicity"

define "SDE Payer":
  SDE."SDE Payer"

define "SDE Race":
  SDE."SDE Race"

define "SDE Sex":
  SDE."SDE Sex"