Proportion

Process

increase

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

define "Denominator":
  "Encounter with a History of Atrial Ablation"
    union "Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Flutter"

define "Denominator Exclusions":
  ( "Denominator" Encounter
      where Encounter.status = 'finished'
        and ( Encounter.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"
            or Encounter.hospitalization.dischargeDisposition in "Left Against Medical Advice"
            or Encounter.hospitalization.dischargeDisposition in "Patient Expired"
            or Encounter.hospitalization.dischargeDisposition in "Discharged to Home for Hospice Care"
            or Encounter.hospitalization.dischargeDisposition in "Discharged to Health Care Facility for Hospice Care"
        )
  )
    union "Encounter with Comfort Measures during Hospitalization for Patients with Documented Atrial Fibrillation or Flutter"

define "Numerator":
  "Denominator" Encounter
    with ["MedicationRequest": "Anticoagulant Therapy"] DischargeAnticoagulant
      such that ( DischargeAnticoagulant.isCommunity ( )
          or DischargeAnticoagulant.isDischarge ( )
      )
        and DischargeAnticoagulant.status in { 'active', 'completed' }
        and DischargeAnticoagulant.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and DischargeAnticoagulant.authoredOn during Encounter.period

//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 "Denominator Exceptions":
  "Denominator" Encounter
    with "Documented Reason for Not Giving Anticoagulant at Discharge" NoDischargeAnticoagulant
      such that NoDischargeAnticoagulant.authoredOn during Encounter.period

define "SDE Sex":
  case
    when Patient.gender = 'male' then "M"
    when Patient.gender = 'female' then "F"
    else null
  end

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

define "Non Elective Inpatient Encounter with Age":
  ["Encounter": "Nonelective Inpatient Encounter"] NonElectiveEncounter
        where AgeInYearsAt(date from start of NonElectiveEncounter.period ) >= 18
         and NonElectiveEncounter.period ends during day of "Measurement Period"

define "Ischemic Stroke Encounter":
  "Non Elective Inpatient Encounter with Age" NonElectiveEncounterWithAge
    where NonElectiveEncounterWithAge.principalDiagnosis().code in "Ischemic Stroke"

define "Encounter with a History of Atrial Ablation":
  ( TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
      where exists ( ["Procedure": "Atrial Ablation"] AtrialAblationProcedure
          where AtrialAblationProcedure.status = 'completed'
            and AtrialAblationProcedure.performed.toInterval ( ) starts before start of IschemicStrokeEncounter.period
      )
  )
    union ( TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
        with ["Condition": "History of Atrial Ablation"] AtrialAblationDiagnosis
          such that AtrialAblationDiagnosis.verificationStatus is not null
            and AtrialAblationDiagnosis.verificationStatus ~ QICoreCommon."confirmed"
            and AtrialAblationDiagnosis.onset.toInterval ( ) starts before start of IschemicStrokeEncounter.period
    )
    union ( TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
        with ["Observation": "History of Atrial Ablation"] AtrialAblationObservation
          such that AtrialAblationObservation.status in { 'final', 'amended', 'corrected' }
            and AtrialAblationObservation.effective.earliest ( ) on or before end of IschemicStrokeEncounter.period
    )

define "Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Flutter":
  ( TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
      with ["Condition": "Atrial Fibrillation or Flutter"] AtrialFibrillationFlutter
        such that AtrialFibrillationFlutter.verificationStatus is not null
          and AtrialFibrillationFlutter.verificationStatus ~ QICoreCommon."confirmed"
          and AtrialFibrillationFlutter.onset.toInterval ( ) starts on or before end of IschemicStrokeEncounter.period
  )
    union TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
      where exists ( ( IschemicStrokeEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
          where EncounterDiagnosis.code in "Atrial Fibrillation or Flutter"
      )

define "Denominator":
  "Encounter with a History of Atrial Ablation"
    union "Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Flutter"

define "Numerator":
  "Denominator" Encounter
    with ["MedicationRequest": "Anticoagulant Therapy"] DischargeAnticoagulant
      such that ( DischargeAnticoagulant.isCommunity ( )
          or DischargeAnticoagulant.isDischarge ( )
      )
        and DischargeAnticoagulant.status in { 'active', 'completed' }
        and DischargeAnticoagulant.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and DischargeAnticoagulant.authoredOn during Encounter.period

define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }

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

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

define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }

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

define "Intervention Comfort Measures":
  ( ["ServiceRequest": code in "Comfort Measures"] SR
    where SR.status in { 'active', 'completed', 'on-hold' }
      and SR.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
      and SR.doNotPerform is not true
  )  
  union ( ["Procedure": "Comfort Measures"] InterventionPerformed
        where InterventionPerformed.status in { 'completed', 'in-progress' }
  )

define "Encounter with Comfort Measures during Hospitalization for Patients with Documented Atrial Fibrillation or Flutter":
  "Denominator" Encounter
    with TJC."Intervention Comfort Measures" ComfortMeasure
      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during Encounter.hospitalizationWithObservation ( )

define "Denominator Exclusions":
  ( "Denominator" Encounter
      where Encounter.status = 'finished'
        and ( Encounter.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"
            or Encounter.hospitalization.dischargeDisposition in "Left Against Medical Advice"
            or Encounter.hospitalization.dischargeDisposition in "Patient Expired"
            or Encounter.hospitalization.dischargeDisposition in "Discharged to Home for Hospice Care"
            or Encounter.hospitalization.dischargeDisposition in "Discharged to Health Care Facility for Hospice Care"
        )
  )
    union "Encounter with Comfort Measures during Hospitalization for Patients with Documented Atrial Fibrillation or Flutter"

define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }

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

define "Documented Reason for Not Giving Anticoagulant at Discharge":
  ["MedicationNotRequested": medication in "Anticoagulant Therapy"] NoAnticoagulant
    where ( NoAnticoagulant.reasonCode in "Medical Reason For Not Providing Treatment"
        or NoAnticoagulant.reasonCode in "Patient Refusal"
    )
      and ( NoAnticoagulant.isCommunity ( )
          or NoAnticoagulant.isDischarge ( )
      )
      and NoAnticoagulant.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }

//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 "Denominator Exceptions":
  "Denominator" Encounter
    with "Documented Reason for Not Giving Anticoagulant at Discharge" NoDischargeAnticoagulant
      such that NoDischargeAnticoagulant.authoredOn during Encounter.period

/*
@description: Returns the condition that is specified as the principal diagnosis for the encounter
*/
define fluent function principalDiagnosis(Encounter Encounter ):
	singleton from ((Encounter.diagnosis D where D.rank = 1 and D.use ~ "Billing") PD
      return singleton from ([Condition] C where C.id = PD.condition.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: Given an interval, return the starting point if the interval has a starting boundary specified,
otherwise, return the ending point
*/
define fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
  (choice.toInterval()) period
    return
      if (period."hasStart"()) then start of period
      else end of period

/*
@description: Returns the Condition resources referenced by the diagnosis element of the Encounter
*/
define fluent function encounterDiagnosis(Encounter Encounter ):
  Encounter.diagnosis D
    return singleton from ([Condition] C where C.id = D.condition.reference.getId())

/*
@description: Returns true if the given MedicationRequest has a category of Community
*/
define fluent function isCommunity(medicationRequest MedicationRequest):
  exists (medicationRequest.category C
    where C ~ Community
  )

/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }

/*
@description: Returns true if the given MedicationRequest has a category of Discharge
*/
define fluent function isDischarge(medicationRequest MedicationRequest):
  exists (medicationRequest.category C
    where C ~ Discharge
  )

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
        }

/*
@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter
*/
define fluent function hospitalizationWithObservation(TheEncounter Encounter ):
  TheEncounter Visit
  		let ObsVisit: Last([Encounter: "Observation Services"] LastObs
  				where LastObs.status = 'finished'
            and LastObs.period ends 1 hour or less on or before start of Visit.period
  				sort by end of period
  			),
  			VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
  			EDVisit: Last([Encounter: "Emergency Department Visit"] LastED
  				where LastED.status = 'finished'
            and LastED.period ends 1 hour or less on or before VisitStart
  				sort by end of period
  			)
  		return Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]