Proportion

Process

increase

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

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  "Encounter Less Than Two Days"
    union "Encounter with Comfort Measures during Day of or Day After Arrival"
    union "Encounter with Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization"

define "Numerator":
  "Encounter with Antithrombotic Therapy"

define "Denominator Exceptions":
  "Encounter with Documented Reason for No Antithrombotic Ordered or Administered Day Of or Day After Hospital Arrival"
    union "Encounter with Pharmacological Contraindications for Antithrombotic Therapy Given Day Of or Day After Hospital Arrival"
    union "Encounter with An INR Greater Than 3.5"

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 Antithrombotic Therapy":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with ["MedicationAdministration": "Antithrombotic Therapy for Ischemic Stroke"] Antithrombotic
      such that Antithrombotic.status in { 'in-progress', 'completed' }
        and Antithrombotic.effective.toInterval ( ) starts during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )

define "Numerator":
  "Encounter with Antithrombotic Therapy"

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

define "Denominator":
  "Initial Population"

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

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

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

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

define "Encounter Less Than Two Days":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    where IschemicStrokeEncounter.hospitalizationWithObservation ( ).lengthInDays ( ) < 2

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 Day of or Day After Arrival":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with TJC."Intervention Comfort Measures" ComfortMeasure
      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )

define "Thrombolytic Therapy Medication or Procedures":
  ( ["MedicationAdministration": "Thrombolytic tPA Therapy"] ThrombolyticMedication
      where ThrombolyticMedication.status in { 'in-progress', 'completed' }
      return {
        id: ThrombolyticMedication.id,
        effective: ThrombolyticMedication.effective
      }
  )
    union ( ["Procedure": "Intravenous or Intraarterial Thrombolytic tPA Therapy"] ThrombolyticProcedure
        where ThrombolyticProcedure.status = 'completed'
        return {
          id: ThrombolyticProcedure.id,
          effective: ThrombolyticProcedure.performed
        }
    )

define "Encounter with Thrombolytic Therapy Medication or Procedures":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with "Thrombolytic Therapy Medication or Procedures" ThrombolyticTherapy
      such that ThrombolyticTherapy.effective.toInterval ( ) starts during Interval[start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) - 24 hours, end of IschemicStrokeEncounter.hospitalizationWithObservation ( ) )

define "Encounter with Thrombolytic Therapy Prior to Arrival":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    where exists ( ( IschemicStrokeEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
        where ( EncounterDiagnosis.code in "Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival" )
    )

define "Encounter with Thrombolytic Therapy Documented As Already Given":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with [Condition: "Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival"] PriorTPA
      such that PriorTPA.recordedDate during CQMCommon."HospitalizationWithObservation" ( IschemicStrokeEncounter )
        and PriorTPA.isActive ( )
        and PriorTPA.verificationStatus is not null
        and PriorTPA.verificationStatus ~ QICoreCommon."confirmed"

define "Encounter with Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization":
  "Encounter with Thrombolytic Therapy Medication or Procedures"
    union "Encounter with Thrombolytic Therapy Prior to Arrival"
    union "Encounter with Thrombolytic Therapy Documented As Already Given"

define "Denominator Exclusions":
  "Encounter Less Than Two Days"
    union "Encounter with Comfort Measures during Day of or Day After Arrival"
    union "Encounter with Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization"

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

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

define "Reason for Not Ordering Antithrombotic":
  ["MedicationNotRequested": medication in "Antithrombotic Therapy for Ischemic Stroke"] NoAntithromboticOrder
    where NoAntithromboticOrder.status = 'completed'
      and NoAntithromboticOrder.intent = 'order'
      and ( NoAntithromboticOrder.reasonCode in "Medical Reason for Not Providing Treatment"
          or NoAntithromboticOrder.reasonCode in "Patient Refusal"
      )
    return {
      id: NoAntithromboticOrder.id,
      authoredOn: NoAntithromboticOrder.authoredOn
    }

define "Reason for Not Administering Antithrombotic":
  ["MedicationAdministrationNotDone": medication in "Antithrombotic Therapy for Ischemic Stroke"] MedicationAdm
    where ( MedicationAdm.statusReason in "Medical Reason for Not Providing Treatment"
        or MedicationAdm.statusReason in "Patient Refusal"
    )
    return {
      id: MedicationAdm.id,
      authoredOn: MedicationAdm.recorded
    }

define "Documented Reason for No Antithrombotic Ordered or Administered":
  "Reason for Not Ordering Antithrombotic"
    union "Reason for Not Administering Antithrombotic"

define "Encounter with Documented Reason for No Antithrombotic Ordered or Administered Day Of or Day After Hospital Arrival":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with "Documented Reason for No Antithrombotic Ordered or Administered" NoAntithrombotic
      such that NoAntithrombotic.authoredOn during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )

define "Encounter with Pharmacological Contraindications for Antithrombotic Therapy Given Day Of or Day After Hospital Arrival":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with ["MedicationAdministration": "Pharmacological Contraindications For Antithrombotic Therapy"] PharmacologicalContraindications
      such that PharmacologicalContraindications.status in { 'in-progress', 'completed' }
        and PharmacologicalContraindications.effective.toInterval ( ) starts during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )

define "Encounter with An INR Greater Than 3.5":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with ["Observation": "INR"] INR
      such that INR.value as Quantity > 3.5
        and INR.status in { 'final', 'amended', 'corrected' }
        and INR.issued during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )

define "Denominator Exceptions":
  "Encounter with Documented Reason for No Antithrombotic Ordered or Administered Day Of or Day After Hospital Arrival"
    union "Encounter with Pharmacological Contraindications for Antithrombotic Therapy Given Day Of or Day After Hospital Arrival"
    union "Encounter with An INR Greater Than 3.5"

/*
@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, '/'))

define fluent function CalendarDayOfOrDayAfter(StartValue DateTime):
  Interval [date from (StartValue), date from (StartValue) + 1 day]

/*
@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]

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: Calculates the difference in calendar days between the start and end of the given interval.
*/
define fluent function lengthInDays(Value Interval<DateTime> ):
  difference in days between start of Value and end of Value

/*
@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: 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
@deprecated: This function is deprecated. Use the fluent function `hospitalizationWithObservation()` instead.
*/
define 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]

/* Candidates for FHIRCommon */

/*
@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse
*/
define fluent function isActive(condition Condition):
  condition.clinicalStatus ~ "active"
    or condition.clinicalStatus ~ "recurrence"
    or condition.clinicalStatus ~ "relapse"

/*
@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
        }