eCQM QICore Content Implementation Guide
2024.0.0 - CI Build
eCQM QICore Content Implementation Guide
2024.0.0 - CI Build
eCQM QICore Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2024.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/ecqm-content-qicore-2024/ and changes regularly. See the Directory of published versions
| Draft as of 2024-07-09 |
<Measure xmlns="http://hl7.org/fhir">
<id value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
<meta>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"/>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm"/>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<table class="grid dict">
<tr>
<th scope="row"><b>Title: </b></th>
<td style="padding-left: 4px;">Antithrombotic Therapy By End of Hospital Day 2FHIR</td>
</tr>
<tr>
<th scope="row"><b>Id: </b></th>
<td style="padding-left: 4px;">AntithromboticTherapyByEndofHospitalDay2FHIR</td>
</tr>
<tr>
<th scope="row"><b>Version: </b></th>
<td style="padding-left: 4px;">0.7.000</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="Measure-AntithromboticTherapyByEndofHospitalDay2FHIR.html">Antithrombotic Therapy By End of Hospital Day 2FHIR</a></td>
</tr>
<tr>
<th scope="row">
<b>
short-name identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>CMS72FHIR</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
version-independent identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>urn:uuid:b6ae4357-9baa-4195-a9cd-50391b7d0dab</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
version-specific identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>urn:uuid:e74bdff8-3857-471e-a0c5-b9307889bda6</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
publisher (CMS) identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>72FHIR</span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Effective Period: </b></th>
<td style="padding-left: 4px;">2025-01-01..2025-12-31</td>
</tr>
<tr>
<th scope="row"><b>Status: </b></th>
<td style="padding-left: 4px;">draft</td>
</tr>
<tr>
<th scope="row"><b>Publisher: </b></th>
<td style="padding-left: 4px;">The Joint Commission</td>
</tr>
<tr>
<th scope="row"><b>Author: </b></th>
<td style="padding-left: 4px;">The Joint Commission</td>
</tr>
<tr>
<th scope="row"><b>Description: </b></th>
<td style="padding-left: 4px;"><div><p>Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Purpose: </b></th>
<td style="padding-left: 4px;"><div><p>UNKNOWN</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Copyright: </b></th>
<td style="padding-left: 4px;"><div><p>Measure specifications are in the Public Domain</p>
<p>LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2023 World Health Organization. All Rights Reserved.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Disclaimer: </b></th>
<td style="padding-left: 4px;"><div><p>These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Scoring: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>Proportion </span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Rationale: </b></th>
<td style="padding-left: 4px;"><div><p>The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks (TIA) continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist.</p>
<p>Aspirin is the recommended antithrombotic medication for early antithrombotic therapy and most frequently administered unless contraindicated. Anticoagulants at doses to prevent venous thromboembolism (VTE) are insufficient. Subcutaneous Lovenox (enoxaparin) and unfractionated heparin (UFH) SQ at lower dosages used for VTE prophylaxis (i.e., enoxaparin SQ 40 mg once daily; enoxaparin SQ 30 mg Q12 hours; UFH 5,000 units or less two or three times daily) are not sufficient for early antithrombotic therapy.</p>
<p>Anticoagulants at doses to prevent VTE are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Clinical recommendation statement: </b></th>
<td style="padding-left: 4px;"><div><p>Antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Guidance (Usage): </b></th>
<td style="padding-left: 4px;">The "Nonelective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient Encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective Inpatient Encounters include emergency, urgent, and unplanned admissions.
NPO (Nothing by mouth) is not a valid reason for not administering antithrombotic therapy by end of hospital day 2 as another route of administration can be used (i.e., rectal or intravenous).
In the denominator exclusions, the intent is to only exclude patients with a total length of stay of <2 days, including Emergency Department (ED) visit (if there is one). For the eCQM we model both of the scenarios of admission via the ED as well as direct admits. This statement addresses direct admits.
The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.
This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS72v13. Please refer to the HL7 QI-Core Implementation Guide (https://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 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).</td>
</tr>
<tr>
<th scope="row"><b>Population Criteria: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>64f0d9e456d636294b157dec</b></th>
</tr>
<tr>
<td>Initial Population:</td>
<td>Inpatient hospitalization (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke that ends during the measurement period</td>
</tr>
<tr>
<td>Denominator:</td>
<td>Equals Initial Population</td>
</tr>
<tr>
<td>Denominator Exclusion:</td>
<td>- Inpatient hospitalization for patients who have a duration of stay less than 2 days.
- Inpatient hospitalization for patients with comfort measures documented day of or the day after arrival.
- Inpatient hospitalization for patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy administered within 24 hours prior to arrival or anytime during hospitalization.</td>
</tr>
<tr>
<td>Numerator:</td>
<td>Inpatient hospitalization for patients who had antithrombotic therapy administered the day of or day after hospital arrival</td>
</tr>
<tr>
<td>Denominator Exception:</td>
<td>- Inpatient hospitalization for patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival.
- Inpatient hospitalization for patients who receive Prasugrel as an antithrombotic therapy the day of or day after hospital arrival.
- Inpatient hospitalization for patients with an international normalised ratio (INR) greater than 3.5.</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b> Supplemental Data Elements: </b></th>
<td style="padding-left: 4px;">
<p>SDE Ethnicity</p>
<p>SDE Payer</p>
<p>SDE Race</p>
<p>SDE Sex</p>
</td>
</tr>
<tr>
<th scope="row">
<b> Supplemental Data Guidance
: </b></th>
<td style="padding-left: 4px;"> For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity-Patient's Ethnicity:
Hispanic or Latino
Not Hispanic or Latino
SDE Payer-Patient's Payer:
Categories of types of health care payer entities as defined by the US Public Health Data Consortium SOP code system
SDE Race-Patient's Race:
Native Hawaiian or Other Pacific Islander
Asian
American Indian or Alaska Native
Other Race
White
Black or African American
SDE Sex-Patient's Sex:
Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.
</td>
</tr>
<tr>
<th scope="row"><b>Libraries: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td><a href="Library-AntithromboticTherapyByEndofHospitalDay2FHIR.html">AntithromboticTherapyByEndofHospitalDay2FHIR</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Terminology and Other Dependencies: </b></th>
<td style="padding-left: 4px;">
<li><code>Library/SupplementalDataElements|3.5.000</code></li>
<li><code>Library/TJCOverall|8.14.000</code></li>
<li><code>Library/FHIRHelpers|4.4.000</code></li>
<li><code>Library/CQMCommon|2.2.000</code></li>
<li><code>Library/QICoreCommon|2.1.000</code></li>
<li><a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">AdministrativeGender</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-diagnosis-role.html">Diagnosis Role</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html">Condition Clinical Status Codes</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-condition-ver-status.html">ConditionVerificationStatus</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.424/expansion">Non-Elective Inpatient Encounter</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.247/expansion">Ischemic Stroke</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.62/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion">Observation Services</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion">Emergency Department Visit</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/1.3.6.1.4.1.33895.1.3.0.45/expansion">Comfort Measures</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.226/expansion">Thrombolytic (t-PA) Therapy</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.21/expansion">Intravenous or Intra-arterial Thrombolytic (t-PA) Therapy</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.21/expansion">Intravenous or Intra arterial Thrombolytic (tPA) Therapy Prior to Arrival</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.473/expansion">Medical Reason</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.93/expansion">Patient Refusal</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.52/expansion">Pharmacological Contraindications For Antithrombotic Therapy</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.213/expansion">INR</a></li>
</td>
</tr>
<tr>
<th scope="row"><b>Parameters:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>name</b></th>
<th><b>use</b></th>
<th><b>min</b></th>
<th><b>max</b></th>
<th><b>type</b></th>
</tr>
<tr>
<td>Measurement Period</td>
<td>In</td>
<td>0</td>
<td>1</td>
<td>Period</td>
</tr>
<tr>
<td>SDE Sex</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>Coding</td>
</tr>
<tr>
<td>Numerator</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>Denominator</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>SDE Payer</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>Initial Population</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>SDE Ethnicity</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>Resource</td>
</tr>
<tr>
<td>Denominator Exclusions</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>SDE Race</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>Resource</td>
</tr>
<tr>
<td>Denominator Exceptions</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>DataRequirements:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>Resource Type</b></th>
<th><b>Resource Elements</b></th>
<th><b>Valueset Name</b></th>
<th><b>Valueset</b></th>
</tr>
<tr>
<td>Patient(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html">QICorePatient</a>)</td>
<td>
ethnicity
race
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
status
status.value
period
rank
rank.value
use
condition
condition.reference
condition.reference.value
</td>
<td>
Observation Services
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion">Observation Services</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
status
status.value
period
rank
rank.value
use
condition
condition.reference
condition.reference.value
</td>
<td>
Emergency Department Visit
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion">Emergency Department Visit</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
rank
rank.value
use
condition
condition.reference
condition.reference.value
</td>
<td>
Nonelective Inpatient Encounter
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.424/expansion">Non-Elective Inpatient Encounter</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
id
id.value
code
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
recordedDate
recordedDate.value
verificationStatus
</td>
<td>
Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.21/expansion">Intravenous or Intra arterial Thrombolytic (tPA) Therapy Prior to Arrival</a></td>
</tr>
<tr>
<td>MedicationAdministration(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationadministration.html">QICoreMedicationAdministration</a>)</td>
<td>
medication
status
status.value
effective
id
id.value
</td>
<td>
Antithrombotic Therapy for Ischemic Stroke
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.62/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62</a></td>
</tr>
<tr>
<td>MedicationAdministration(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationadministration.html">QICoreMedicationAdministration</a>)</td>
<td>
medication
status
status.value
effective
id
id.value
</td>
<td>
Thrombolytic tPA Therapy
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.226/expansion">Thrombolytic (t-PA) Therapy</a></td>
</tr>
<tr>
<td>MedicationAdministration(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationadministration.html">QICoreMedicationAdministration</a>)</td>
<td>
medication
status
status.value
effective
id
id.value
</td>
<td>
Pharmacological Contraindications For Antithrombotic Therapy
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.52/expansion">Pharmacological Contraindications For Antithrombotic Therapy</a></td>
</tr>
<tr>
<td>Coverage(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html">QICoreCoverage</a>)</td>
<td>
type
period
</td>
<td>
Payer Type
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a></td>
</tr>
<tr>
<td>ServiceRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html">QICoreServiceRequest</a>)</td>
<td>
code
status
status.value
intent
intent.value
doNotPerform
doNotPerform.value
</td>
<td>
Comfort Measures
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/1.3.6.1.4.1.33895.1.3.0.45/expansion">Comfort Measures</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
status
status.value
</td>
<td>
Comfort Measures
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/1.3.6.1.4.1.33895.1.3.0.45/expansion">Comfort Measures</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
status
status.value
id
id.value
performed
</td>
<td>
Intravenous or Intraarterial Thrombolytic tPA Therapy
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.21/expansion">Intravenous or Intra-arterial Thrombolytic (t-PA) Therapy</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-mednotrequested.html">QICoreMedicationNotRequested</a>)</td>
<td>
medication
status
status.value
intent
intent.value
reasonCode
id
id.value
authoredOn
authoredOn.value
</td>
<td>
Antithrombotic Therapy for Ischemic Stroke
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.62/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62</a></td>
</tr>
<tr>
<td>MedicationAdministration(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-mednotadministered.html">QICoreMedicationAdministrationNotDone</a>)</td>
<td>
medication
statusReason
id
id.value
extension
</td>
<td>
Antithrombotic Therapy for Ischemic Stroke
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.62/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62</a></td>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
<td>
code
value
status
status.value
issued
issued.value
</td>
<td>
INR
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.213/expansion">INR</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Direct Reference Codes:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>display</b></th>
<th><b>code</b></th>
<th><b>system</b></th>
</tr>
<tr>
<td>Male</td>
<td>M</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">http://hl7.org/fhir/administrative-gender</a></td>
</tr>
<tr>
<td>Female</td>
<td>F</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">http://hl7.org/fhir/administrative-gender</a></td>
</tr>
<tr>
<td>Billing</td>
<td>billing</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-diagnosis-role.html">http://terminology.hl7.org/CodeSystem/diagnosis-role</a></td>
</tr>
<tr>
<td>Active</td>
<td>active</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
</tr>
<tr>
<td>Recurrence</td>
<td>recurrence</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
</tr>
<tr>
<td>Relapse</td>
<td>relapse</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
</tr>
<tr>
<td>Confirmed</td>
<td>confirmed</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-condition-ver-status.html">http://terminology.hl7.org/CodeSystem/condition-ver-status</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Logic Definitions:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>Group</b></th>
<th><b>Scoring</b></th>
<th><b>Population Criteria</b></th>
<th><b>Expression</b></th>
</tr>
<tr>
<td> 64f0d9e456d636294b157dec </td>
<td colspan="3" style="padding-left: 4px;">
<b>Group scoring:</b>
<span> proportion </span>
<b>Measure scoring:</b>
<p style="margin-bottom: 5px;">
<span>Proportion</span>
</p>
<tr>
<th scope="row"><b>Type: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>Process </span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Rate Aggregation: </b></th>
<td colspan="3" style="padding-left: 4px;">None</td>
</tr>
<tr>
<th scope="row"><b>Improvement Notation: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>increase </span>
</p>
</td>
</tr>
</td>
<tr>
<td/>
<td/>
<td>Initial Population</td>
<td>
<pre><code class="language-cql">define "Initial Population":
TJC."Ischemic Stroke Encounter"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator</td>
<td>
<pre><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exclusion</td>
<td>
<pre><code class="language-cql">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"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Numerator</td>
<td>
<pre><code class="language-cql">define "Numerator":
"Encounter with Antithrombotic Therapy"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exception</td>
<td>
<pre><code class="language-cql">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"</code></pre>
</td>
</tr>
</tr>
</table>
<table class="grid-dict">
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Sex</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Sex":
case
when Patient.gender = 'male' then "M"
when Patient.gender = 'female' then "F"
else null
end</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>SDE Sex</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Sex":
SDE."SDE Sex"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>TJCOverall</td>
<td>Non Elective Inpatient Encounter with Age</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>TJCOverall</td>
<td>Ischemic Stroke Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Ischemic Stroke Encounter":
"Non Elective Inpatient Encounter with Age" NonElectiveEncounterWithAge
where NonElectiveEncounterWithAge.principalDiagnosis().code in "Ischemic Stroke"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>Encounter with Antithrombotic Therapy</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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 ( )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>Numerator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Numerator":
"Encounter with Antithrombotic Therapy"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>Initial Population</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Initial Population":
TJC."Ischemic Stroke Encounter"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>Denominator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Payer</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Payer":
[Coverage: type in "Payer Type"] Payer
return {
code: Payer.type,
period: Payer.period
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>SDE Payer</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Payer":
SDE."SDE Payer"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Ethnicity</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Ethnicity":
Patient.ethnicity E
return Tuple {
codes: { E.ombCategory } union E.detailed,
display: E.text
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>SDE Ethnicity</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Ethnicity":
SDE."SDE Ethnicity"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>Encounter Less Than Two Days</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter Less Than Two Days":
TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
where IschemicStrokeEncounter.hospitalizationWithObservation ( ).lengthInDays ( ) < 2</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>TJCOverall</td>
<td>Intervention Comfort Measures</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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' }
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>Encounter with Comfort Measures during Day of or Day After Arrival</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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 ( )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>Thrombolytic Therapy Medication or Procedures</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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
}
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>Encounter with Thrombolytic Therapy Medication or Procedures</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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 ( ) )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>Encounter with Thrombolytic Therapy Prior to Arrival</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>Encounter with Thrombolytic Therapy Documented As Already Given</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>Encounter with Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>Denominator Exclusions</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Race</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Race":
Patient.race R
return Tuple {
codes: R.ombCategory union R.detailed,
display: R.text
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>SDE Race</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Race":
SDE."SDE Race"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>Reason for Not Ordering Antithrombotic</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>Reason for Not Administering Antithrombotic</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>Documented Reason for No Antithrombotic Ordered or Administered</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Documented Reason for No Antithrombotic Ordered or Administered":
"Reason for Not Ordering Antithrombotic"
union "Reason for Not Administering Antithrombotic"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>Encounter with Documented Reason for No Antithrombotic Ordered or Administered Day Of or Day After Hospital Arrival</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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 ( )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>Encounter with Pharmacological Contraindications for Antithrombotic Therapy Given Day Of or Day After Hospital Arrival</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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 ( )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>Encounter with An INR Greater Than 3.5</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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 ( )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AntithromboticTherapyByEndofHospitalDay2FHIR</td>
<td>Denominator Exceptions</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CQMCommon</td>
<td>principalDiagnosis</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@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())
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>QICoreCommon</td>
<td>getId</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@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, '/'))</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>TJCOverall</td>
<td>CalendarDayOfOrDayAfter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function CalendarDayOfOrDayAfter(StartValue DateTime):
Interval [date from (StartValue), date from (StartValue) + 1 day]</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CQMCommon</td>
<td>hospitalizationWithObservation</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@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]</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>FHIRHelpers</td>
<td>ToString</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define function ToString(value uri): value.value</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>FHIRHelpers</td>
<td>ToCode</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@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
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CQMCommon</td>
<td>lengthInDays</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@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</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CQMCommon</td>
<td>encounterDiagnosis</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@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())</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CQMCommon</td>
<td>HospitalizationWithObservation</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@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]</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>QICoreCommon</td>
<td>isActive</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/* 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"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>FHIRHelpers</td>
<td>ToConcept</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@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
}</code></pre>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</text>
<contained>
<Library>
<id value="effective-data-requirements"/>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://hl7.org/fhir/administrative-gender"/>
<code value="M"/>
<display value="Male"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://hl7.org/fhir/administrative-gender"/>
<code value="F"/>
<display value="Female"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/diagnosis-role"/>
<code value="billing"/>
<display value="Billing"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="active"/>
<display value="Active"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="recurrence"/>
<display value="Recurrence"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="relapse"/>
<display value="Relapse"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
<code value="confirmed"/>
<display value="Confirmed"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Sex"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Sex":
case
when Patient.gender = 'male' then "M"
when Patient.gender = 'female' then "F"
else null
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="0"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString value="SDE Sex"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Sex":
SDE."SDE Sex""/>
</extension>
<extension url="displaySequence">
<valueInteger value="1"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="TJCOverall"/>
</extension>
<extension url="name">
<valueString value="Non Elective Inpatient Encounter with Age"/>
</extension>
<extension url="statement">
<valueString
value="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""/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="TJCOverall"/>
</extension>
<extension url="name">
<valueString value="Ischemic Stroke Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Ischemic Stroke Encounter":
"Non Elective Inpatient Encounter with Age" NonElectiveEncounterWithAge
where NonElectiveEncounterWithAge.principalDiagnosis().code in "Ischemic Stroke""/>
</extension>
<extension url="displaySequence">
<valueInteger value="3"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString value="Encounter with Antithrombotic Therapy"/>
</extension>
<extension url="statement">
<valueString
value="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 ( )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString value="Numerator"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator":
"Encounter with Antithrombotic Therapy""/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString value="Initial Population"/>
</extension>
<extension url="statement">
<valueString
value="define "Initial Population":
TJC."Ischemic Stroke Encounter""/>
</extension>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator":
"Initial Population""/>
</extension>
<extension url="displaySequence">
<valueInteger value="7"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Payer"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Payer":
[Coverage: type in "Payer Type"] Payer
return {
code: Payer.type,
period: Payer.period
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="8"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString value="SDE Payer"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Payer":
SDE."SDE Payer""/>
</extension>
<extension url="displaySequence">
<valueInteger value="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Ethnicity"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Ethnicity":
Patient.ethnicity E
return Tuple {
codes: { E.ombCategory } union E.detailed,
display: E.text
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="10"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString value="SDE Ethnicity"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Ethnicity":
SDE."SDE Ethnicity""/>
</extension>
<extension url="displaySequence">
<valueInteger value="11"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString value="Encounter Less Than Two Days"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter Less Than Two Days":
TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
where IschemicStrokeEncounter.hospitalizationWithObservation ( ).lengthInDays ( ) < 2"/>
</extension>
<extension url="displaySequence">
<valueInteger value="12"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="TJCOverall"/>
</extension>
<extension url="name">
<valueString value="Intervention Comfort Measures"/>
</extension>
<extension url="statement">
<valueString
value="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' }
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="13"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with Comfort Measures during Day of or Day After Arrival"/>
</extension>
<extension url="statement">
<valueString
value="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 ( )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="14"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString value="Thrombolytic Therapy Medication or Procedures"/>
</extension>
<extension url="statement">
<valueString
value="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
}
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="15"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with Thrombolytic Therapy Medication or Procedures"/>
</extension>
<extension url="statement">
<valueString
value="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 ( ) )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="16"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with Thrombolytic Therapy Prior to Arrival"/>
</extension>
<extension url="statement">
<valueString
value="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" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="17"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with Thrombolytic Therapy Documented As Already Given"/>
</extension>
<extension url="statement">
<valueString
value="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""/>
</extension>
<extension url="displaySequence">
<valueInteger value="18"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization"/>
</extension>
<extension url="statement">
<valueString
value="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""/>
</extension>
<extension url="displaySequence">
<valueInteger value="19"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator Exclusions"/>
</extension>
<extension url="statement">
<valueString
value="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""/>
</extension>
<extension url="displaySequence">
<valueInteger value="20"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Race"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Race":
Patient.race R
return Tuple {
codes: R.ombCategory union R.detailed,
display: R.text
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="21"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString value="SDE Race"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Race":
SDE."SDE Race""/>
</extension>
<extension url="displaySequence">
<valueInteger value="22"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString value="Reason for Not Ordering Antithrombotic"/>
</extension>
<extension url="statement">
<valueString
value="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
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="23"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString value="Reason for Not Administering Antithrombotic"/>
</extension>
<extension url="statement">
<valueString
value="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
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="24"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString
value="Documented Reason for No Antithrombotic Ordered or Administered"/>
</extension>
<extension url="statement">
<valueString
value="define "Documented Reason for No Antithrombotic Ordered or Administered":
"Reason for Not Ordering Antithrombotic"
union "Reason for Not Administering Antithrombotic""/>
</extension>
<extension url="displaySequence">
<valueInteger value="25"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with Documented Reason for No Antithrombotic Ordered or Administered Day Of or Day After Hospital Arrival"/>
</extension>
<extension url="statement">
<valueString
value="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 ( )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="26"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with Pharmacological Contraindications for Antithrombotic Therapy Given Day Of or Day After Hospital Arrival"/>
</extension>
<extension url="statement">
<valueString
value="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 ( )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="27"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString value="Encounter with An INR Greater Than 3.5"/>
</extension>
<extension url="statement">
<valueString
value="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 ( )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="28"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator Exceptions"/>
</extension>
<extension url="statement">
<valueString
value="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""/>
</extension>
<extension url="displaySequence">
<valueInteger value="29"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CQMCommon"/>
</extension>
<extension url="name">
<valueString value="principalDiagnosis"/>
</extension>
<extension url="statement">
<valueString
value="/*
@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())
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="30"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="getId"/>
</extension>
<extension url="statement">
<valueString
value="/*
@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, '/'))"/>
</extension>
<extension url="displaySequence">
<valueInteger value="31"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="TJCOverall"/>
</extension>
<extension url="name">
<valueString value="CalendarDayOfOrDayAfter"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function CalendarDayOfOrDayAfter(StartValue DateTime):
Interval [date from (StartValue), date from (StartValue) + 1 day]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="32"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CQMCommon"/>
</extension>
<extension url="name">
<valueString value="hospitalizationWithObservation"/>
</extension>
<extension url="statement">
<valueString
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]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="33"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value uri): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="34"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToCode"/>
</extension>
<extension url="statement">
<valueString
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
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="35"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CQMCommon"/>
</extension>
<extension url="name">
<valueString value="lengthInDays"/>
</extension>
<extension url="statement">
<valueString
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"/>
</extension>
<extension url="displaySequence">
<valueInteger value="36"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CQMCommon"/>
</extension>
<extension url="name">
<valueString value="encounterDiagnosis"/>
</extension>
<extension url="statement">
<valueString
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())"/>
</extension>
<extension url="displaySequence">
<valueInteger value="37"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CQMCommon"/>
</extension>
<extension url="name">
<valueString value="HospitalizationWithObservation"/>
</extension>
<extension url="statement">
<valueString
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
@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]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="38"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="isActive"/>
</extension>
<extension url="statement">
<valueString
value="/* 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""/>
</extension>
<extension url="displaySequence">
<valueInteger value="39"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToConcept"/>
</extension>
<extension url="statement">
<valueString
value="/*
@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
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="40"/>
</extension>
</extension>
<name value="EffectiveDataRequirements"/>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/library-type"/>
<code value="module-definition"/>
</coding>
</type>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library SDE"/>
<resource value="Library/SupplementalDataElements|3.5.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library TJC"/>
<resource value="Library/TJCOverall|8.14.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource value="Library/FHIRHelpers|4.4.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library CQMCommon"/>
<resource value="Library/CQMCommon|2.2.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library QICoreCommon"/>
<resource value="Library/QICoreCommon|2.1.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system AdministrativeGender"/>
<resource value="http://hl7.org/fhir/administrative-gender"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system DiagnosisRole"/>
<resource
value="http://terminology.hl7.org/CodeSystem/diagnosis-role"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ConditionClinicalStatusCodes"/>
<resource
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ConditionVerificationStatusCodes"/>
<resource
value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Nonelective Inpatient Encounter"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Ischemic Stroke"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Antithrombotic Therapy for Ischemic Stroke"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Observation Services"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Emergency Department Visit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Payer Type"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Comfort Measures"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Thrombolytic tPA Therapy"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.226"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Intravenous or Intraarterial Thrombolytic tPA Therapy"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.21"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.21"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Medical Reason for Not Providing Treatment"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.473"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Patient Refusal"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Pharmacological Contraindications For Antithrombotic Therapy"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set INR"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.213"/>
</relatedArtifact>
<parameter>
<name value="Measurement Period"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="Period"/>
</parameter>
<parameter>
<name value="SDE Sex"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Coding"/>
</parameter>
<parameter>
<name value="Numerator"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Denominator"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="SDE Payer"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Initial Population"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="SDE Ethnicity"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Denominator Exclusions"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="SDE Race"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Denominator Exceptions"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<dataRequirement>
<type value="Patient"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
<mustSupport value="ethnicity"/>
<mustSupport value="race"/>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
<mustSupport value="rank"/>
<mustSupport value="rank.value"/>
<mustSupport value="use"/>
<mustSupport value="condition"/>
<mustSupport value="condition.reference"/>
<mustSupport value="condition.reference.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"/>
</codeFilter>
<codeFilter>
<path value="status.value"/>
<code>
<code value="finished"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
<mustSupport value="rank"/>
<mustSupport value="rank.value"/>
<mustSupport value="use"/>
<mustSupport value="condition"/>
<mustSupport value="condition.reference"/>
<mustSupport value="condition.reference.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"/>
</codeFilter>
<codeFilter>
<path value="status.value"/>
<code>
<code value="finished"/>
</code>
</codeFilter>
<dateFilter>
<path value="period"/>
<valuePeriod>
<extension url="http://hl7.org/fhir/uv/crmi-analysisException">
<valueString
value="Error attempting to determine filter value: toFhirValue not implemented for Subtract"/>
</extension>
</valuePeriod>
</dateFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<mustSupport value="rank"/>
<mustSupport value="rank.value"/>
<mustSupport value="use"/>
<mustSupport value="condition"/>
<mustSupport value="condition.reference"/>
<mustSupport value="condition.reference.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"/>
</codeFilter>
<dateFilter>
<path value="period"/>
<valuePeriod>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
<valueExpression>
<language value="text/cql-identifier"/>
<expression value="Measurement Period"/>
</valueExpression>
</extension>
</valuePeriod>
</dateFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<mustSupport value="code"/>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
<mustSupport value="code"/>
<mustSupport value="recordedDate"/>
<mustSupport value="recordedDate.value"/>
<mustSupport value="verificationStatus"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.21"/>
</codeFilter>
<codeFilter>
<path value="verificationStatus"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationAdministration"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration"/>
<mustSupport value="medication"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="effective"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationAdministration"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration"/>
<mustSupport value="medication"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="effective"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.226"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationAdministration"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration"/>
<mustSupport value="medication"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="effective"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Coverage"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="ServiceRequest"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"/>
<mustSupport value="code"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="intent"/>
<mustSupport value="intent.value"/>
<mustSupport value="doNotPerform"/>
<mustSupport value="doNotPerform.value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"/>
<mustSupport value="code"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"/>
<mustSupport value="code"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<mustSupport value="performed"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.21"/>
</codeFilter>
<codeFilter>
<path value="status.value"/>
<code>
<code value="completed"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationRequest"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-mednotrequested"/>
<mustSupport value="medication"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="intent"/>
<mustSupport value="intent.value"/>
<mustSupport value="reasonCode"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<mustSupport value="authoredOn"/>
<mustSupport value="authoredOn.value"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationAdministration"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-mednotadministered"/>
<mustSupport value="medication"/>
<mustSupport value="statusReason"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<mustSupport value="extension"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
<mustSupport value="code"/>
<mustSupport value="value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="issued"/>
<mustSupport value="issued.value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.213"/>
</codeFilter>
</dataRequirement>
</Library>
</contained>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance" id="supplementalDataGuidance">
<extension url="guidance">
<valueString
value="For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity-Patient's Ethnicity:
Hispanic or Latino
Not Hispanic or Latino
SDE Payer-Patient's Payer:
Categories of types of health care payer entities as defined by the US Public Health Data Consortium SOP code system
SDE Race-Patient's Race:
Native Hawaiian or Other Pacific Islander
Asian
American Indian or Alaska Native
Other Race
White
Black or African American
SDE Sex-Patient's Sex:
Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.
"/>
</extension>
<extension url="usage">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
<display value="Supplemental Data"/>
</coding>
<text value="Supplemental Data Guidance"/>
</valueCodeableConcept>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements" id="effective-data-requirements">
<valueReference>
<reference value="#effective-data-requirements"/>
</valueReference>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem">
<valueReference>
<reference value="Device/cqf-tooling"/>
</valueReference>
</extension>
<url
value="https://madie.cms.gov/Measure/AntithromboticTherapyByEndofHospitalDay2FHIR"/>
<identifier>
<use value="usual"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="short-name"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/shortName"/>
<value value="CMS72FHIR"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="version-independent"/>
</coding>
</type>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:b6ae4357-9baa-4195-a9cd-50391b7d0dab"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="version-specific"/>
</coding>
</type>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:e74bdff8-3857-471e-a0c5-b9307889bda6"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="publisher"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/cmsId"/>
<value value="72FHIR"/>
<assigner>
<display value="CMS"/>
</assigner>
</identifier>
<version value="0.7.000"/>
<name value="AntithromboticTherapyByEndofHospitalDay2FHIR"/>
<title value="Antithrombotic Therapy By End of Hospital Day 2FHIR"/>
<status value="draft"/>
<experimental value="false"/>
<date value="2024-07-09T14:53:55+00:00"/>
<publisher value="The Joint Commission"/>
<contact>
<telecom>
<system value="url"/>
<value value="https://www.jointcommission.org/"/>
</telecom>
</contact>
<description
value="Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2"/>
<purpose value="UNKNOWN"/>
<usage
value="The "Nonelective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient Encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective Inpatient Encounters include emergency, urgent, and unplanned admissions.
NPO (Nothing by mouth) is not a valid reason for not administering antithrombotic therapy by end of hospital day 2 as another route of administration can be used (i.e., rectal or intravenous).
In the denominator exclusions, the intent is to only exclude patients with a total length of stay of <2 days, including Emergency Department (ED) visit (if there is one). For the eCQM we model both of the scenarios of admission via the ED as well as direct admits. This statement addresses direct admits.
The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.
This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS72v13. Please refer to the HL7 QI-Core Implementation Guide (https://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 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html)."/>
<copyright
value="Measure specifications are in the Public Domain
LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2023 World Health Organization. All Rights Reserved."/>
<effectivePeriod>
<start value="2025-01-01"/>
<end value="2025-12-31"/>
</effectivePeriod>
<author>
<name value="The Joint Commission"/>
<telecom>
<system value="url"/>
<value value="https://www.jointcommission.org/"/>
</telecom>
</author>
<library
value="https://madie.cms.gov/Library/AntithromboticTherapyByEndofHospitalDay2FHIR"/>
<disclaimer
value="These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty."/>
<scoring>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</scoring>
<rationale
value="The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks (TIA) continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist.
Aspirin is the recommended antithrombotic medication for early antithrombotic therapy and most frequently administered unless contraindicated. Anticoagulants at doses to prevent venous thromboembolism (VTE) are insufficient. Subcutaneous Lovenox (enoxaparin) and unfractionated heparin (UFH) SQ at lower dosages used for VTE prophylaxis (i.e., enoxaparin SQ 40 mg once daily; enoxaparin SQ 30 mg Q12 hours; UFH 5,000 units or less two or three times daily) are not sufficient for early antithrombotic therapy.
Anticoagulants at doses to prevent VTE are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA."/>
<clinicalRecommendationStatement
value="Antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist"/>
<group id="64f0d9e456d636294b157dec">
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
<valueCode value="Encounter"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
<code value="process"/>
<display value="Process"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation">
<valueCode value="None"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
<code value="decrease"/>
<display value="increase"/>
</coding>
</valueCodeableConcept>
</extension>
<description
value="Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2"/>
<population id="671415E2-A9AB-4A88-8D9F-E13567DB60DE">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="initial-population"/>
<display value="Initial Population"/>
</coding>
</code>
<description
value="Inpatient hospitalization (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke that ends during the measurement period"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Initial Population"/>
</criteria>
</population>
<population id="66E700CD-3526-4907-B48F-20A3C99FF470">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator"/>
<display value="Denominator"/>
</coding>
</code>
<description value="Equals Initial Population"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator"/>
</criteria>
</population>
<population id="0B767BB2-1D05-4020-B629-548946B64CBD">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exclusion"/>
<display value="Denominator Exclusion"/>
</coding>
</code>
<description
value="- Inpatient hospitalization for patients who have a duration of stay less than 2 days.
- Inpatient hospitalization for patients with comfort measures documented day of or the day after arrival.
- Inpatient hospitalization for patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy administered within 24 hours prior to arrival or anytime during hospitalization."/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exclusions"/>
</criteria>
</population>
<population id="DADB9060-BF4C-4032-94D5-8D981DDFDD1B">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="numerator"/>
<display value="Numerator"/>
</coding>
</code>
<description
value="Inpatient hospitalization for patients who had antithrombotic therapy administered the day of or day after hospital arrival"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Numerator"/>
</criteria>
</population>
<population id="998D63FA-104C-4FFB-9641-37E14045AF9D">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exception"/>
<display value="Denominator Exception"/>
</coding>
</code>
<description
value="- Inpatient hospitalization for patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival.
- Inpatient hospitalization for patients who receive Prasugrel as an antithrombotic therapy the day of or day after hospital arrival.
- Inpatient hospitalization for patients with an international normalised ratio (INR) greater than 3.5."/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exceptions"/>
</criteria>
</population>
</group>
<supplementalData id="sde-ethnicity">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Ethnicity"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Ethnicity"/>
</criteria>
</supplementalData>
<supplementalData id="sde-payer">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Payer"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Payer"/>
</criteria>
</supplementalData>
<supplementalData id="sde-race">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Race"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Race"/>
</criteria>
</supplementalData>
<supplementalData id="sde-sex">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Sex"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Sex"/>
</criteria>
</supplementalData>
</Measure>
IG © 2023+ cqframework. Package gov.healthit.ecqi.ecqms#2024.0.0 based on FHIR 4.0.1. Generated 2024-11-07
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