Process

increase

define "Initial Population":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    where AgeInYearsAt(date from start of(EDwithSTEMI.period)) >= 18

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter"
    union "Adverse Effect to Thrombolytic Medications Before End of ED Encounter"
    union "Active Exclusion Diagnosis at Start of ED Encounter"
    union "Active Oral Anticoagulant Medication at the Start of ED Encounter"
    union "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start"
    union "Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter"
    union "Intubation or Mechanical Circulatory Assist Procedure During ED Encounter or Within 24 Hours of ED Encounter Start"
    union "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter"
    union "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter"
    union "ED Encounter with Discharge Disposition as Patient Expired"

define "Numerator":
  "Fibrinolytic Therapy within 30 Minutes of Arrival"
    union "PCI within 90 Minutes of Arrival"
    union "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival"

define "Denominator Exceptions":
  "Received tPA in Another Facility within 24 hours Prior to Admission"

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

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

define "ED Encounter During MP":
  ["Encounter": "Emergency Department Evaluation and Management Visit"] EDEncounter
    where EDEncounter.period ends during day of "Measurement Period"
      and EDEncounter.status = 'finished'
      and EDEncounter.class ~ "EMER"

define "ED Encounter with Encounter Diagnosis of STEMI":
  "ED Encounter During MP" EDEncounter
    where ( EDEncounter.reasonCode in "STEMI"
        or exists ( ( EDEncounter.encounterDiagnosis ( ) ) EncDiagnosis
            where EncDiagnosis.code in "STEMI"
        )
    )

define "ED Encounter with Diagnosis of STEMI":
  "ED Encounter During MP" EDEncounter
    with ["Condition": "STEMI"] DxSTEMI
      such that DxSTEMI.clinicalStatus ~ QICoreCommon."active"
        and DxSTEMI.prevalenceInterval ( ) starts during EDEncounter.period

define "ED Encounter with STEMI Diagnosis":
  "ED Encounter with Encounter Diagnosis of STEMI"
    union "ED Encounter with Diagnosis of STEMI"

define "Fibrinolytic Therapy within 30 Minutes of Arrival":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    with ["MedicationAdministration": "Fibrinolytic Therapy"] Fibrinolytic
      such that Fibrinolytic.status = 'completed'
        and start of ( Fibrinolytic.effective.toInterval ( ) ) 30 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )

define "PCI within 90 Minutes of Arrival":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    with ["Procedure": "Percutaneous Coronary Intervention"] PCI
      such that PCI.performed.toInterval ( ) starts 90 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )
        and PCI.status = 'completed'

define "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    where ( EDwithSTEMI.period ) ends 45 minutes or less after start of ( EDwithSTEMI.period )
      and EDwithSTEMI.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"

define "Numerator":
  "Fibrinolytic Therapy within 30 Minutes of Arrival"
    union "PCI within 90 Minutes of Arrival"
    union "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival"

define "Initial Population":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    where AgeInYearsAt(date from start of(EDwithSTEMI.period)) >= 18

define "Denominator":
  "Initial Population"

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

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

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

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

define "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter":
  "ED Encounter with STEMI Diagnosis" EDwSTEMI
    with ["AllergyIntolerance": "Thrombolytic medications"] ThrombolyticAllergy
      such that ThrombolyticAllergy.clinicalStatus ~ QICoreCommon."allergy-active"
        and ThrombolyticAllergy.onset.toInterval ( ) overlaps ( EDwSTEMI.period )

/*define "Adverse Effect to Thrombolytic Medications Before End of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
    with [AdverseEvent: event in "Thrombolytic medications"] ThrombolyticAdverseEvent
    such that ThrombolyticAdverseEvent.category in "Adverse reaction to thrombolytics"
    and ThrombolyticAdverseEvent.recordedDate before end of ( EDwSTEMI.period )
        and ThrombolyticAdverseEvent.actuality = 'actual'*/
/*KS Note - not sure we need category in the logic - it is must support, but not sure this brings value to the measure logic*/



define "Adverse Effect to Thrombolytic Medications Before End of ED Encounter":
  "ED Encounter with STEMI Diagnosis" EDwSTEMI
    with [AdverseEvent: event in "Thrombolytics Adverse Event"] ThrombolyticAdverseEvent
      such that ThrombolyticAdverseEvent.recordedDate before end of ( EDwSTEMI.period )
        and ThrombolyticAdverseEvent.actuality = 'actual'

define "Active Exclusion Diagnosis at Start of ED Encounter":
/*KS 8-10-23: in CQLIT-389, discussed the impacts of requiring a clinical status of active but the condition could end before the end (during) the ED Visit, which would trigger an inactive status. Decided to not follow the Authoring Patterns and remove the requirement for a clinicalstatus of 'active'  */
  
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    with ( ["Condition": "Active Bleeding Excluding Menses or Bleeding Diathesis"]
      union ["Condition": "Malignant Intracranial Neoplasm Group"]
      union ["Condition": "Cerebral Vascular Lesion"]
      union ["Condition": "Dementia and Related Intracranial Pathologies"]
      union ["Condition": "Pregnant State"]
      union ["Condition": "Allergy to thrombolytics"] ) ActiveExclusionDx
      such that /*ActiveExclusionDx.isActive ()
        and */
      ActiveExclusionDx.prevalenceInterval ( ) overlaps before ( EDwithSTEMI.period )

define "Active Oral Anticoagulant Medication at the Start of ED Encounter":
    /*this definition differs from QDM re: timing - cannot use overlaps for a single point in time*/
  
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    with ["MedicationRequest": "Oral Anticoagulant Medications"] OralAnticoagulant
      such that OralAnticoagulant.status = 'active'
        and OralAnticoagulant.intent = 'order'
        and OralAnticoagulant.authoredOn 90 days or less before or on start of EDwithSTEMI.period

define "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start":
/*Did not include a status of active as any diagnosis that resolves during the ED visit would not be counted*/
  
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    with ( ["Condition": "Aortic Dissection or Ruptured Aortic Aneurysm"]
      union ["Condition": "Neurologic impairment"]
      union ["Condition": "Cardiopulmonary Arrest"] ) ExclusionDiagnosis
      such that ( ExclusionDiagnosis.prevalenceInterval ( ) starts during EDwithSTEMI.period )
        or ( ExclusionDiagnosis.prevalenceInterval ( ) starts 24 hours or less before start of EDwithSTEMI.period )

define "Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    with ["Procedure": "Major Surgical Procedure"] MajorSurgery
      such that MajorSurgery.performed.toInterval ( ) starts 21 days or less before start of ( EDwithSTEMI.period )
        and MajorSurgery.status = 'completed'

define "Intubation or Mechanical Circulatory Assist Procedure During ED Encounter or Within 24 Hours of ED Encounter Start":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    with ( ["Procedure": "Endotracheal Intubation"]
      union ["Procedure": "Insertion or Replacement of Mechanical Circulatory Assist Device"] ) AirwayProcedure
      such that ( ( AirwayProcedure.performed.toInterval ( ) starts during ( EDwithSTEMI.period ) )
          or ( AirwayProcedure.performed.toInterval ( ) starts 24 hours or less before start of ( EDwithSTEMI.period ) )
      )
        and AirwayProcedure.status = 'completed'

define "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter":
  "ED Encounter with STEMI Diagnosis" EDwSTEMI
    with ( ["Condition": "Ischemic Stroke"]
      union ["Condition": "Closed Head and Facial Trauma"]
      union ["Condition": "Active Peptic Ulcer"]
      union ["Condition": "Cardiopulmonary Arrest"] ) ExclusionCondition
      such that /* ExclusionCondition.isActive ()
   and */
      ExclusionCondition.prevalenceInterval ( ) starts during Interval[start of ( EDwSTEMI.period ) - 90 days, start of ( EDwSTEMI.period )]

define "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    with ["Procedure": "Intracranial or Intraspinal surgery"] CranialorSpinalSurgery
      such that CranialorSpinalSurgery.performed.toInterval ( ) starts 90 days or less before start of ( EDwithSTEMI.period )
        and CranialorSpinalSurgery.status = 'completed'

define "ED Encounter with Discharge Disposition as Patient Expired":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    where EDwithSTEMI.hospitalization.dischargeDisposition in "Patient Expired"

define "Denominator Exclusions":
  "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter"
    union "Adverse Effect to Thrombolytic Medications Before End of ED Encounter"
    union "Active Exclusion Diagnosis at Start of ED Encounter"
    union "Active Oral Anticoagulant Medication at the Start of ED Encounter"
    union "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start"
    union "Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter"
    union "Intubation or Mechanical Circulatory Assist Procedure During ED Encounter or Within 24 Hours of ED Encounter Start"
    union "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter"
    union "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter"
    union "ED Encounter with Discharge Disposition as Patient Expired"

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

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

define "Received tPA in Another Facility within 24 hours Prior to Admission":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    with ( ["Condition": "Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility"] ) TPA
      such that TPA.prevalenceInterval ( ) starts during EDwithSTEMI.period

define "Denominator Exceptions":
  "Received tPA in Another Facility within 24 hours Prior to Admission"

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

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

/*
@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).
@comment: This function can be used to determine the logical id of a given resource. It can be used in
a single-server environment to trace references. However, this function does not attempt to resolve
or distinguish the base of the given url, and so cannot be used safely in multi-server environments.
*/
define fluent function getId(uri String):
  Last(Split(uri, '/'))

/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting 
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
  or condition.clinicalStatus ~ "recurrence"
  or condition.clinicalStatus ~ "relapse" then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
    (end of condition.abatementInterval()) abatementDate
    return if abatementDate is null then
      Interval[start of condition.onset.toInterval(), abatementDate)
    else
      Interval[start of condition.onset.toInterval(), abatementDate]

define fluent function currentemergencyDepartmentArrivalTime(EDEncounter Encounter):
/*
@description: Returns the emergency department arrival time for the encounter.
*/
  
  start of ( singleton from ( ( ( EDEncounter.location ) ) EDLocation
        where CQMCommon.GetLocation ( EDLocation.location ).type in "Emergency Department Visit"
    )
  ).period

/*
@description: Returns the Location resource specified by the given reference
@deprecated: This function is deprecated. Use the fluent function `getLocation()` instead.
*/
define function "GetLocation"(reference Reference ):
  singleton from (
    [Location] L where L.id = reference.reference.getId()
  )

define function ToString(value uri): value.value

/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }