Outcome

decrease

define "Initial Population":
  "Encounter with Opioid Administration Outside of Operating Room"

define "Denominator":
  "Initial Population"

define "Numerator":
  "Encounter with Non Enteral Opioid Antagonist Administration Outside of Operating Room and within 12 Hrs After Opioid"

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 "Opioid Antagonist Administration":
  ["MedicationAdministration": "Opioid Antagonist"] AntagonistGiven
    where AntagonistGiven.status = 'completed'
      and AntagonistGiven.status != 'not-done'

define "Opioid Administration":
  ["MedicationAdministration": "Opioids, All"] Opioids
    where Opioids.status = 'completed'
      and Opioids.status != 'not-done'

define "Qualifying Encounter":
  ["Encounter": "Encounter Inpatient"] InpatientEncounter
    where AgeInYearsAt(date from start of InpatientEncounter.period) >= 18
      and InpatientEncounter.period ends during day of "Measurement Period"
      and InpatientEncounter.status = 'finished'

define "Encounter with Opioid Administration Outside of Operating Room":
  "Qualifying Encounter" InpatientEncounter
    with "Opioid Administration" OpioidGiven
      such that QICoreCommon."ToInterval" ( OpioidGiven.effective ) starts during CQMCommon."HospitalizationWithObservation" ( InpatientEncounter )
        and not exists ( InpatientEncounter.location EncounterLocation
            where CQMCommon.GetLocation ( EncounterLocation.location ).type in "Operating Room Suite"
              and QICoreCommon."ToInterval" ( OpioidGiven.effective ) starts during EncounterLocation.period
        )

define "Initial Population":
  "Encounter with Opioid Administration Outside of Operating Room"

define "Denominator":
  "Initial Population"

define "Encounter with Non Enteral Opioid Antagonist Administration Outside of Operating Room and within 12 Hrs After Opioid":
  // Opioids administered before opioid antagonist AND excludes opioid antagonist administered in operating room AND limits opioid antagonist to non-enteral routes//
  
  from
    "Opioid Antagonist Administration" OpioidAntagonistGiven,
    "Opioid Administration" OpioidGiven,
    "Denominator" EncounterWithQualifyingAge
    where not exists ( EncounterWithQualifyingAge.location EncounterLocation
        where CQMCommon.GetLocation ( EncounterLocation.location ).type in "Operating Room Suite"
          and QICoreCommon."ToInterval" ( OpioidAntagonistGiven.effective ) starts during EncounterLocation.period
    )
      and ( QICoreCommon."ToInterval" ( OpioidAntagonistGiven.effective ) starts during CQMCommon."HospitalizationWithObservation" ( EncounterWithQualifyingAge )
          and QICoreCommon."ToInterval" ( OpioidGiven.effective ) starts during CQMCommon."HospitalizationWithObservation" ( EncounterWithQualifyingAge )
          and QICoreCommon."ToInterval" ( OpioidGiven.effective ) ends 12 hours or less before start of QICoreCommon."ToInterval" ( OpioidAntagonistGiven.effective )
          and OpioidAntagonistGiven.dosage.route in "Routes of Administration for Opioid Antagonists"
      )
    return EncounterWithQualifyingAge

define "Numerator":
  "Encounter with Non Enteral Opioid Antagonist Administration Outside of Operating Room and within 12 Hrs After Opioid"

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

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

/*
@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]

/*
@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()
  )

/*
@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: 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
        }

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
        }