Outcome

define "Initial Population":
  "Measure Population"

define "Measure Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population Exclusion":
  "Encounter with Discharge for Hospice Care"
    union "Encounter with Hospice during Eligible Encounter"

define function "Measure Observation 1"(MalnutritionRiskScreening Encounter):
  if "Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral" contains MalnutritionRiskScreening then 1 
    else 0

Outcome

define "Initial Population":
  "Measure Population"

define "Measure Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population Exclusion":
  "Encounter with Discharge for Hospice Care"
    union "Encounter with Hospice during Eligible Encounter"

define function "Measure Observation 2"(NutritionAssessment Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral" contains NutritionAssessment then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral" contains NutritionAssessment then if "Most Recent Encounter with Nutrition Assessment and Identified Status" contains NutritionAssessment then 1 
    else 0 
    else 0

Outcome

define "Initial Population":
  "Measure Population"

define "Measure Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population Exclusion":
  "Encounter with Discharge for Hospice Care"
    union "Encounter with Hospice during Eligible Encounter"

define function "Measure Observation 3"(MalnutritionDiagnosis Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral" contains MalnutritionDiagnosis then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral" contains MalnutritionDiagnosis then if "Encounter with Malnutrition Diagnosis" contains MalnutritionDiagnosis then if "Encounter with Nutrition Assessment Not or Mildly Malnourished" contains MalnutritionDiagnosis then 0 
    else if "Encounter with Nutrition Assessment Status Moderately Or Severely Malnourished" contains MalnutritionDiagnosis then 1 
    else 0 
    else 0 
    else 0

Outcome

define "Initial Population":
  "Measure Population"

define "Measure Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population Exclusion":
  "Encounter with Discharge for Hospice Care"
    union "Encounter with Hospice during Eligible Encounter"

define function "Measure Observation 4"(NutritionCarePlan Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral" contains NutritionCarePlan then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral" contains NutritionCarePlan then if "Encounter with Nutrition Care Plan" contains NutritionCarePlan then if "Encounter with Nutrition Assessment Not or Mildly Malnourished" contains NutritionCarePlan then 0 
    else if "Encounter with Nutrition Assessment Status Moderately Or Severely Malnourished" contains NutritionCarePlan then 1 
    else 0 
    else 0 
    else 0

Outcome

define "Initial Population":
  "Measure Population"

define "Measure Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population Exclusion":
  "Encounter with Discharge for Hospice Care"
    union "Encounter with Hospice during Eligible Encounter"

define function "Measure Observation Total Malnutrition Components Score"(QualifyingEncounter Encounter):
  Sum({ "Measure Observation 1"(QualifyingEncounter), "Measure Observation 2"(QualifyingEncounter), "Measure Observation 3"(QualifyingEncounter), "Measure Observation 4"(QualifyingEncounter) })

Outcome

define "Initial Population":
  "Measure Population"

define "Measure Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population Exclusion":
  "Encounter with Discharge for Hospice Care"
    union "Encounter with Hospice during Eligible Encounter"

define function "Measure Observation Total Malnutrition Care Score as Percentage"(QualifyingEncounter Encounter):
  100 * ( "Measure Observation Total Malnutrition Components Score"(QualifyingEncounter) / "Total Malnutrition Care Score Eligible Occurrences"(QualifyingEncounter) )

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

define "SDE Patient sex for quality measurement":
  SDE."SDE Sex"

define "Measure Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Encounter with Discharge for Hospice Care":
  ( "Measure Population" QualifyingEncounter
      where QualifyingEncounter.status = 'finished'
        and ( QualifyingEncounter.hospitalization.dischargeDisposition in "Hospice Care Referral or Admission" )
  )

define "Encounter with Hospice during Eligible Encounter":
  from
    "Measure Population" QualifyingEncounter,
    ( ["ServiceRequest": code in "Hospice Status"]
      union ["Procedure": "Hospice Status"] ) HospiceStatus
    where "Hospice Status" contains HospiceStatus.code as Concept
      and HospiceStatus.status in { 'active', 'completed' }
      and Coalesce(start of HospiceStatus.performed.toInterval(), HospiceStatus.authoredOn) during day of QualifyingEncounter."hospitalizationWithObservation" ( )
    return QualifyingEncounter

define "Measure Population Exclusion":
  "Encounter with Discharge for Hospice Care"
    union "Encounter with Hospice during Eligible Encounter"

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

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

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

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

define "Initial Population":
  "Measure Population"

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

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

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

define function ToString(value uri): value.value

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

define function "Measure Observation 1"(MalnutritionRiskScreening Encounter):
  if "Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral" contains MalnutritionRiskScreening then 1 
    else 0

define function "Measure Observation Total Malnutrition Components Score"(QualifyingEncounter Encounter):
  Sum({ "Measure Observation 1"(QualifyingEncounter), "Measure Observation 2"(QualifyingEncounter), "Measure Observation 3"(QualifyingEncounter), "Measure Observation 4"(QualifyingEncounter) })

define function "Measure Observation 2"(NutritionAssessment Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral" contains NutritionAssessment then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral" contains NutritionAssessment then if "Most Recent Encounter with Nutrition Assessment and Identified Status" contains NutritionAssessment then 1 
    else 0 
    else 0

define function "Measure Observation 3"(MalnutritionDiagnosis Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral" contains MalnutritionDiagnosis then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral" contains MalnutritionDiagnosis then if "Encounter with Malnutrition Diagnosis" contains MalnutritionDiagnosis then if "Encounter with Nutrition Assessment Not or Mildly Malnourished" contains MalnutritionDiagnosis then 0 
    else if "Encounter with Nutrition Assessment Status Moderately Or Severely Malnourished" contains MalnutritionDiagnosis then 1 
    else 0 
    else 0 
    else 0

define function "Measure Observation 4"(NutritionCarePlan Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral" contains NutritionCarePlan then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral" contains NutritionCarePlan then if "Encounter with Nutrition Care Plan" contains NutritionCarePlan then if "Encounter with Nutrition Assessment Not or Mildly Malnourished" contains NutritionCarePlan then 0 
    else if "Encounter with Nutrition Assessment Status Moderately Or Severely Malnourished" contains NutritionCarePlan then 1 
    else 0 
    else 0 
    else 0

define function "Measure Observation Total Malnutrition Care Score as Percentage"(QualifyingEncounter Encounter):
  100 * ( "Measure Observation Total Malnutrition Components Score"(QualifyingEncounter) / "Total Malnutrition Care Score Eligible Occurrences"(QualifyingEncounter) )

define function "Total Malnutrition Care Score Eligible Occurrences"(QualifyingEncounter Encounter):
  if ( ( "Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral" contains QualifyingEncounter )
      and ( "Encounter with Malnutrition Risk Screening Not At Risk" contains QualifyingEncounter )
  )
    and not ( "Encounter with Dietitian Referral" contains QualifyingEncounter ) then 1 
    else if ( ( ( "Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral" contains QualifyingEncounter )
        and ( "Encounter with Malnutrition Risk Screening At Risk" contains QualifyingEncounter )
    )
      or ( "Encounter with Dietitian Referral" contains QualifyingEncounter )
  )
    and ( "Encounter with Nutrition Assessment Not or Mildly Malnourished" contains QualifyingEncounter )
    or not ( "Most Recent Encounter with Nutrition Assessment and Identified Status" contains QualifyingEncounter ) then 2 
    else 4