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
| Active as of 2024-12-18 |
{
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"id" : "CMS986FHIRMalnutritionScore",
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"http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"
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"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <table class=\"grid dict\">\n \n <tr>\n <th scope=\"row\"><b>Title: </b></th>\n <td style=\"padding-left: 4px;\">Malnutrition Care ScoreFHIR</td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Id: </b></th>\n <td style=\"padding-left: 4px;\">CMS986FHIRMalnutritionScore</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Version: </b></th>\n <td style=\"padding-left: 4px;\">0.2.002</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Url: </b></th>\n <td style=\"padding-left: 4px;\"><a href=\"Measure-CMS986FHIRMalnutritionScore.html\">Malnutrition Care ScoreFHIR</a></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\">\n <b>\n \n \n Short Name Identifier:\n \n \n </b>\n </th>\n\n <td style=\"padding-left: 4px;\">\n \n <p style=\"margin-bottom: 5px;\">\n <span>CMS986FHIR</span>\n </p>\n \n </td>\n </tr>\n \n <tr>\n <th scope=\"row\">\n <b>\n \n \n Version Independent Identifier:\n \n \n </b>\n </th>\n\n <td style=\"padding-left: 4px;\">\n \n <p style=\"margin-bottom: 5px;\">\n <span>urn:uuid:eed68e80-b466-4369-be87-166ada45f7c5</span>\n </p>\n \n </td>\n </tr>\n \n <tr>\n <th scope=\"row\">\n <b>\n \n \n Version Specific Identifier:\n \n \n </b>\n </th>\n\n <td style=\"padding-left: 4px;\">\n \n <p style=\"margin-bottom: 5px;\">\n <span>urn:uuid:af2116f9-3ffe-4baf-9ce0-0730ea210c49</span>\n </p>\n \n </td>\n </tr>\n \n <tr>\n <th scope=\"row\">\n <b>\n \n \n Endorser (CMS Consensus Based Entity) Identifier:\n \n \n </b>\n </th>\n\n <td style=\"padding-left: 4px;\">\n \n <p style=\"margin-bottom: 5px;\">\n <span>3592e</span>\n </p>\n \n </td>\n </tr>\n \n <tr>\n <th scope=\"row\">\n <b>\n \n \n Publisher (CMS) Identifier:\n \n \n </b>\n </th>\n\n <td style=\"padding-left: 4px;\">\n \n <p style=\"margin-bottom: 5px;\">\n <span>986FHIR</span>\n </p>\n \n </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Effective Period: </b></th>\n <td style=\"padding-left: 4px;\">2026-01-01..2026-12-31</td>\n </tr>\n \n\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Publisher: </b></th>\n <td style=\"padding-left: 4px;\">Academy of Nutrition and Dietetics</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Author: </b></th>\n <td style=\"padding-left: 4px;\">Academy of Nutrition and Dietetics</td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Description: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>This measure assesses the percentage of eligible encounters of adults aged 18 years and older at the start of the eligible encounter during the measurement period, with a length of stay equal to or greater than 24 hours, who received optimal malnutrition care where care performed was appropriate to the patient's level of malnutrition risk and severity. Malnutrition care best practices recommend that for each eligible encounter, adult inpatients are (1) screened for malnutrition risk or for a dietitian referral order to be placed, (2) assessed by a registered dietitian (RD) or registered dietitian nutritionist (RDN) to confirm findings of malnutrition risk, and if identified with a "moderate" or "severe" malnutrition status in the current performed malnutrition assessment, (3) receive a "moderate" or "severe" malnutrition diagnosis by a physician or eligible provider as defined by the Centers for Medicare & Medicaid Services (CMS), and (4) have a current nutrition care plan performed by an RD/RDN.</p>\n</div></td>\n </tr>\n \n\n \n\n \n\n \n\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Purpose: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>UNKNOWN</p>\n</div></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Copyright: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>Copyright (C) Academy of Nutrition and Dietetics 2025</p>\n<p>Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets.</p>\n<p>LOINC(R) copyright 2004-2024 Regenstrief Institute, Inc.</p>\n<p>ICD-10 copyright 2024 World Health Organization.</p>\n<p>This material contains SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2024. International Health Terminology Standards Development Organisation.\nAll Rights Reserved</p>\n</div></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Disclaimer: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>This performance measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.</p>\n<p>THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.</p>\n<p>Due to technical limitations, copyright is indicated by (C) or [C], registered trademarks are indicated by (R) or [R], and unregistered trademarks are indicated by (TM) or [TM].</p>\n</div></td>\n </tr>\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Rationale: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>Malnutrition has been documented in approximately one-third of patients in developed countries upon admission to the hospital, and, if left untreated, can significantly impact important clinical outcomes (Mogensen et al., 2019). Adult patients with malnutrition have a significantly longer hospital length of stay (LOS) (Hudson, Chittams, Griffith, & Compher, 2018 and Mosquera et al., 2016) and significantly more patients with malnutrition have a LOS of >7 days when compared to their well-nourished counterparts. Additionally, both higher rates of 30-day readmission and a significantly higher likelihood of 30-day readmission are observed in these patients (Mogensen et al., 2019; Hiller, Shaw, & Fabri, 2016; Mosquera et al., 2016). Lastly, hospitalized adults with malnutrition have an increased likelihood of death within 90 days of discharge (Hiller, Shaw, & Fabri, 2016). These consequences demonstrate the importance of addressing malnutrition in hospitalized patients to improve outcomes.</p>\n<p>The components of this measure are supported by clinical guidance that recommends (1) malnutrition screening for patients admitted into the acute inpatient care setting; (2) nutrition assessment for patients identified at risk for malnutrition or with a dietitian referral order to form the basis for appropriate nutrition interventions; (3) appropriate recognition, diagnosis, and documentation of the nutrition status of a patient in order to (4) address their condition with an appropriate plan of care and communicate patient needs to other care providers (Academy of Nutrition and Dietetics, 2017).</p>\n<p>The process for risk identification, assessment, diagnosis, and treatment of malnutrition necessitates a multi-disciplinary care team that begins with the identification of an initial risk population for a more thorough assessment by the RD/RDN. The RD/RDN, in turn, provides the necessary treatment recommendations to address nutrition problems utilizing a nutrition diagnosis and care plan, along with the clinical indicators that inform a medical diagnosis of malnutrition completed by a physician or eligible clinician as defined by CMS. The four measure observations individually provide a portion of the necessary information on the quality of care for patients at risk for or with malnutrition. Therefore, the four components are summed and averaged according to a patient’s degree of malnutrition and/or malnutrition risk to determine an encounter-level Malnutrition Care Score.</p>\n<p>High performance on this measure requires malnutrition risk screening and/or referral to RDNs for appropriate nutrition assessment for identified patients during the current hospitalization. For patients identified with moderate or severe malnutrition by the nutrition assessment, best practice also recommends a medical diagnosis by a physician or other eligible clinician and the execution of the nutrition care plan by an RD/RDN. Evidence demonstrates that implementing a standardized protocol for screening, assessment, diagnosis, and care planning results in better identification of patients with malnutrition and subsequent improvements in rates of associated nutrition interventions. Outcomes modeling demonstrates benefits to patient outcomes, including reduced risk of 30-day readmissions, length of hospital stays, and complications, as well as improved quality of life after hospitalization (Sriram et al., 2016).</p>\n</div></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Clinical recommendation statement: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>American Society for Parenteral and Enteral Nutrition (ASPEN) clinical guidelines on nutrition screening, assessment, and intervention in adults indicate that screening for nutrition risk is suggested for hospitalized patients (Mueller, Compher, Druyan, & ASPEN Board of Directors, 2011).</p>\n<p>This guideline places nutrition assessment and screening in the context of intervention as part of nutrition care. Screening those individuals at risk for malnutrition is the first step in nutrition care as risk for malnutrition, identified by nutrition screening, is associated with longer length of hospital stay, complications, and mortality. Malnutrition screening is also a predictor of mortality risk.</p>\n<p>Malnourished patients, identified by nutrition assessment tools, have more complications and longer hospitalizations than do patients with optimal nutrition status. Such patients, identified by nutrition assessment tools, have more infectious and noninfectious complications, longer hospital length of stay, and greater mortality.</p>\n<p>Nutrition intervention is recommended for patients identified by assessment as at risk for malnutrition or malnourished. Nutrition intervention with associated monitoring and evaluation plants in patients identified as at risk for malnutrition or malnourished improves clinical outcomes. Nutrition interventions and their associated monitoring and evaluation plans in malnourished patients are associated with improved nutrition status, nutrient intake, physical function, and quality of life. Hospital readmissions, inpatient length of stay, and complications were reduced with increased nutrition support interventions.</p>\n</div></td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Guidance (Usage): </b></th>\n <td style=\"padding-left: 4px;\">This measure is constructed of four clinically eligible components that are aggregated as an arithmetic average of eligible encounters and expressed as a percentage. The four populations used to calculate the four components may differ and the measure observations for the four components do not need to be performed sequentially. \n\nThis eCQM is an episode-based measure. An episode is defined as each eligible encounter with a length of stay of greater than or equal to 24 hours among individuals 18 years of age and older at the start of the inpatient encounter. \n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS986v5.\n\nPlease refer to the HL7 QI-Core Implementation Guide\n(https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and\nmapping recommendations from QDM to QI-Core\n4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).</td>\n </tr>\n \n\n \n \n <tr>\n <th scope=\"row\"><b>Population Criteria: </b></th>\n <td style=\"padding-left: 4px;\">\n \n <table class=\"grid-dict\">\n \n <tr>\n <th><b>675761f046b6174510cfee0b</b></th>\n </tr>\n \n \n <tr>\n <td>Initial Population:</td>\n\n \n \n <td>Eligible encounters during the measurement period with length of stay of 24 hours or more among individuals 18 years of age and older at the start of the inpatient encounter</td>\n \n \n\n </tr>\n \n <tr>\n <td>Measure Population:</td>\n\n \n \n <td>Equals Initial Population</td>\n \n \n\n </tr>\n \n <tr>\n <td>Measure Population Exclusion:</td>\n\n \n \n <td>Encounters with hospice care ordered during the inpatient qualifying encounter and encounters with a discharge disposition of hospice</td>\n \n \n\n </tr>\n \n <tr>\n <td>Measure Observation:</td>\n\n \n \n <td>Component Measure 1: Eligible encounters for patients with a current "Malnutrition Risk Screening" performed by an eligible healthcare clinician or a Dietitian Referral. \n\n"Measure Observation 1" is "Encounters with Malnutrition Risk Screening and Identified Result or a Dietitian Referral" \n\n"Measure Observation 1" identifies eligible encounters where a "Malnutrition Risk Screening" was performed or authored during the encounter (including preceding observation or emergency department encounters) with an identified "Malnutrition Screening Finding of Not At Risk Result" or "Malnutrition Screening Finding of At Risk Result". It also identifies an eligible encounter where there is a Dietitian Referral, whether there is a "Malnutrition Risk Screening" performed or not.</td>\n \n \n\n </tr>\n \n \n </table>\n \n <table class=\"grid-dict\">\n \n <tr>\n <th><b>675761f046b6174510cfee0c</b></th>\n </tr>\n \n \n <tr>\n <td>Initial Population:</td>\n\n \n \n <td>Eligible encounters during the measurement period with length of stay of 24 hours or more among individuals 18 years of age and older at the start of the inpatient encounter</td>\n \n \n\n </tr>\n \n <tr>\n <td>Measure Population:</td>\n\n \n \n <td>Equals Initial Population</td>\n \n \n\n </tr>\n \n <tr>\n <td>Measure Population Exclusion:</td>\n\n \n \n <td>Encounters with hospice care ordered during the inpatient qualifying encounter and encounters with a discharge disposition of hospice</td>\n \n \n\n </tr>\n \n <tr>\n <td>Measure Observation:</td>\n\n \n \n <td>Component Measure 2: Eligible encounters for patients with a current "Nutrition Assessment" performed by an RD/RDN, after a "Malnutrition Screening Finding of At Risk Result" during the current encounter or a "Dietitian Referral" order from a physician or eligible clinician during the current encounter. \n\n"Measure Observation 2" is "Encounter with Nutrition Assessment and Identified Status" \n\n"Measure Observation 2" identifies eligible encounters where a "Nutrition Assessment" was performed or authored during the encounter (including preceding observation or emergency department encounters) with an identified "Nutrition Assessment Status Finding of Well Nourished or Not Malnourished or Mildly Malnourished", "Nutrition Assessment Status Finding of Moderately Malnourished", or "Nutrition Assessment Status Finding of Severely Malnourished".</td>\n \n \n\n </tr>\n \n \n </table>\n \n <table class=\"grid-dict\">\n \n <tr>\n <th><b>675761f046b6174510cfee0d</b></th>\n </tr>\n \n \n <tr>\n <td>Initial Population:</td>\n\n \n \n <td>Eligible encounters during the measurement period with length of stay of 24 hours or more among individuals 18 years of age and older at the start of the inpatient encounter</td>\n \n \n\n </tr>\n \n <tr>\n <td>Measure Population:</td>\n\n \n \n <td>Equals Initial Population</td>\n \n \n\n </tr>\n \n <tr>\n <td>Measure Population Exclusion:</td>\n\n \n \n <td>Encounters with hospice care ordered during the inpatient qualifying encounter and encounters with a discharge disposition of hospice-</td>\n \n \n\n </tr>\n \n <tr>\n <td>Measure Observation:</td>\n\n \n \n <td>Component Measure 3: Eligible encounters for patients with a documented "Malnutrition Diagnosis" as a result of a "Nutrition Assessment Status Finding of Moderately Malnourished" OR "Nutrition Assessment Status Finding of Severely Malnourished". \n\n"Measure Observation 3" is "Encounters with Malnutrition Diagnosis"\n\n"Measure Observation 3" identifies eligible encounters where a "Malnutrition Diagnosis" was active during the encounter (including preceding observation or emergency department encounters).</td>\n \n \n\n </tr>\n \n \n </table>\n \n <table class=\"grid-dict\">\n \n <tr>\n <th><b>675761f046b6174510cfee0e</b></th>\n </tr>\n \n \n <tr>\n <td>Initial Population:</td>\n\n \n \n <td>Eligible encounters during the measurement period with length of stay of 24 hours or more among individuals 18 years of age and older at the start of the inpatient encounter</td>\n \n \n\n </tr>\n \n <tr>\n <td>Measure Population:</td>\n\n \n \n <td>Equals Initial Population</td>\n \n \n\n </tr>\n \n <tr>\n <td>Measure Population Exclusion:</td>\n\n \n \n <td>Encounters with hospice care ordered during the inpatient qualifying encounter and encounters with a discharge disposition of hospice</td>\n \n \n\n </tr>\n \n <tr>\n <td>Measure Observation:</td>\n\n \n \n <td>Component Measure 4: Eligible encounters for patients with a current "Nutrition Care Plan" performed as a result of a current "Nutrition Assessment Status Finding of Moderately Malnourished" OR current “Nutrition Assessment Status Finding of Severely Malnourished”. \n\n“Measure Observation 4” is “Encounters with Nutrition Care Plan”\n\n"Measure Observation 4" identifies eligible encounters where a "Nutrition Care Plan" was performed or authored during the encounter (including preceding observation or emergency department encounters). </td>\n \n \n\n </tr>\n \n \n </table>\n \n <table class=\"grid-dict\">\n \n <tr>\n <th><b>675761f046b6174510cfee0f</b></th>\n </tr>\n \n \n <tr>\n <td>Initial Population:</td>\n\n \n \n <td>None</td>\n \n \n\n </tr>\n \n <tr>\n <td>Measure Population:</td>\n\n \n \n <td>None</td>\n \n \n\n </tr>\n \n <tr>\n <td>Measure Population Exclusion:</td>\n\n \n \n <td>None</td>\n \n \n\n </tr>\n \n <tr>\n <td>Measure Observation:</td>\n\n \n \n <td>"Population 5 Measure Observation Total Malnutrition Components Score" Calculations\n-For each eligible encounter, Population Criteria 5 represents the subtotal of Measure Observations performed for Population Criteria 1, 2, 3, and 4. Possible values may be 0, 1, 2, 3, or 4.\n \n"Population 5 Measure Observation Total Malnutrition Components Score" is ("Measure Observation 1" plus "Measure Observation 2" plus "Measure Observation 3" plus "Measure Observation 4")</td>\n \n \n\n </tr>\n \n \n </table>\n \n <table class=\"grid-dict\">\n \n <tr>\n <th><b>675761f046b6174510cfee10</b></th>\n </tr>\n \n \n <tr>\n <td>Initial Population:</td>\n\n \n \n <td>None</td>\n \n \n\n </tr>\n \n <tr>\n <td>Measure Population:</td>\n\n \n \n <td>None</td>\n \n \n\n </tr>\n \n <tr>\n <td>Measure Population Exclusion:</td>\n\n \n \n <td>None</td>\n \n \n\n </tr>\n \n <tr>\n <td>Measure Observation:</td>\n\n \n \n <td>"Population 6 Measure Observation Total Malnutrition Care Score as Percentage" Calculations:\n-For each eligible encounter, Population Criteria 6 represents the sum of performed Measure Observations 1, 2, 3, and 4 divided by the number of clinically eligible occurrences. \n\n"Population 6 Measure Observation Total Malnutrition Care Score as Percentage" is 100 multiplied by ("Total Malnutrition Components Score" divided by "Total Malnutrition Care Score Eligible Occurrences"). Possible values may be 0, 50, 75, or 100 percent. \n\n"Total Malnutrition Care Score Eligible Occurrences" is always 4 except in the following instances:\n-The "Total Malnutrition Care Score Eligible Occurrences" is 1 if\n---A "Malnutrition Risk Screening" was performed and a "Malnutrition Screening Finding of Not At Risk Result" was identified AND "Dietitian Referral" was not ordered.\n- The "Total Malnutrition Care Score Eligible Occurrences" are 2\n---If a "Nutrition Assessment" was performed and a "Nutrition Status Finding of Well Nourished or Not Malnourished or Mildly Malnourished" was identified\n--- A "Malnutrition Risk Screening" was performed and a "Malnutrition Screening Finding of Not At Risk Result" was identified AND "Dietitian Referral" was ordered OR a "Malnutrition Risk Screening" was performed and a "Malnutrition Screening Finding of At Risk Result" was identified but the “Nutrition Assessment” was not performed</td>\n \n \n\n </tr>\n \n \n </table>\n \n </td>\n </tr>\n \n \n\n \n <tr>\n <th scope=\"row\"><b> Supplemental Data Elements: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n \n <p>SDE Payer Type</p>\n \n \n \n \n \n <p>SDE Patient sex for quality measurement</p>\n \n \n \n \n \n <p>SDE Race</p>\n \n \n \n \n \n <p>SDE Ethnicity</p>\n \n \n \n </td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\">\n <b> Supplemental Data Guidance\n : </b></th>\n <td style=\"padding-left: 4px;\"> For every patient evaluated by this measure also identify payer, race, ethnicity and sex </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Libraries: </b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n \n <tr>\n <td><a href=\"Library-CMS986FHIRMalnutritionScore.html\">CMS986FHIRMalnutritionScore</a></td>\n </tr>\n \n </table>\n </td>\n </tr>\n \n\n \n\n \n \n <tr>\n <th scope=\"row\"><b>Terminology and Other Dependencies: </b></th>\n <td style=\"padding-left: 4px;\">\n \n <li><code>Library/SupplementalDataElements|3.5.000</code></li>\n \n <li><code>Library/FHIRHelpers|4.4.000</code></li>\n \n <li><code>Library/QICoreCommon|2.1.000</code></li>\n \n <li><code>Library/CQMCommon|2.2.000</code></li>\n \n <li><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">AdministrativeGender</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1116.365/expansion\">Hospice Care Referral or Admission</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1095.101/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1095.101</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion\">Observation Services</a></li>\n \n <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>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion\">Payer</a></li>\n \n </td>\n </tr>\n <tr>\n <th scope=\"row\"><b>Parameters:</b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr>\n <th><b>name</b></th>\n <th><b>use</b></th>\n <th><b>min</b></th>\n <th><b>max</b></th>\n <th><b>type</b></th>\n </tr>\n \n <tr>\n <td>Measurement Period</td>\n <td>In</td>\n <td>0</td>\n <td>1</td>\n <td>Period</td>\n </tr>\n \n <tr>\n <td>SDE Patient sex for quality measurement</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>Coding</td>\n </tr>\n \n <tr>\n <td>Measure Population Exclusion</td>\n <td>Out</td>\n <td>0</td>\n <td>*</td>\n <td>Resource</td>\n </tr>\n \n <tr>\n <td>SDE Race</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>Resource</td>\n </tr>\n \n <tr>\n <td>SDE Payer Type</td>\n <td>Out</td>\n <td>0</td>\n <td>*</td>\n <td>Resource</td>\n </tr>\n \n <tr>\n <td>Initial Population</td>\n <td>Out</td>\n <td>0</td>\n <td>*</td>\n <td>Resource</td>\n </tr>\n \n <tr>\n <td>SDE Ethnicity</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>Resource</td>\n </tr>\n \n <tr>\n <td>Measure Population</td>\n <td>Out</td>\n <td>0</td>\n <td>*</td>\n <td>Resource</td>\n </tr>\n \n </table>\n </td>\n </tr>\n\n <tr>\n <th scope=\"row\"><b>DataRequirements:</b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr>\n <th><b>Resource Type</b></th>\n <th><b>Resource Elements</b></th>\n <th><b>Valueset Name</b></th>\n <th><b>Valueset</b></th>\n </tr>\n \n <tr>\n <td>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n <td>\n \n race\n \n ethnicity\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n period\n \n status\n \n status.value\n \n hospitalization\n \n hospitalization.dischargeDisposition\n \n </td>\n <td>\n \n \n Encounter Inpatient\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Observation Services\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion\">Observation Services</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Emergency Department Visit\n \n \n </td>\n <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>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n period\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Encounter Inpatient\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</a></td>\n </tr>\n \n <tr>\n <td>ServiceRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html\">QICoreServiceRequest</a>)</td>\n <td>\n \n code\n \n </td>\n <td>\n \n \n Hospice Status\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1095.101/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1095.101</a></td>\n </tr>\n \n <tr>\n <td>Procedure(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html\">QICoreProcedure</a>)</td>\n <td>\n \n code\n \n </td>\n <td>\n \n \n Hospice Status\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1095.101/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1095.101</a></td>\n </tr>\n \n <tr>\n <td>Coverage(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html\">QICoreCoverage</a>)</td>\n <td>\n \n type\n \n period\n \n </td>\n <td>\n \n \n Payer Type\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion\">Payer</a></td>\n </tr>\n \n </table>\n </td>\n </tr>\n\n \n <tr>\n <th scope=\"row\"><b>Direct Reference Codes:</b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr>\n <th><b>display</b></th>\n <th><b>code</b></th>\n <th><b>system</b></th>\n </tr>\n \n <tr>\n <td>Male</td>\n <td>M</td>\n <td><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">http://hl7.org/fhir/administrative-gender</a></td>\n </tr>\n \n <tr>\n <td>Female</td>\n <td>F</td>\n <td><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">http://hl7.org/fhir/administrative-gender</a></td>\n </tr>\n \n </table>\n </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Logic Definitions:</b></th>\n <td style=\"padding-left: 4px;\">\n \n <table class=\"grid-dict\">\n <tr>\n <th><b>Group</b></th>\n <th><b>Scoring</b></th>\n <th><b>Population Criteria</b></th>\n <th><b>Expression</b></th>\n </tr>\n <tr>\n \n <td> 675761f046b6174510cfee0b </td>\n <td colspan=\"3\" style=\"padding-left: 4px;\">\n \n <b>Group scoring:</b>\n \n <span> continuous-variable </span>\n \n \n\n \n\n \n\n \n\n \n <tr>\n \n <th scope=\"row\"><b>Type: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <span>Outcome </span>\n </p>\n \n \n \n </td>\n \n </tr>\n \n\n \n\n \n\n \n\n \n\n </td>\n \n <tr>\n <td/>\n <td/>\n <td>Initial Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Initial Population":\n "Measure Population"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Measure Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Measure Population":\n [Encounter: "Encounter Inpatient"] EncounterInpatient\n where EncounterInpatient.period ends during day of "Measurement Period"\n and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18\n and ( duration in hours of EncounterInpatient.period >= 24 )\n and EncounterInpatient.status = 'finished'</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Measure Population Exclusion</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Measure Population Exclusion":\n "Encounter with Discharge for Hospice Care"\n union "Encounter with Hospice during Eligible Encounter"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Measure Observation</td>\n <td>\n \n <pre><code class=\"language-cql\">define function "Measure Observation 1"(MalnutritionRiskScreening Encounter):\n if "Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral" contains MalnutritionRiskScreening then 1 \n else 0</code></pre>\n \n </td>\n </tr>\n \n \n \n <td> 675761f046b6174510cfee0c </td>\n <td colspan=\"3\" style=\"padding-left: 4px;\">\n \n <b>Group scoring:</b>\n \n <span> continuous-variable </span>\n \n \n\n \n\n \n\n \n\n \n <tr>\n \n <th scope=\"row\"><b>Type: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <span>Outcome </span>\n </p>\n \n \n \n </td>\n \n </tr>\n \n\n \n\n \n\n \n\n \n\n </td>\n \n <tr>\n <td/>\n <td/>\n <td>Initial Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Initial Population":\n "Measure Population"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Measure Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Measure Population":\n [Encounter: "Encounter Inpatient"] EncounterInpatient\n where EncounterInpatient.period ends during day of "Measurement Period"\n and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18\n and ( duration in hours of EncounterInpatient.period >= 24 )\n and EncounterInpatient.status = 'finished'</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Measure Population Exclusion</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Measure Population Exclusion":\n "Encounter with Discharge for Hospice Care"\n union "Encounter with Hospice during Eligible Encounter"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Measure Observation</td>\n <td>\n \n <pre><code class=\"language-cql\">define function "Measure Observation 2"(NutritionAssessment Encounter):\n if "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral" contains NutritionAssessment then 0 \n 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 \n else 0 \n else 0</code></pre>\n \n </td>\n </tr>\n \n \n \n <td> 675761f046b6174510cfee0d </td>\n <td colspan=\"3\" style=\"padding-left: 4px;\">\n \n <b>Group scoring:</b>\n \n <span> continuous-variable </span>\n \n \n\n \n\n \n\n \n\n \n <tr>\n \n <th scope=\"row\"><b>Type: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <span>Outcome </span>\n </p>\n \n \n \n </td>\n \n </tr>\n \n\n \n\n \n\n \n\n \n\n </td>\n \n <tr>\n <td/>\n <td/>\n <td>Initial Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Initial Population":\n "Measure Population"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Measure Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Measure Population":\n [Encounter: "Encounter Inpatient"] EncounterInpatient\n where EncounterInpatient.period ends during day of "Measurement Period"\n and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18\n and ( duration in hours of EncounterInpatient.period >= 24 )\n and EncounterInpatient.status = 'finished'</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Measure Population Exclusion</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Measure Population Exclusion":\n "Encounter with Discharge for Hospice Care"\n union "Encounter with Hospice during Eligible Encounter"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Measure Observation</td>\n <td>\n \n <pre><code class=\"language-cql\">define function "Measure Observation 3"(MalnutritionDiagnosis Encounter):\n if "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral" contains MalnutritionDiagnosis then 0 \n 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 \n else if "Encounter with Nutrition Assessment Status Moderately Or Severely Malnourished" contains MalnutritionDiagnosis then 1 \n else 0 \n else 0 \n else 0</code></pre>\n \n </td>\n </tr>\n \n \n \n <td> 675761f046b6174510cfee0e </td>\n <td colspan=\"3\" style=\"padding-left: 4px;\">\n \n <b>Group scoring:</b>\n \n <span> continuous-variable </span>\n \n \n\n \n\n \n\n \n\n \n <tr>\n \n <th scope=\"row\"><b>Type: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <span>Outcome </span>\n </p>\n \n \n \n </td>\n \n </tr>\n \n\n \n\n \n\n \n\n \n\n </td>\n \n <tr>\n <td/>\n <td/>\n <td>Initial Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Initial Population":\n "Measure Population"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Measure Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Measure Population":\n [Encounter: "Encounter Inpatient"] EncounterInpatient\n where EncounterInpatient.period ends during day of "Measurement Period"\n and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18\n and ( duration in hours of EncounterInpatient.period >= 24 )\n and EncounterInpatient.status = 'finished'</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Measure Population Exclusion</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Measure Population Exclusion":\n "Encounter with Discharge for Hospice Care"\n union "Encounter with Hospice during Eligible Encounter"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Measure Observation</td>\n <td>\n \n <pre><code class=\"language-cql\">define function "Measure Observation 4"(NutritionCarePlan Encounter):\n if "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral" contains NutritionCarePlan then 0 \n 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 \n else if "Encounter with Nutrition Assessment Status Moderately Or Severely Malnourished" contains NutritionCarePlan then 1 \n else 0 \n else 0 \n else 0</code></pre>\n \n </td>\n </tr>\n \n \n \n <td> 675761f046b6174510cfee0f </td>\n <td colspan=\"3\" style=\"padding-left: 4px;\">\n \n <b>Group scoring:</b>\n \n <span> continuous-variable </span>\n \n \n\n \n\n \n\n \n\n \n <tr>\n \n <th scope=\"row\"><b>Type: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <span>Outcome </span>\n </p>\n \n \n \n </td>\n \n </tr>\n \n\n \n\n \n\n \n\n \n\n </td>\n \n <tr>\n <td/>\n <td/>\n <td>Initial Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Initial Population":\n "Measure Population"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Measure Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Measure Population":\n [Encounter: "Encounter Inpatient"] EncounterInpatient\n where EncounterInpatient.period ends during day of "Measurement Period"\n and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18\n and ( duration in hours of EncounterInpatient.period >= 24 )\n and EncounterInpatient.status = 'finished'</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Measure Population Exclusion</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Measure Population Exclusion":\n "Encounter with Discharge for Hospice Care"\n union "Encounter with Hospice during Eligible Encounter"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Measure Observation</td>\n <td>\n \n <pre><code class=\"language-cql\">define function "Measure Observation Total Malnutrition Components Score"(QualifyingEncounter Encounter):\n Sum({ "Measure Observation 1"(QualifyingEncounter), "Measure Observation 2"(QualifyingEncounter), "Measure Observation 3"(QualifyingEncounter), "Measure Observation 4"(QualifyingEncounter) })</code></pre>\n \n </td>\n </tr>\n \n \n \n <td> 675761f046b6174510cfee10 </td>\n <td colspan=\"3\" style=\"padding-left: 4px;\">\n \n <b>Group scoring:</b>\n \n <span> continuous-variable </span>\n \n \n\n \n\n \n\n \n\n \n <tr>\n \n <th scope=\"row\"><b>Type: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <span>Outcome </span>\n </p>\n \n \n \n </td>\n \n </tr>\n \n\n \n\n \n\n \n\n \n\n </td>\n \n <tr>\n <td/>\n <td/>\n <td>Initial Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Initial Population":\n "Measure Population"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Measure Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Measure Population":\n [Encounter: "Encounter Inpatient"] EncounterInpatient\n where EncounterInpatient.period ends during day of "Measurement Period"\n and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18\n and ( duration in hours of EncounterInpatient.period >= 24 )\n and EncounterInpatient.status = 'finished'</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Measure Population Exclusion</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Measure Population Exclusion":\n "Encounter with Discharge for Hospice Care"\n union "Encounter with Hospice during Eligible Encounter"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Measure Observation</td>\n <td>\n \n <pre><code class=\"language-cql\">define function "Measure Observation Total Malnutrition Care Score as Percentage"(QualifyingEncounter Encounter):\n 100 * ( "Measure Observation Total Malnutrition Components Score"(QualifyingEncounter) / "Total Malnutrition Care Score Eligible Occurrences"(QualifyingEncounter) )</code></pre>\n \n </td>\n </tr>\n \n \n \n </tr>\n </table>\n \n\n <table class=\"grid-dict\">\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>SupplementalDataElements</td>\n \n \n <td>SDE Sex</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "SDE Sex":\n case\n when Patient.gender = 'male' then "M"\n when Patient.gender = 'female' then "F"\n else null\n end</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS986FHIRMalnutritionScore</td>\n \n \n <td>SDE Patient sex for quality measurement</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "SDE Patient sex for quality measurement":\n SDE."SDE Sex"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS986FHIRMalnutritionScore</td>\n \n \n <td>Measure Population</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Measure Population":\n [Encounter: "Encounter Inpatient"] EncounterInpatient\n where EncounterInpatient.period ends during day of "Measurement Period"\n and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18\n and ( duration in hours of EncounterInpatient.period >= 24 )\n and EncounterInpatient.status = 'finished'</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS986FHIRMalnutritionScore</td>\n \n \n <td>Encounter with Discharge for Hospice Care</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Encounter with Discharge for Hospice Care":\n ( "Measure Population" QualifyingEncounter\n where QualifyingEncounter.status = 'finished'\n and ( QualifyingEncounter.hospitalization.dischargeDisposition in "Hospice Care Referral or Admission" )\n )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS986FHIRMalnutritionScore</td>\n \n \n <td>Encounter with Hospice during Eligible Encounter</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Encounter with Hospice during Eligible Encounter":\n from\n "Measure Population" QualifyingEncounter,\n ( ["ServiceRequest": code in "Hospice Status"]\n union ["Procedure": "Hospice Status"] ) HospiceStatus\n where "Hospice Status" contains HospiceStatus.code as Concept\n and HospiceStatus.status in { 'active', 'completed' }\n and Coalesce(start of HospiceStatus.performed.toInterval(), HospiceStatus.authoredOn) during day of QualifyingEncounter."hospitalizationWithObservation" ( )\n return QualifyingEncounter</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS986FHIRMalnutritionScore</td>\n \n \n <td>Measure Population Exclusion</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Measure Population Exclusion":\n "Encounter with Discharge for Hospice Care"\n union "Encounter with Hospice during Eligible Encounter"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>SupplementalDataElements</td>\n \n \n <td>SDE Race</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "SDE Race":\n Patient.race R\n return Tuple {\n codes: R.ombCategory union R.detailed,\n display: R.text\n }</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS986FHIRMalnutritionScore</td>\n \n \n <td>SDE Race</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "SDE Race":\n SDE."SDE Race"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>SupplementalDataElements</td>\n \n \n <td>SDE Payer</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "SDE Payer":\n [Coverage: type in "Payer Type"] Payer\n return {\n code: Payer.type,\n period: Payer.period\n }</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS986FHIRMalnutritionScore</td>\n \n \n <td>SDE Payer Type</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "SDE Payer Type":\n SDE."SDE Payer"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS986FHIRMalnutritionScore</td>\n \n \n <td>Initial Population</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Initial Population":\n "Measure Population"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>SupplementalDataElements</td>\n \n \n <td>SDE Ethnicity</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "SDE Ethnicity":\n Patient.ethnicity E\n return Tuple {\n codes: { E.ombCategory } union E.detailed,\n display: E.text\n }</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS986FHIRMalnutritionScore</td>\n \n \n <td>SDE Ethnicity</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "SDE Ethnicity":\n SDE."SDE Ethnicity"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CQMCommon</td>\n \n \n <td>hospitalizationWithObservation</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@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\n*/\ndefine fluent function hospitalizationWithObservation(TheEncounter Encounter ):\n TheEncounter Visit\n \t\tlet ObsVisit: Last([Encounter: "Observation Services"] LastObs\n \t\t\t\twhere LastObs.status = 'finished'\n and LastObs.period ends 1 hour or less on or before start of Visit.period\n \t\t\t\tsort by end of period\n \t\t\t),\n \t\t\tVisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n \t\t\tEDVisit: Last([Encounter: "Emergency Department Visit"] LastED\n \t\t\t\twhere LastED.status = 'finished'\n and LastED.period ends 1 hour or less on or before VisitStart\n \t\t\t\tsort by end of period\n \t\t\t)\n \t\treturn Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>FHIRHelpers</td>\n \n \n <td>ToString</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function ToString(value uri): value.value</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>FHIRHelpers</td>\n \n \n <td>ToCode</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n if coding is null then\n null\n else\n System.Code {\n code: coding.code.value,\n system: coding.system.value,\n version: coding.version.value,\n display: coding.display.value\n }</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS986FHIRMalnutritionScore</td>\n \n \n <td>Measure Observation 1</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function "Measure Observation 1"(MalnutritionRiskScreening Encounter):\n if "Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral" contains MalnutritionRiskScreening then 1 \n else 0</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS986FHIRMalnutritionScore</td>\n \n \n <td>Measure Observation Total Malnutrition Components Score</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function "Measure Observation Total Malnutrition Components Score"(QualifyingEncounter Encounter):\n Sum({ "Measure Observation 1"(QualifyingEncounter), "Measure Observation 2"(QualifyingEncounter), "Measure Observation 3"(QualifyingEncounter), "Measure Observation 4"(QualifyingEncounter) })</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS986FHIRMalnutritionScore</td>\n \n \n <td>Measure Observation 2</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function "Measure Observation 2"(NutritionAssessment Encounter):\n if "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral" contains NutritionAssessment then 0 \n 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 \n else 0 \n else 0</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS986FHIRMalnutritionScore</td>\n \n \n <td>Measure Observation 3</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function "Measure Observation 3"(MalnutritionDiagnosis Encounter):\n if "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral" contains MalnutritionDiagnosis then 0 \n 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 \n else if "Encounter with Nutrition Assessment Status Moderately Or Severely Malnourished" contains MalnutritionDiagnosis then 1 \n else 0 \n else 0 \n else 0</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS986FHIRMalnutritionScore</td>\n \n \n <td>Measure Observation 4</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function "Measure Observation 4"(NutritionCarePlan Encounter):\n if "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral" contains NutritionCarePlan then 0 \n 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 \n else if "Encounter with Nutrition Assessment Status Moderately Or Severely Malnourished" contains NutritionCarePlan then 1 \n else 0 \n else 0 \n else 0</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS986FHIRMalnutritionScore</td>\n \n \n <td>Measure Observation Total Malnutrition Care Score as Percentage</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function "Measure Observation Total Malnutrition Care Score as Percentage"(QualifyingEncounter Encounter):\n 100 * ( "Measure Observation Total Malnutrition Components Score"(QualifyingEncounter) / "Total Malnutrition Care Score Eligible Occurrences"(QualifyingEncounter) )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS986FHIRMalnutritionScore</td>\n \n \n <td>Total Malnutrition Care Score Eligible Occurrences</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function "Total Malnutrition Care Score Eligible Occurrences"(QualifyingEncounter Encounter):\n if ( ( "Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral" contains QualifyingEncounter )\n and ( "Encounter with Malnutrition Risk Screening Not At Risk" contains QualifyingEncounter )\n )\n and not ( "Encounter with Dietitian Referral" contains QualifyingEncounter ) then 1 \n else if ( ( ( "Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral" contains QualifyingEncounter )\n and ( "Encounter with Malnutrition Risk Screening At Risk" contains QualifyingEncounter )\n )\n or ( "Encounter with Dietitian Referral" contains QualifyingEncounter )\n )\n and ( "Encounter with Nutrition Assessment Not or Mildly Malnourished" contains QualifyingEncounter )\n or not ( "Most Recent Encounter with Nutrition Assessment and Identified Status" contains QualifyingEncounter ) then 2 \n else 4</code></pre>\n </td>\n \n </tr>\n \n </table>\n </td>\n </tr>\n \n \n \n\n </table>\n</div>"
},
"contained" : [
{
"resourceType" : "Library",
"id" : "effective-data-requirements",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://hl7.org/fhir/administrative-gender",
"code" : "M",
"display" : "Male"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://hl7.org/fhir/administrative-gender",
"code" : "F",
"display" : "Female"
}
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "SupplementalDataElements"
},
{
"url" : "name",
"valueString" : "SDE Sex"
},
{
"url" : "statement",
"valueString" : "define \"SDE Sex\":\n case\n when Patient.gender = 'male' then \"M\"\n when Patient.gender = 'female' then \"F\"\n else null\n end"
},
{
"url" : "displaySequence",
"valueInteger" : 0
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS986FHIRMalnutritionScore"
},
{
"url" : "name",
"valueString" : "SDE Patient sex for quality measurement"
},
{
"url" : "statement",
"valueString" : "define \"SDE Patient sex for quality measurement\":\n SDE.\"SDE Sex\""
},
{
"url" : "displaySequence",
"valueInteger" : 1
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS986FHIRMalnutritionScore"
},
{
"url" : "name",
"valueString" : "Measure Population"
},
{
"url" : "statement",
"valueString" : "define \"Measure Population\":\n [Encounter: \"Encounter Inpatient\"] EncounterInpatient\n where EncounterInpatient.period ends during day of \"Measurement Period\"\n and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18\n and ( duration in hours of EncounterInpatient.period >= 24 )\n and EncounterInpatient.status = 'finished'"
},
{
"url" : "displaySequence",
"valueInteger" : 2
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS986FHIRMalnutritionScore"
},
{
"url" : "name",
"valueString" : "Encounter with Discharge for Hospice Care"
},
{
"url" : "statement",
"valueString" : "define \"Encounter with Discharge for Hospice Care\":\n ( \"Measure Population\" QualifyingEncounter\n where QualifyingEncounter.status = 'finished'\n and ( QualifyingEncounter.hospitalization.dischargeDisposition in \"Hospice Care Referral or Admission\" )\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 3
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS986FHIRMalnutritionScore"
},
{
"url" : "name",
"valueString" : "Encounter with Hospice during Eligible Encounter"
},
{
"url" : "statement",
"valueString" : "define \"Encounter with Hospice during Eligible Encounter\":\n from\n \"Measure Population\" QualifyingEncounter,\n ( [\"ServiceRequest\": code in \"Hospice Status\"]\n union [\"Procedure\": \"Hospice Status\"] ) HospiceStatus\n where \"Hospice Status\" contains HospiceStatus.code as Concept\n and HospiceStatus.status in { 'active', 'completed' }\n and Coalesce(start of HospiceStatus.performed.toInterval(), HospiceStatus.authoredOn) during day of QualifyingEncounter.\"hospitalizationWithObservation\" ( )\n return QualifyingEncounter"
},
{
"url" : "displaySequence",
"valueInteger" : 4
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS986FHIRMalnutritionScore"
},
{
"url" : "name",
"valueString" : "Measure Population Exclusion"
},
{
"url" : "statement",
"valueString" : "define \"Measure Population Exclusion\":\n \"Encounter with Discharge for Hospice Care\"\n union \"Encounter with Hospice during Eligible Encounter\""
},
{
"url" : "displaySequence",
"valueInteger" : 5
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "SupplementalDataElements"
},
{
"url" : "name",
"valueString" : "SDE Race"
},
{
"url" : "statement",
"valueString" : "define \"SDE Race\":\n Patient.race R\n return Tuple {\n codes: R.ombCategory union R.detailed,\n display: R.text\n }"
},
{
"url" : "displaySequence",
"valueInteger" : 6
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS986FHIRMalnutritionScore"
},
{
"url" : "name",
"valueString" : "SDE Race"
},
{
"url" : "statement",
"valueString" : "define \"SDE Race\":\n SDE.\"SDE Race\""
},
{
"url" : "displaySequence",
"valueInteger" : 7
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "SupplementalDataElements"
},
{
"url" : "name",
"valueString" : "SDE Payer"
},
{
"url" : "statement",
"valueString" : "define \"SDE Payer\":\n [Coverage: type in \"Payer Type\"] Payer\n return {\n code: Payer.type,\n period: Payer.period\n }"
},
{
"url" : "displaySequence",
"valueInteger" : 8
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS986FHIRMalnutritionScore"
},
{
"url" : "name",
"valueString" : "SDE Payer Type"
},
{
"url" : "statement",
"valueString" : "define \"SDE Payer Type\":\n SDE.\"SDE Payer\""
},
{
"url" : "displaySequence",
"valueInteger" : 9
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS986FHIRMalnutritionScore"
},
{
"url" : "name",
"valueString" : "Initial Population"
},
{
"url" : "statement",
"valueString" : "define \"Initial Population\":\n \"Measure Population\""
},
{
"url" : "displaySequence",
"valueInteger" : 10
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "SupplementalDataElements"
},
{
"url" : "name",
"valueString" : "SDE Ethnicity"
},
{
"url" : "statement",
"valueString" : "define \"SDE Ethnicity\":\n Patient.ethnicity E\n return Tuple {\n codes: { E.ombCategory } union E.detailed,\n display: E.text\n }"
},
{
"url" : "displaySequence",
"valueInteger" : 11
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS986FHIRMalnutritionScore"
},
{
"url" : "name",
"valueString" : "SDE Ethnicity"
},
{
"url" : "statement",
"valueString" : "define \"SDE Ethnicity\":\n SDE.\"SDE Ethnicity\""
},
{
"url" : "displaySequence",
"valueInteger" : 12
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CQMCommon"
},
{
"url" : "name",
"valueString" : "hospitalizationWithObservation"
},
{
"url" : "statement",
"valueString" : "/*\n@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\n*/\ndefine fluent function hospitalizationWithObservation(TheEncounter Encounter ):\n TheEncounter Visit\n \t\tlet ObsVisit: Last([Encounter: \"Observation Services\"] LastObs\n \t\t\t\twhere LastObs.status = 'finished'\n and LastObs.period ends 1 hour or less on or before start of Visit.period\n \t\t\t\tsort by end of period\n \t\t\t),\n \t\t\tVisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n \t\t\tEDVisit: Last([Encounter: \"Emergency Department Visit\"] LastED\n \t\t\t\twhere LastED.status = 'finished'\n and LastED.period ends 1 hour or less on or before VisitStart\n \t\t\t\tsort by end of period\n \t\t\t)\n \t\treturn Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]"
},
{
"url" : "displaySequence",
"valueInteger" : 13
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "FHIRHelpers"
},
{
"url" : "name",
"valueString" : "ToString"
},
{
"url" : "statement",
"valueString" : "define function ToString(value uri): value.value"
},
{
"url" : "displaySequence",
"valueInteger" : 14
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "FHIRHelpers"
},
{
"url" : "name",
"valueString" : "ToCode"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n if coding is null then\n null\n else\n System.Code {\n code: coding.code.value,\n system: coding.system.value,\n version: coding.version.value,\n display: coding.display.value\n }"
},
{
"url" : "displaySequence",
"valueInteger" : 15
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS986FHIRMalnutritionScore"
},
{
"url" : "name",
"valueString" : "Measure Observation 1"
},
{
"url" : "statement",
"valueString" : "define function \"Measure Observation 1\"(MalnutritionRiskScreening Encounter):\n if \"Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral\" contains MalnutritionRiskScreening then 1 \n else 0"
},
{
"url" : "displaySequence",
"valueInteger" : 16
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS986FHIRMalnutritionScore"
},
{
"url" : "name",
"valueString" : "Measure Observation Total Malnutrition Components Score"
},
{
"url" : "statement",
"valueString" : "define function \"Measure Observation Total Malnutrition Components Score\"(QualifyingEncounter Encounter):\n Sum({ \"Measure Observation 1\"(QualifyingEncounter), \"Measure Observation 2\"(QualifyingEncounter), \"Measure Observation 3\"(QualifyingEncounter), \"Measure Observation 4\"(QualifyingEncounter) })"
},
{
"url" : "displaySequence",
"valueInteger" : 17
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS986FHIRMalnutritionScore"
},
{
"url" : "name",
"valueString" : "Measure Observation 2"
},
{
"url" : "statement",
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"valueString" : "define function \"Measure Observation 3\"(MalnutritionDiagnosis Encounter):\n if \"Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral\" contains MalnutritionDiagnosis then 0 \n 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 \n else if \"Encounter with Nutrition Assessment Status Moderately Or Severely Malnourished\" contains MalnutritionDiagnosis then 1 \n else 0 \n else 0 \n else 0"
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"value" : "3592e",
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"code" : "publisher",
"display" : "Publisher"
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},
"system" : "https://madie.cms.gov/measure/cmsId",
"value" : "986FHIR",
"assigner" : {
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],
"version" : "0.2.002",
"name" : "CMS986FHIRMalnutritionScore",
"title" : "Malnutrition Care ScoreFHIR",
"status" : "active",
"experimental" : false,
"date" : "2024-12-18T21:25:47+00:00",
"publisher" : "Academy of Nutrition and Dietetics",
"contact" : [
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"value" : "www.eatrightpro.org"
}
]
}
],
"description" : "This measure assesses the percentage of eligible encounters of adults aged 18 years and older at the start of the eligible encounter during the measurement period, with a length of stay equal to or greater than 24 hours, who received optimal malnutrition care where care performed was appropriate to the patient's level of malnutrition risk and severity. Malnutrition care best practices recommend that for each eligible encounter, adult inpatients are (1) screened for malnutrition risk or for a dietitian referral order to be placed, (2) assessed by a registered dietitian (RD) or registered dietitian nutritionist (RDN) to confirm findings of malnutrition risk, and if identified with a \"moderate\" or \"severe\" malnutrition status in the current performed malnutrition assessment, (3) receive a \"moderate\" or \"severe\" malnutrition diagnosis by a physician or eligible provider as defined by the Centers for Medicare & Medicaid Services (CMS), and (4) have a current nutrition care plan performed by an RD/RDN.",
"purpose" : "UNKNOWN",
"usage" : "This measure is constructed of four clinically eligible components that are aggregated as an arithmetic average of eligible encounters and expressed as a percentage. The four populations used to calculate the four components may differ and the measure observations for the four components do not need to be performed sequentially. \n\nThis eCQM is an episode-based measure. An episode is defined as each eligible encounter with a length of stay of greater than or equal to 24 hours among individuals 18 years of age and older at the start of the inpatient encounter. \n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS986v5.\n\nPlease refer to the HL7 QI-Core Implementation Guide\n(https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and\nmapping recommendations from QDM to QI-Core\n4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).",
"copyright" : "Copyright (C) Academy of Nutrition and Dietetics 2025 \n\nLimited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. \n\nLOINC(R) copyright 2004-2024 Regenstrief Institute, Inc. \n\nICD-10 copyright 2024 World Health Organization. \n\nThis material contains SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2024. International Health Terminology Standards Development Organisation.\nAll Rights Reserved",
"effectivePeriod" : {
"start" : "2026-01-01",
"end" : "2026-12-31"
},
"author" : [
{
"name" : "Academy of Nutrition and Dietetics",
"telecom" : [
{
"system" : "url",
"value" : "www.eatrightpro.org"
}
]
}
],
"library" : [
🔗 "https://madie.cms.gov/Library/CMS986FHIRMalnutritionScore"
],
"disclaimer" : "This performance measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. \n\nTHE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND. \n\nDue to technical limitations, copyright is indicated by (C) or [C], registered trademarks are indicated by (R) or [R], and unregistered trademarks are indicated by (TM) or [TM].",
"rationale" : "Malnutrition has been documented in approximately one-third of patients in developed countries upon admission to the hospital, and, if left untreated, can significantly impact important clinical outcomes (Mogensen et al., 2019). Adult patients with malnutrition have a significantly longer hospital length of stay (LOS) (Hudson, Chittams, Griffith, & Compher, 2018 and Mosquera et al., 2016) and significantly more patients with malnutrition have a LOS of >7 days when compared to their well-nourished counterparts. Additionally, both higher rates of 30-day readmission and a significantly higher likelihood of 30-day readmission are observed in these patients (Mogensen et al., 2019; Hiller, Shaw, & Fabri, 2016; Mosquera et al., 2016). Lastly, hospitalized adults with malnutrition have an increased likelihood of death within 90 days of discharge (Hiller, Shaw, & Fabri, 2016). These consequences demonstrate the importance of addressing malnutrition in hospitalized patients to improve outcomes. \n\nThe components of this measure are supported by clinical guidance that recommends (1) malnutrition screening for patients admitted into the acute inpatient care setting; (2) nutrition assessment for patients identified at risk for malnutrition or with a dietitian referral order to form the basis for appropriate nutrition interventions; (3) appropriate recognition, diagnosis, and documentation of the nutrition status of a patient in order to (4) address their condition with an appropriate plan of care and communicate patient needs to other care providers (Academy of Nutrition and Dietetics, 2017).\n\nThe process for risk identification, assessment, diagnosis, and treatment of malnutrition necessitates a multi-disciplinary care team that begins with the identification of an initial risk population for a more thorough assessment by the RD/RDN. The RD/RDN, in turn, provides the necessary treatment recommendations to address nutrition problems utilizing a nutrition diagnosis and care plan, along with the clinical indicators that inform a medical diagnosis of malnutrition completed by a physician or eligible clinician as defined by CMS. The four measure observations individually provide a portion of the necessary information on the quality of care for patients at risk for or with malnutrition. Therefore, the four components are summed and averaged according to a patient’s degree of malnutrition and/or malnutrition risk to determine an encounter-level Malnutrition Care Score.\n\nHigh performance on this measure requires malnutrition risk screening and/or referral to RDNs for appropriate nutrition assessment for identified patients during the current hospitalization. For patients identified with moderate or severe malnutrition by the nutrition assessment, best practice also recommends a medical diagnosis by a physician or other eligible clinician and the execution of the nutrition care plan by an RD/RDN. Evidence demonstrates that implementing a standardized protocol for screening, assessment, diagnosis, and care planning results in better identification of patients with malnutrition and subsequent improvements in rates of associated nutrition interventions. Outcomes modeling demonstrates benefits to patient outcomes, including reduced risk of 30-day readmissions, length of hospital stays, and complications, as well as improved quality of life after hospitalization (Sriram et al., 2016).",
"clinicalRecommendationStatement" : "American Society for Parenteral and Enteral Nutrition (ASPEN) clinical guidelines on nutrition screening, assessment, and intervention in adults indicate that screening for nutrition risk is suggested for hospitalized patients (Mueller, Compher, Druyan, & ASPEN Board of Directors, 2011).\n\nThis guideline places nutrition assessment and screening in the context of intervention as part of nutrition care. Screening those individuals at risk for malnutrition is the first step in nutrition care as risk for malnutrition, identified by nutrition screening, is associated with longer length of hospital stay, complications, and mortality. Malnutrition screening is also a predictor of mortality risk. \n\nMalnourished patients, identified by nutrition assessment tools, have more complications and longer hospitalizations than do patients with optimal nutrition status. Such patients, identified by nutrition assessment tools, have more infectious and noninfectious complications, longer hospital length of stay, and greater mortality. \n\nNutrition intervention is recommended for patients identified by assessment as at risk for malnutrition or malnourished. Nutrition intervention with associated monitoring and evaluation plants in patients identified as at risk for malnutrition or malnourished improves clinical outcomes. Nutrition interventions and their associated monitoring and evaluation plans in malnourished patients are associated with improved nutrition status, nutrient intake, physical function, and quality of life. Hospital readmissions, inpatient length of stay, and complications were reduced with increased nutrition support interventions.",
"guidance" : "This measure is constructed of four clinically eligible components that are aggregated as an arithmetic average of eligible encounters and expressed as a percentage. The four populations used to calculate the four components may differ and the measure observations for the four components do not need to be performed sequentially. \n\nThis eCQM is an episode-based measure. An episode is defined as each eligible encounter with a length of stay of greater than or equal to 24 hours among individuals 18 years of age and older at the start of the inpatient encounter. \n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS986v5.\n\nPlease refer to the HL7 QI-Core Implementation Guide\n(https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and\nmapping recommendations from QDM to QI-Core\n4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).",
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"display" : "Initial Population"
}
]
},
"description" : "Eligible encounters during the measurement period with length of stay of 24 hours or more among individuals 18 years of age and older at the start of the inpatient encounter",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Initial Population"
}
},
{
"id" : "bc3d85e4-8f7d-4cc7-b260-9e8dc2d0848f",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "measure-population",
"display" : "Measure Population"
}
]
},
"description" : "Equals Initial Population",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Measure Population"
}
},
{
"id" : "ca60181c-e0e1-4427-91a3-f00a2e0090b9",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "measure-population-exclusion",
"display" : "Measure Population Exclusion"
}
]
},
"description" : "Encounters with hospice care ordered during the inpatient qualifying encounter and encounters with a discharge disposition of hospice",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Measure Population Exclusion"
}
},
{
"id" : "087da320-e1ff-48ff-9b16-3990ff169148",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod",
"valueString" : "Sum"
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference",
"valueString" : "bc3d85e4-8f7d-4cc7-b260-9e8dc2d0848f"
}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "measure-observation",
"display" : "Measure Observation"
}
]
},
"description" : "Component Measure 1: Eligible encounters for patients with a current \"Malnutrition Risk Screening\" performed by an eligible healthcare clinician or a Dietitian Referral. \n\n\"Measure Observation 1\" is \"Encounters with Malnutrition Risk Screening and Identified Result or a Dietitian Referral\" \n\n\"Measure Observation 1\" identifies eligible encounters where a \"Malnutrition Risk Screening\" was performed or authored during the encounter (including preceding observation or emergency department encounters) with an identified \"Malnutrition Screening Finding of Not At Risk Result\" or \"Malnutrition Screening Finding of At Risk Result\". It also identifies an eligible encounter where there is a Dietitian Referral, whether there is a \"Malnutrition Risk Screening\" performed or not.",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Measure Observation 1"
}
}
]
},
{
"id" : "675761f046b6174510cfee0c",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
"code" : "continuous-variable",
"display" : "Continuous Variable"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
"valueCode" : "Encounter"
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-type",
"code" : "outcome",
"display" : "Outcome"
}
]
}
}
],
"description" : "Nutrition Assessment",
"population" : [
{
"id" : "1cad8fc2-f1f6-446c-9e7b-9d547a1b38fd",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "initial-population",
"display" : "Initial Population"
}
]
},
"description" : "Eligible encounters during the measurement period with length of stay of 24 hours or more among individuals 18 years of age and older at the start of the inpatient encounter",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Initial Population"
}
},
{
"id" : "61fd8f89-4579-4d93-a27f-a2ef3daaa94d",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "measure-population",
"display" : "Measure Population"
}
]
},
"description" : "Equals Initial Population",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Measure Population"
}
},
{
"id" : "1d4ffe03-1baf-4195-a012-f58bdd808bc2",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "measure-population-exclusion",
"display" : "Measure Population Exclusion"
}
]
},
"description" : "Encounters with hospice care ordered during the inpatient qualifying encounter and encounters with a discharge disposition of hospice",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Measure Population Exclusion"
}
},
{
"id" : "a816b04b-5147-476c-9136-819b5734be37",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod",
"valueString" : "Sum"
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference",
"valueString" : "61fd8f89-4579-4d93-a27f-a2ef3daaa94d"
}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "measure-observation",
"display" : "Measure Observation"
}
]
},
"description" : "Component Measure 2: Eligible encounters for patients with a current \"Nutrition Assessment\" performed by an RD/RDN, after a \"Malnutrition Screening Finding of At Risk Result\" during the current encounter or a \"Dietitian Referral\" order from a physician or eligible clinician during the current encounter. \n\n\"Measure Observation 2\" is \"Encounter with Nutrition Assessment and Identified Status\" \n\n\"Measure Observation 2\" identifies eligible encounters where a \"Nutrition Assessment\" was performed or authored during the encounter (including preceding observation or emergency department encounters) with an identified \"Nutrition Assessment Status Finding of Well Nourished or Not Malnourished or Mildly Malnourished\", \"Nutrition Assessment Status Finding of Moderately Malnourished\", or \"Nutrition Assessment Status Finding of Severely Malnourished\".",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Measure Observation 2"
}
}
]
},
{
"id" : "675761f046b6174510cfee0d",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
"code" : "continuous-variable",
"display" : "Continuous Variable"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
"valueCode" : "Encounter"
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-type",
"code" : "outcome",
"display" : "Outcome"
}
]
}
}
],
"description" : "Malnutrition Diagnosis",
"population" : [
{
"id" : "2ed7e4ba-50d2-4b51-bc06-c2bf9ee27bd1",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "initial-population",
"display" : "Initial Population"
}
]
},
"description" : "Eligible encounters during the measurement period with length of stay of 24 hours or more among individuals 18 years of age and older at the start of the inpatient encounter",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Initial Population"
}
},
{
"id" : "67cef5f1-a6ec-4c0e-a077-b8b867431182",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "measure-population",
"display" : "Measure Population"
}
]
},
"description" : "Equals Initial Population",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Measure Population"
}
},
{
"id" : "31429f74-0129-41bd-9dfd-41d8246a7480",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "measure-population-exclusion",
"display" : "Measure Population Exclusion"
}
]
},
"description" : "Encounters with hospice care ordered during the inpatient qualifying encounter and encounters with a discharge disposition of hospice-",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Measure Population Exclusion"
}
},
{
"id" : "f936bb5d-3610-453b-abb1-d7358aca957a",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod",
"valueString" : "Sum"
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference",
"valueString" : "67cef5f1-a6ec-4c0e-a077-b8b867431182"
}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "measure-observation",
"display" : "Measure Observation"
}
]
},
"description" : "Component Measure 3: Eligible encounters for patients with a documented \"Malnutrition Diagnosis\" as a result of a \"Nutrition Assessment Status Finding of Moderately Malnourished\" OR \"Nutrition Assessment Status Finding of Severely Malnourished\". \n\n\"Measure Observation 3\" is \"Encounters with Malnutrition Diagnosis\"\n\n\"Measure Observation 3\" identifies eligible encounters where a \"Malnutrition Diagnosis\" was active during the encounter (including preceding observation or emergency department encounters).",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Measure Observation 3"
}
}
]
},
{
"id" : "675761f046b6174510cfee0e",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
"code" : "continuous-variable",
"display" : "Continuous Variable"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
"valueCode" : "Encounter"
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-type",
"code" : "outcome",
"display" : "Outcome"
}
]
}
}
],
"description" : "Nutrition Care Plan",
"population" : [
{
"id" : "57378bbc-9b1d-40da-b945-603862bb6ba4",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "initial-population",
"display" : "Initial Population"
}
]
},
"description" : "Eligible encounters during the measurement period with length of stay of 24 hours or more among individuals 18 years of age and older at the start of the inpatient encounter",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Initial Population"
}
},
{
"id" : "aaabf807-f476-4158-96dc-d6f9e2e360c4",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "measure-population",
"display" : "Measure Population"
}
]
},
"description" : "Equals Initial Population",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Measure Population"
}
},
{
"id" : "24ab8637-e79a-4cdc-b9cf-ee512a4974c4",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "measure-population-exclusion",
"display" : "Measure Population Exclusion"
}
]
},
"description" : "Encounters with hospice care ordered during the inpatient qualifying encounter and encounters with a discharge disposition of hospice",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Measure Population Exclusion"
}
},
{
"id" : "e7adef10-7076-4e5a-8643-95ca17d02ecf",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod",
"valueString" : "Sum"
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference",
"valueString" : "aaabf807-f476-4158-96dc-d6f9e2e360c4"
}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "measure-observation",
"display" : "Measure Observation"
}
]
},
"description" : "Component Measure 4: Eligible encounters for patients with a current \"Nutrition Care Plan\" performed as a result of a current \"Nutrition Assessment Status Finding of Moderately Malnourished\" OR current “Nutrition Assessment Status Finding of Severely Malnourished”. \n\n“Measure Observation 4” is “Encounters with Nutrition Care Plan”\n\n\"Measure Observation 4\" identifies eligible encounters where a \"Nutrition Care Plan\" was performed or authored during the encounter (including preceding observation or emergency department encounters). ",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Measure Observation 4"
}
}
]
},
{
"id" : "675761f046b6174510cfee0f",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
"code" : "continuous-variable",
"display" : "Continuous Variable"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
"valueCode" : "Encounter"
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-type",
"code" : "outcome",
"display" : "Outcome"
}
]
}
}
],
"description" : "Total Malnutrition Care Components",
"population" : [
{
"id" : "d3214243-5af2-4430-84a1-861477bee9e3",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "initial-population",
"display" : "Initial Population"
}
]
},
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Initial Population"
}
},
{
"id" : "7137d595-07cf-4680-a21e-b5380d5e6f20",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "measure-population",
"display" : "Measure Population"
}
]
},
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Measure Population"
}
},
{
"id" : "76fdb80b-7dfc-4d3b-8e81-00ecda865c06",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "measure-population-exclusion",
"display" : "Measure Population Exclusion"
}
]
},
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Measure Population Exclusion"
}
},
{
"id" : "b6dc0a60-e3dc-4ef4-8f58-8728a69cba3c",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod",
"valueString" : "Count"
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference",
"valueString" : "7137d595-07cf-4680-a21e-b5380d5e6f20"
}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "measure-observation",
"display" : "Measure Observation"
}
]
},
"description" : "\"Population 5 Measure Observation Total Malnutrition Components Score\" Calculations\n-For each eligible encounter, Population Criteria 5 represents the subtotal of Measure Observations performed for Population Criteria 1, 2, 3, and 4. Possible values may be 0, 1, 2, 3, or 4.\n \n\"Population 5 Measure Observation Total Malnutrition Components Score\" is (\"Measure Observation 1\" plus \"Measure Observation 2\" plus \"Measure Observation 3\" plus \"Measure Observation 4\")",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Measure Observation Total Malnutrition Components Score"
}
}
]
},
{
"id" : "675761f046b6174510cfee10",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
"code" : "continuous-variable",
"display" : "Continuous Variable"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
"valueCode" : "Encounter"
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-type",
"code" : "outcome",
"display" : "Outcome"
}
]
}
}
],
"description" : "Encounter Malnutrition Care Score",
"population" : [
{
"id" : "bd53026c-9027-4fdb-b5e6-d818dfb017f4",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "initial-population",
"display" : "Initial Population"
}
]
},
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Initial Population"
}
},
{
"id" : "5be2bfc9-e31c-4253-bc4c-395baa4b101b",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "measure-population",
"display" : "Measure Population"
}
]
},
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Measure Population"
}
},
{
"id" : "d7198be8-1437-4dde-bd26-82402849f7f7",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "measure-population-exclusion",
"display" : "Measure Population Exclusion"
}
]
},
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Measure Population Exclusion"
}
},
{
"id" : "dd53fd31-7801-4b1f-ad36-8e688706d0eb",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod",
"valueString" : "Average"
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference",
"valueString" : "5be2bfc9-e31c-4253-bc4c-395baa4b101b"
}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "measure-observation",
"display" : "Measure Observation"
}
]
},
"description" : "\"Population 6 Measure Observation Total Malnutrition Care Score as Percentage\" Calculations:\n-For each eligible encounter, Population Criteria 6 represents the sum of performed Measure Observations 1, 2, 3, and 4 divided by the number of clinically eligible occurrences. \n\n\"Population 6 Measure Observation Total Malnutrition Care Score as Percentage\" is 100 multiplied by (\"Total Malnutrition Components Score\" divided by \"Total Malnutrition Care Score Eligible Occurrences\"). Possible values may be 0, 50, 75, or 100 percent. \n\n\"Total Malnutrition Care Score Eligible Occurrences\" is always 4 except in the following instances:\n-The \"Total Malnutrition Care Score Eligible Occurrences\" is 1 if\n---A \"Malnutrition Risk Screening\" was performed and a \"Malnutrition Screening Finding of Not At Risk Result\" was identified AND \"Dietitian Referral\" was not ordered.\n- The \"Total Malnutrition Care Score Eligible Occurrences\" are 2\n---If a \"Nutrition Assessment\" was performed and a \"Nutrition Status Finding of Well Nourished or Not Malnourished or Mildly Malnourished\" was identified\n--- A \"Malnutrition Risk Screening\" was performed and a \"Malnutrition Screening Finding of Not At Risk Result\" was identified AND \"Dietitian Referral\" was ordered OR a \"Malnutrition Risk Screening\" was performed and a \"Malnutrition Screening Finding of At Risk Result\" was identified but the “Nutrition Assessment” was not performed",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Measure Observation Total Malnutrition Care Score as Percentage"
}
}
]
}
],
"supplementalData" : [
{
"id" : "sde-payer-type",
"usage" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code" : "supplemental-data"
}
]
}
],
"description" : "SDE Payer Type",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "SDE Payer Type"
}
},
{
"id" : "sde-patient-sex-for-quality-measurement",
"usage" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code" : "supplemental-data"
}
]
}
],
"description" : "SDE Patient sex for quality measurement",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "SDE Patient sex for quality measurement"
}
},
{
"id" : "sde-race",
"usage" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code" : "supplemental-data"
}
]
}
],
"description" : "SDE Race",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "SDE Race"
}
},
{
"id" : "sde-ethnicity",
"usage" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code" : "supplemental-data"
}
]
}
],
"description" : "SDE Ethnicity",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "SDE Ethnicity"
}
}
]
}
IG © 2023+ cqframework. Package gov.healthit.ecqi.ecqms#2024.0.0 based on FHIR 4.0.1. Generated 2024-12-19
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