eCQM QICore Content Implementation Guide
2024.0.0 - CI Build
eCQM QICore Content Implementation Guide
2024.0.0 - CI Build
eCQM QICore Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2024.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/ecqm-content-qicore-2024/ and changes regularly. See the Directory of published versions
| Draft as of 2024-07-09 |
{
"resourceType" : "Measure",
"id" : "CesareanBirthFHIR",
"meta" : {
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🔗 "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"🔗 ,
"http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm"🔗 ,
"http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"
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},
"text" : {
"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;\">Cesarean BirthFHIR</td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Id: </b></th>\n <td style=\"padding-left: 4px;\">CesareanBirthFHIR</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Version: </b></th>\n <td style=\"padding-left: 4px;\">0.2.000</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-CesareanBirthFHIR.html\">Cesarean BirthFHIR</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>CMS334FHIR</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:e5be4439-ce75-43cc-aabc-856aec66e841</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:b59bf22e-550d-4bb0-a530-4d5564dfa47a</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>0471e</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>334FHIR</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;\">2025-01-01..2025-12-31</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Status: </b></th>\n <td style=\"padding-left: 4px;\">draft</td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Publisher: </b></th>\n <td style=\"padding-left: 4px;\">The Joint Commission</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Author: </b></th>\n <td style=\"padding-left: 4px;\">The Joint Commission</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>Nulliparous women with a term, singleton baby in a vertex position delivered by cesarean birth</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>Measure specifications are in the Public Domain.</p>\n<p>LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2023 World Health Organization. All Rights Reserved.</p>\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>These performance measures are not clinical guidelines and do not establish a standard of medical care and have not been tested for all potential applications. The measures and specifications are provided without warranty.</p>\n</div></td>\n </tr>\n \n\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Scoring: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <span>Proportion </span>\n </p>\n \n \n \n </td>\n </tr>\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>The removal of any pressure to not perform a cesarean birth has led to a skyrocketing of hospital, state and national cesarean birth (CB) rates. Some hospitals’ CB rates were over 50%. Hospitals with CB rates at 15-20% have infant outcomes that are just as good and better maternal outcomes (Symum & Zayas-Castro, 2023). There is no data that higher rates improve any outcomes, yet the CB rates continue to rise (Bailit, Garrett, Miller, McMahon, & Cefalo, 2002; Main, Bloomfield, & Hunt, 2004). This measure seeks to focus attention on the most variable portion of the CB epidemic, the term labor CB in nulliparous women. This population segment accounts for the large majority of the variable portion of the CB rate and is the area most affected by subjectivity.</p>\n<p>As compared to other CB measures, what is different about Nulliparous, Term, Singleton, Vertex (NTSV) CB rate is that there are clear cut quality improvement activities that can be done to address the differences. Main et al. (2012) found that over 60% of the variation among hospitals can be attributed to first birth labor induction rates and first birth early labor admission rates (Main et al., 2006). The results showed if labor was forced when the cervix was not ready the outcomes were poorer. Rosenstein et al. (2021) also showed that labor and delivery guidelines can make a difference in labor outcomes. Many authors have shown that physician factors, rather than patient characteristics or obstetric diagnoses are the major drivers for the difference in rates within a hospital (Berkowitz, Fiarman, Mojica, Bauman, & de Regt, 1989; Goyert, Bottoms, Treadwell, & Nehra, 1989; Luthy, Malmgren, Zingheim, & Leininger, 2003; Symum & Zayas-Castro, 2023; Main et al., 2006). The dramatic variation in cesarean rates seen in all populations studied is striking. Cesarean rates varied tenfold in US hospitals nationwide across hospitals (Agency for Healthcare Research and Quality [AHRQ], 2002), from 7.1% to 69.9%, and there was a 15-fold variation among low-risk women, from 2.4% to 36.5% (Kozhimannil, Law, & Virnig, 2013).</p>\n<p>A reduction in the number of NTSV patients delivering by cesarean birth will result in increased patient safety, a substantial decrease in maternal and neonatal morbidity and substantial savings in health care costs (Main et al., 2019). Successful quality improvement efforts incorporate audit and feedback strategies combined with provider and nurse education, guidelines and peer review.</p>\n<p>The measure will assist health care organizations to track NTSV patients delivering by cesarean birth to reduce the occurrence. Nulliparous women have 4-6 times the cesarean birth rate than multiparous women thus the NTSV population is the largest driver of primary cesarean birth rate (Sakala, Belanoff, Declercq, 2020). NTSV has a large variation among facilities, thus identifying an important population on which to focus quality improvement efforts.</p>\n<p>In accordance with the American College of Obstetricians and Gynecologists (ACOG) recommendations (2020), cesarean delivery is indicated for patients with active genital lesions of genital herpes or prodromal symptoms (i.e., vulvar pain or burning at delivery) that may indicate viral shedding. Therefore, the measure will exclude encounters with a diagnosis of active genital herpes.</p>\n<p>In addition, the accepted approach to treat placenta accreta spectrum, or the range of pathologic adherence of the placenta that includes placenta increta, placenta percreta, and placenta accreta, as well as placenta previa, is cesarean delivery (ACOG & Society for Maternal-Fetal Medicine (SMFM), 2018). Vasa previa is an indication for cesarean delivery (SMFM Publications Committee, Sinkey, Odibo, & Dashe, 2015). Accordingly, placenta previa, vasa previa, and placenta accreta spectrum are all qualifying conditions to also be excluded from the measure.</p>\n<p>Ultimately, a reduction in primary cesarean births will reduce the number of women having repeat cesarean births (almost 90% of mothers who have a primary cesarean birth will have subsequent cesarean birth (CDC, 2020)). Thus, improvement in the rates of cesarean delivery for the first birth will reduce the morbidity of all future births and avoid all the controversies with trial of labor after cesarean/elective repeat cesarean deliveries.</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>The American College of Obstetrics and Gynecology (ACOG) report, Evaluation of Cesarean Delivery, recognizes the importance of the Nulliparous, Term Singleton Vertex (NTSV) population as the optimal focus for measurement and quality improvement action. A reduction in the number of nulliparous patients with live term singleton newborns in vertex position delivering by cesarean birth will result in increased patient safety, a substantial decrease in maternal and neonatal morbidity and substantial savings in health care costs.</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;\">Vertex position is modeled implicitly, as the measure excludes deliveries with abnormal presentations.\n\nPatients who do not receive prenatal care and have no documented gestational age or estimated due date are implicitly excluded from the measure, as gestational age is required to meet denominator criteria. \n\nThis measure allows for 3 approaches to determine gestational age (GA) in the following order of precedence:\n\n1. The GA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.*\n2. The GA is obtained from a discrete field in the electronic health record. This option is only used when the calculated GA is not available.\n3. The GA is based on ICD10 or SNOMED codes indicative of weeks gestation. This option is only used when results from items #1 and #2 (see above) are not available.\n\nWherever gestational age is mentioned, relative to the delivery, the intent is to capture the last estimated gestational age prior to or at the time of delivery. \n \n*ACOG ReVITALize Guidelines for Calculating Gestational Age: \n \n Gestational Age = (280-(EDD minus Reference Date))/7\n\n--Estimated Due Date (EDD): The best obstetrical Estimated Due Date is determined by last menstrual period if confirmed by early ultrasound or no ultrasound performed, or early ultrasound if no known last menstrual period or the ultrasound is not consistent with last menstrual period, or known date of fertilization (e.g., assisted reproductive technology) \n--Reference Date is the date on which you are trying to determine gestational age. For purposes of this eCQM, Reference Date would be the Date of Delivery. \n\nNote however the calculation may yield a non-whole number and gestational age should be rounded off to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks.\n\nThe timing relationship of relevantDatetime 42 weeks or less before TimeOfDelivery is applied to the data elements of parity, gravida, preterm/term live births for which prenatal records may include relevant information. \n\nNote: The eCQM and chart-based measure slightly digress in the denominator and denominator exclusion logic. The chart-based measure excludes single stillbirth and patients with multiple gestations from the denominator. These concepts are mutually exclusive of the denominator requirement of live singleton newborn and therefore the logic does not address single stillbirth nor multiple gestation.\n\nParity, preterm and term live births may be updated by the electronic health record software or by clinicians during a delivery encounter. To capture the pre-delivery value, organizations may need to create a rule or calculation to capture the number prior to the delivery start time.\n\n"Gravida", "PretermBirth", "TermBirth" and "Parity" results should be submitted via QRDA I as integer and not as number or quantity.\n\nThis eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS334v6.1. \n\nPlease refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).\n\nDefinitions: \nParity: The number of pregnancies reaching 20 weeks gestation regardless of the number of fetuses or outcomes\nGravidity: The number of pregnancies, current and past, regardless of the pregnancy outcome \nPreterm Birth: The number of births >= 20 weeks and < 37 weeks gestation, regardless of outcome \nTerm Birth: The number of births >= 37 weeks gestation, regardless of outcome\nNulliparous: Parity = 0 or Gravidity = 1 or Preterm & Term Births both = 0.\n\nNote regarding Improvement Notation: Within Optimal Range. The Joint Commission does not want to encourage inappropriately low Cesarean rates that may be unsafe to patients. Acceptable PC-02 rates are 30% or lower, however there is not an established threshold for what rate may be too low. PC-06 serves as a balancing measure for PC-02 to guard against any unanticipated or unintended consequences and to identify unforeseen complications that might arise as a result of quality improvement activities and efforts for this measure. In order to identify areas for improvement, hospitals may want to review results based on specific ICD-10 codes or patient populations. Data could then be analyzed further determine specific patterns or trends to help reduce cesarean births.</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>64fb5619da013638e7b3da14</b></th>\n </tr>\n \n \n <tr>\n <td>Initial Population:</td>\n\n \n \n <td>Inpatient hospitalizations for patients age greater than or equal to 8 years and less than 65 admitted to the hospital for inpatient acute care who undergo a delivery procedure with a discharge date during the measurement period</td>\n \n \n\n </tr>\n \n <tr>\n <td>Denominator:</td>\n\n \n \n <td>Inpatient hospitalizations for nulliparous patients who delivered a live term singleton newborn greater than or equal to 37 weeks' gestation\n\nSee Guidance and Definition Sections for more details.</td>\n \n \n\n </tr>\n \n <tr>\n <td>Denominator Exclusion:</td>\n\n \n \n <td>Inpatient hospitalizations for patients with any of the following conditions during the encounter:\n-abnormal presentation\n-genital herpes\n -placenta previa\n-vasa previa\n- placenta accreta\n-placenta increta\n-placenta percreta</td>\n \n \n\n </tr>\n \n <tr>\n <td>Numerator:</td>\n\n \n \n <td>Inpatient hospitalizations for patients who deliver by cesarean section</td>\n \n \n\n </tr>\n \n \n <tr><b>Stratifier Criteria: </b></tr>\n \n <tr>\n \n <td>Stratum:</td>\n \n\n \n <td>None</td>\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 Ethnicity</p>\n \n \n \n \n \n <p>SDE Race</p>\n \n \n \n \n \n <p>SDE Sex</p>\n \n \n \n \n \n <p>SDE Payer</p>\n \n \n \n \n \n <p>SDE Variable Calculated Gestational Age</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, sex and calculated gestational age.; SDE Ethnicity \n SDE Race \n SDE Sex \n SDE Payer \nSDE Variable Calculated Gestational Age\n </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-CesareanBirthFHIR.html\">CesareanBirthFHIR</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/PCMaternal|5.19.000</code></li>\n \n <li><code>Library/CQMCommon|2.2.000</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><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">AdministrativeGender</a></li>\n \n <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html\">Logical Observation Identifiers, Names and Codes (LOINC)</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/2.16.840.1.113762.1.4.1045.59/expansion\">Delivery Procedures</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/2.16.840.1.113762.1.4.1029.369/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.369</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.26/expansion\">Estimated Gestational Age at Delivery</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.68/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.68</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.99/expansion\">Delivery of Singleton</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.282/expansion\">Cesarean Birth</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 <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.105/expansion\">Abnormal Presentation</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.37/expansion\">Placenta Previa</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.110.12.1049/expansion\">Genital Herpes</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 Sex</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>Coding</td>\n </tr>\n \n <tr>\n <td>Numerator</td>\n <td>Out</td>\n <td>0</td>\n <td>*</td>\n <td>Resource</td>\n </tr>\n \n <tr>\n <td>Denominator</td>\n <td>Out</td>\n <td>0</td>\n <td>*</td>\n <td>Resource</td>\n </tr>\n \n <tr>\n <td>SDE Payer</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>Denominator Exclusions</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 Variable Calculated Gestational Age</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 ethnicity\n \n race\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 condition\n \n condition.reference\n \n condition.reference.value\n \n id\n \n id.value\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 period\n \n status\n \n status.value\n \n condition\n \n condition.reference\n \n condition.reference.value\n \n id\n \n id.value\n \n </td>\n <td>\n \n \n ED Visit and OB Triage\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1029.369/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.369</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 condition\n \n condition.reference\n \n condition.reference.value\n \n id\n \n id.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>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 status\n \n status.value\n \n performed\n \n </td>\n <td>\n \n \n Delivery Procedures\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.59/expansion\">Delivery Procedures</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 performed\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Cesarean Birth\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.282/expansion\">Cesarean Birth</a></td>\n </tr>\n \n <tr>\n <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n <td>\n \n code\n \n value\n \n status\n \n status.value\n \n effective\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n <td>\n \n code\n \n value\n \n status\n \n status.value\n \n effective\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n <td>\n \n code\n \n effective\n \n value\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Estimated Gestational Age at Delivery\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.26/expansion\">Estimated Gestational Age at Delivery</a></td>\n </tr>\n \n <tr>\n <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n <td>\n \n code\n \n value\n \n status\n \n status.value\n \n effective\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n <td>\n \n code\n \n effective\n \n status\n \n status.value\n \n value\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n <td>\n \n code\n \n effective\n \n status\n \n status.value\n \n value\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n <td>\n \n code\n \n effective\n \n status\n \n status.value\n \n value\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n <td>\n \n code\n \n effective\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Abnormal Presentation\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.105/expansion\">Abnormal Presentation</a></td>\n </tr>\n \n <tr>\n <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n <td>\n \n id\n \n id.value\n \n code\n \n </td>\n <td>\n \n </td>\n <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 <tr>\n <td>Date and time of obstetric delivery</td>\n <td>93857-1</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html\">http://loinc.org</a></td>\n </tr>\n \n <tr>\n <td>Delivery date Estimated</td>\n <td>11778-8</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html\">http://loinc.org</a></td>\n </tr>\n \n <tr>\n <td>[#] Pregnancies</td>\n <td>11996-6</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html\">http://loinc.org</a></td>\n </tr>\n \n <tr>\n <td>[#] Parity</td>\n <td>11977-6</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html\">http://loinc.org</a></td>\n </tr>\n \n <tr>\n <td>[#] Births.preterm</td>\n <td>11637-6</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html\">http://loinc.org</a></td>\n </tr>\n \n <tr>\n <td>[#] Births.term</td>\n <td>11639-2</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html\">http://loinc.org</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> 64fb5619da013638e7b3da14 </td>\n <td colspan=\"3\" style=\"padding-left: 4px;\">\n \n <b>Group scoring:</b>\n \n <span> proportion </span>\n \n \n\n \n\n \n <b>Measure scoring:</b>\n \n <p style=\"margin-bottom: 5px;\">\n <span>Proportion</span>\n </p>\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 <tr>\n <th scope=\"row\"><b>Rate Aggregation: </b></th>\n <td colspan=\"3\" style=\"padding-left: 4px;\">None</td>\n </tr>\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 PCMaternal."Delivery Encounter with Age Range"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Denominator</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Denominator":\n "Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Denominator Exclusion</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Denominator Exclusions":\n "Delivery Encounter with Abnormal Presentation, Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Numerator</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Numerator":\n "Delivery Encounter with Cesarean Birth"</code></pre>\n \n </td>\n </tr>\n \n \n <tr>\n <td/>\n <td/>\n <td/>\n <td>\n \n None\n \n </td>\n </tr>\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>CesareanBirthFHIR</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 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>CQMCommon</td>\n \n \n <td>Inpatient Encounter</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Inpatient Encounter":\n [Encounter: "Encounter Inpatient"] EncounterInpatient\n\t\twhere EncounterInpatient.status = 'finished'\n\t\tand EncounterInpatient.period ends during day of "Measurement 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>PCMaternal</td>\n \n \n <td>Encounter with Age Range</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Encounter with Age Range":\n CQMCommon."Inpatient Encounter" InpatientEncounter\n where AgeInYearsAt(date from start of InpatientEncounter.period) in Interval[ 8, 65 )</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>PCMaternal</td>\n \n \n <td>Delivery Encounter with Age Range</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Delivery Encounter with Age Range":\n "Encounter with Age Range" EncounterWithAge\n with ["Procedure": "Delivery Procedures"] DeliveryProcedure\n such that DeliveryProcedure.status = 'completed'\n and DeliveryProcedure.performed.toInterval ( ) starts during EncounterWithAge.hospitalizationWithEDOBTriageObservation ()</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>CesareanBirthFHIR</td>\n \n \n <td>Delivery Encounter with Calculated Gestational Age Greater than or Equal to 37 Weeks</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Delivery Encounter with Calculated Gestational Age Greater than or Equal to 37 Weeks":\n PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter\n where DeliveryEncounter.calculatedGestationalAge ( ) >= 37</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>CesareanBirthFHIR</td>\n \n \n <td>Delivery Encounter with Estimated Gestational Age Greater than or Equal to 37 Weeks</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Delivery Encounter with Estimated Gestational Age Greater than or Equal to 37 Weeks":\n PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter\n where DeliveryEncounter.calculatedGestationalAge ( ) is null\n and DeliveryEncounter.lastEstimatedGestationalAge ( ) >= 37 weeks</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>CesareanBirthFHIR</td>\n \n \n <td>Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks Based on Coding</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks Based on Coding":\n PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter\n let CGA: DeliveryEncounter.calculatedGestationalAge ( ),\n EGA: DeliveryEncounter.lastEstimatedGestationalAge ( )\n where CGA is null\n and EGA is null\n and exists ( ( DeliveryEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n where EncounterDiagnosis.code in "37 to 42 Plus Weeks Gestation"\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>CesareanBirthFHIR</td>\n \n \n <td>Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks":\n "Delivery Encounter with Calculated Gestational Age Greater than or Equal to 37 Weeks"\n union "Delivery Encounter with Estimated Gestational Age Greater than or Equal to 37 Weeks"\n union "Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks Based on Coding"</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>CesareanBirthFHIR</td>\n \n \n <td>Encounter with Singleton Delivery</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Encounter with Singleton Delivery":\n PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter\n where exists ( ( DeliveryEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n where EncounterDiagnosis.code in "Delivery of Singleton"\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>CesareanBirthFHIR</td>\n \n \n <td>Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births":\n ( "Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks"\n intersect "Encounter with Singleton Delivery" ) SingletonEncounterGE37Weeks\n where ( ( SingletonEncounterGE37Weeks.lastGravida ( ) = 1 )\n or ( SingletonEncounterGE37Weeks.lastParity ( ) = 0 )\n or ( ( SingletonEncounterGE37Weeks.lastHistoryPretermBirth ( ) = 0 )\n and ( SingletonEncounterGE37Weeks.lastHistoryTermBirth ( ) = 0 )\n )\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>CesareanBirthFHIR</td>\n \n \n <td>Delivery Encounter with Cesarean Birth</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Delivery Encounter with Cesarean Birth":\n "Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births" ThirtysevenWeeksPlusEncounter\n with ["Procedure": "Cesarean Birth"] CSection\n such that CSection.performed.toInterval ( ) during ThirtysevenWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )\n and CSection.status = 'completed'</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>CesareanBirthFHIR</td>\n \n \n <td>Numerator</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Numerator":\n "Delivery Encounter with Cesarean Birth"</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>CesareanBirthFHIR</td>\n \n \n <td>Denominator</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Denominator":\n "Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births"</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>CesareanBirthFHIR</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 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>CesareanBirthFHIR</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 PCMaternal."Delivery Encounter with Age Range"</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>CesareanBirthFHIR</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>CesareanBirthFHIR</td>\n \n \n <td>Encounter with Abnormal Presentation</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Encounter with Abnormal Presentation":\n "Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births" ThirtysevenWeeksPlusEncounter\n let LastAbnormalPresentation: Last(["Observation": "Abnormal Presentation"] AbnormalPresentation\n where AbnormalPresentation.effective.earliest() before or on ThirtysevenWeeksPlusEncounter.lastTimeOfDelivery()\n and AbnormalPresentation.status in { 'final', 'amended', 'corrected' }\n sort by effective.earliest()\n )\n where LastAbnormalPresentation.effective.earliest ( ) during ThirtysevenWeeksPlusEncounter.period\n or exists ( ( ThirtysevenWeeksPlusEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n where EncounterDiagnosis.code in "Abnormal Presentation"\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>CesareanBirthFHIR</td>\n \n \n <td>Encounter with Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Encounter with Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum":\n "Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births" ThirtysevenWeeksPlusEncounter\n where exists ( ( ThirtysevenWeeksPlusEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n where EncounterDiagnosis.code in "Placenta Accreta Spectrum Previa or Vasa Previa"\n or EncounterDiagnosis.code in "Genital Herpes"\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>CesareanBirthFHIR</td>\n \n \n <td>Delivery Encounter with Abnormal Presentation, Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Delivery Encounter with Abnormal Presentation, Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum":\n "Encounter with Abnormal Presentation"\n union "Encounter with Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum"</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>CesareanBirthFHIR</td>\n \n \n <td>Denominator Exclusions</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Denominator Exclusions":\n "Delivery Encounter with Abnormal Presentation, Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum"</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>CesareanBirthFHIR</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>PCMaternal</td>\n \n \n <td>Variable Calculated Gestational Age</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Variable Calculated Gestational Age":\n // This definition establishes a variable of CGA (Calculated Gestational Age). CGA is a supplemental data element to store the calculated gestational age result from the "CalculatedGestationalAge" function. The data element enables the capturing and saving of the CGA for data analysis post data receipt. Hospitals do not need to submit any additional data to comply with this definition\n "Delivery Encounter with Age Range" DeliveryEncounter\n let CGA: DeliveryEncounter.calculatedGestationalAge()\n // return { QualifyingEncounter, CGA }\n return {\n EncounterID: DeliveryEncounter.id,\n CalculatedCGA: CGA\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>CesareanBirthFHIR</td>\n \n \n <td>SDE Variable Calculated Gestational Age</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "SDE Variable Calculated Gestational Age":\n PCMaternal."Variable Calculated Gestational Age"</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>PCMaternal</td>\n \n \n <td>hospitalizationWithEDOBTriageObservation</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*define function "HospitalizationWithEDOBTriageObservation"(Encounter Encounter ):\n HospitalizationWithEDOBTriageObservation returns the total interval from the start of any immediately prior emergency department visit or OB Triage visit through the observation visit to the discharge of the given encounter\n Encounter Visit\n let ObsVisit: Last(["Encounter": "Observation Services"] LastObs\n where LastObs.period ends 1 hour or less on or before start of Visit.period\n and LastObs.status = 'finished'\n sort by \n end of period\n ),\n VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n EDOBTriageVisit: Last(["Encounter": "ED Visit and OB Triage"] LastEDOBTriage\n where LastEDOBTriage.period ends 1 hour or less on or before VisitStart\n and LastEDOBTriage.status = 'finished'\n sort by \n end of period\n )\n return Interval[Coalesce(start of EDOBTriageVisit.period, VisitStart), \n end of Visit.period]*/\n \n \ndefine fluent function hospitalizationWithEDOBTriageObservation (TheEncounter Encounter ):\n /*hospitalizationWithEDOBTriageObservation returns the total interval from the start of any immediately prior emergency department visit or OB Triage visit through the observation visit to the discharge of the given encounter*/\n TheEncounter Visit\n let ObsVisit: Last(["Encounter": "Observation Services"] LastObs\n where LastObs.period ends 1 hour or less on or before start of Visit.period\n and LastObs.status = 'finished'\n sort by \n end of period\n ),\n VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n EDOBTriageVisit: Last(["Encounter": "ED Visit and OB Triage"] LastEDOBTriage\n where LastEDOBTriage.period ends 1 hour or less on or before VisitStart\n and LastEDOBTriage.status = 'finished'\n sort by \n end of period\n )\n return Interval[Coalesce(start of EDOBTriageVisit.period, VisitStart), \n 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>PCMaternal</td>\n \n \n <td>calculatedGestationalAge</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define fluent function calculatedGestationalAge (TheEncounter Encounter ):\n //Gestational Age = (280-(Estimated Delivery Date minus Reference Date/Delivery Date))/7\n ( 280 - ( difference in days between TheEncounter.lastTimeOfDelivery () and TheEncounter.lastEstimatedDeliveryDate( )) ) div 7</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>PCMaternal</td>\n \n \n <td>lastTimeOfDelivery</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define fluent function lastTimeOfDelivery (TheEncounter Encounter ):\n Last(["Observation": "Date and time of obstetric delivery"] TimeOfDelivery\n where TimeOfDelivery.value as DateTime is not null\n and TimeOfDelivery.status in { 'final', 'amended', 'corrected' }\n and TimeOfDelivery.effective.earliest () during TheEncounter.hospitalizationWithEDOBTriageObservation ()\n and TimeOfDelivery.value as DateTime during TheEncounter.hospitalizationWithEDOBTriageObservation()\n sort by effective.earliest()\n ).value as DateTime</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>QICoreCommon</td>\n \n \n <td>earliest</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Given an interval, return the starting point if the interval has a starting boundary specified,\notherwise, return the ending point\n*/\ndefine fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):\n (choice.toInterval()) period\n return\n if (period."hasStart"()) then start of period\n else end of 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>PCMaternal</td>\n \n \n <td>lastEstimatedDeliveryDate</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*===============================================================*/\n /* 03/14/2022 from MATGlobalCommonFunctionsv7.000 - latest QDM */\n /* even though this PCMaternalFHIR was derived from */\n /* PCMaternal=2.1.000 cql, to make next update easier. */\n /* Will need to re-insert "Global". in front of these */\n /* function names later (whereever they are directly used.*/\n\ndefine fluent function lastEstimatedDeliveryDate (TheEncounter Encounter ):\n /*This function identifies the last time the EDD was assessed 42 weeks or less prior to or on delivery and stores the result of that assessment.*/\n Last(["Observation": "Delivery date Estimated"] EstimatedDateOfDelivery\n where EstimatedDateOfDelivery.value as DateTime is not null\n and EstimatedDateOfDelivery.status in { 'final', 'amended', 'corrected' }\n and EstimatedDateOfDelivery.effective.earliest ( ) 42 weeks or less before or on TheEncounter.lastTimeOfDelivery ()\n sort by effective.earliest ( )\n ).value as DateTime</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>PCMaternal</td>\n \n \n <td>lastEstimatedGestationalAge</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*define fluent function lastEstimatedGestationalAge (TheEncounter Encounter ):\n Last(["Observation": "Estimated Gestational Age at Delivery"] EstimatedGestationalAge\n where EstimatedGestationalAge.value is not null\n and EstimatedGestationalAge.status in { 'final', 'amended', 'corrected' }\n and EstimatedGestationalAge.effective.earliest() 24 hours or less before or on TheEncounter.lastTimeOfDelivery ()\n sort by effective.earliest ()\n ).value as Quantity*/\n \n define fluent function lastEstimatedGestationalAge (TheEncounter Encounter ):\n Last(["Observation": "Estimated Gestational Age at Delivery"] EstimatedGestationalAge\n let EGATiming: EstimatedGestationalAge.effective.earliest() where \n (EGATiming 24 hours or less before or on TheEncounter.lastTimeOfDelivery () \n and EstimatedGestationalAge.value is not null \n and EstimatedGestationalAge.status in { 'final', 'amended', 'corrected' }) or \n (EGATiming same day as TheEncounter.lastTimeOfDelivery () \n and EGATiming during TheEncounter.hospitalizationWithEDOBTriageObservation() \n and EstimatedGestationalAge.value is not null)\n sort by effective.earliest ())\n .value as Quantity</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>encounterDiagnosis</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns the Condition resources referenced by the diagnosis element of the Encounter\n*/\ndefine fluent function encounterDiagnosis(Encounter Encounter ):\n Encounter.diagnosis D\n return singleton from ([Condition] C where C.id = D.condition.reference.getId())</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>QICoreCommon</td>\n \n \n <td>getId</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).\n@comment: This function can be used to determine the logical id of a given resource. It can be used in\na single-server environment to trace references. However, this function does not attempt to resolve\nor distinguish the base of the given url, and so cannot be used safely in multi-server environments.\n*/\ndefine fluent function getId(uri String):\n Last(Split(uri, '/'))</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>CesareanBirthFHIR</td>\n \n \n <td>lastGravida</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">// and EncounterDiagnoses.verificationStatus ~ FHIRCommon."confirmed"\n\n\ndefine fluent function lastGravida(TheEncounter Encounter):\n Last(["Observation": "[#] Pregnancies"] Gravida\n where Gravida.value is not null\n and Gravida.status in { 'final', 'amended', 'corrected' }\n and Gravida.effective.earliest() 42 weeks or less before TheEncounter.lastTimeOfDelivery()\n sort by effective.earliest()\n ).value as Integer</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>CesareanBirthFHIR</td>\n \n \n <td>lastParity</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define fluent function lastParity(TheEncounter Encounter):\n Last(["Observation": "[#] Parity"] Parity\n where Parity.effective.earliest() 42 weeks or less before TheEncounter.lastTimeOfDelivery()\n and Parity.status in { 'final', 'amended', 'corrected' }\n and Parity.value is not null\n sort by effective.earliest()\n ).value as Integer</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>CesareanBirthFHIR</td>\n \n \n <td>lastHistoryPretermBirth</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define fluent function lastHistoryPretermBirth(TheEncounter Encounter):\n Last(["Observation": "[#] Births.preterm"] PretermBirth\n where PretermBirth.effective.earliest() 42 weeks or less before TheEncounter.lastTimeOfDelivery()\n and PretermBirth.status in { 'final', 'amended', 'corrected' }\n and PretermBirth.value is not null\n sort by effective.earliest()\n ).value as Integer</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>CesareanBirthFHIR</td>\n \n \n <td>lastHistoryTermBirth</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define fluent function lastHistoryTermBirth(TheEncounter Encounter):\n Last(["Observation": "[#] Births.term"] TermBirth\n where TermBirth.effective.earliest() 42 weeks or less before TheEncounter.lastTimeOfDelivery()\n and TermBirth.status in { 'final', 'amended', 'corrected' }\n and TermBirth.value is not null\n sort by effective.earliest()\n ).value as Integer</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 </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"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "93857-1",
"display" : "Date and time of obstetric delivery"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "11778-8",
"display" : "Delivery date Estimated"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "11996-6",
"display" : "[#] Pregnancies"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "11977-6",
"display" : "[#] Parity"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "11637-6",
"display" : "[#] Births.preterm"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "11639-2",
"display" : "[#] Births.term"
}
},
{
"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" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "SDE Sex"
},
{
"url" : "statement",
"valueString" : "define \"SDE Sex\":\n SDE.\"SDE Sex\""
},
{
"url" : "displaySequence",
"valueInteger" : 1
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CQMCommon"
},
{
"url" : "name",
"valueString" : "Inpatient Encounter"
},
{
"url" : "statement",
"valueString" : "define \"Inpatient Encounter\":\n [Encounter: \"Encounter Inpatient\"] EncounterInpatient\n\t\twhere EncounterInpatient.status = 'finished'\n\t\tand EncounterInpatient.period ends during day of \"Measurement Period\""
},
{
"url" : "displaySequence",
"valueInteger" : 2
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PCMaternal"
},
{
"url" : "name",
"valueString" : "Encounter with Age Range"
},
{
"url" : "statement",
"valueString" : "define \"Encounter with Age Range\":\n CQMCommon.\"Inpatient Encounter\" InpatientEncounter\n where AgeInYearsAt(date from start of InpatientEncounter.period) in Interval[ 8, 65 )"
},
{
"url" : "displaySequence",
"valueInteger" : 3
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PCMaternal"
},
{
"url" : "name",
"valueString" : "Delivery Encounter with Age Range"
},
{
"url" : "statement",
"valueString" : "define \"Delivery Encounter with Age Range\":\n \"Encounter with Age Range\" EncounterWithAge\n with [\"Procedure\": \"Delivery Procedures\"] DeliveryProcedure\n such that DeliveryProcedure.status = 'completed'\n and DeliveryProcedure.performed.toInterval ( ) starts during EncounterWithAge.hospitalizationWithEDOBTriageObservation ()"
},
{
"url" : "displaySequence",
"valueInteger" : 4
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "Delivery Encounter with Calculated Gestational Age Greater than or Equal to 37 Weeks"
},
{
"url" : "statement",
"valueString" : "define \"Delivery Encounter with Calculated Gestational Age Greater than or Equal to 37 Weeks\":\n PCMaternal.\"Delivery Encounter with Age Range\" DeliveryEncounter\n where DeliveryEncounter.calculatedGestationalAge ( ) >= 37"
},
{
"url" : "displaySequence",
"valueInteger" : 5
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "Delivery Encounter with Estimated Gestational Age Greater than or Equal to 37 Weeks"
},
{
"url" : "statement",
"valueString" : "define \"Delivery Encounter with Estimated Gestational Age Greater than or Equal to 37 Weeks\":\n PCMaternal.\"Delivery Encounter with Age Range\" DeliveryEncounter\n where DeliveryEncounter.calculatedGestationalAge ( ) is null\n and DeliveryEncounter.lastEstimatedGestationalAge ( ) >= 37 weeks"
},
{
"url" : "displaySequence",
"valueInteger" : 6
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks Based on Coding"
},
{
"url" : "statement",
"valueString" : "define \"Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks Based on Coding\":\n PCMaternal.\"Delivery Encounter with Age Range\" DeliveryEncounter\n let CGA: DeliveryEncounter.calculatedGestationalAge ( ),\n EGA: DeliveryEncounter.lastEstimatedGestationalAge ( )\n where CGA is null\n and EGA is null\n and exists ( ( DeliveryEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n where EncounterDiagnosis.code in \"37 to 42 Plus Weeks Gestation\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 7
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks"
},
{
"url" : "statement",
"valueString" : "define \"Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks\":\n \"Delivery Encounter with Calculated Gestational Age Greater than or Equal to 37 Weeks\"\n union \"Delivery Encounter with Estimated Gestational Age Greater than or Equal to 37 Weeks\"\n union \"Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks Based on Coding\""
},
{
"url" : "displaySequence",
"valueInteger" : 8
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "Encounter with Singleton Delivery"
},
{
"url" : "statement",
"valueString" : "define \"Encounter with Singleton Delivery\":\n PCMaternal.\"Delivery Encounter with Age Range\" DeliveryEncounter\n where exists ( ( DeliveryEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n where EncounterDiagnosis.code in \"Delivery of Singleton\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 9
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births"
},
{
"url" : "statement",
"valueString" : "define \"Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births\":\n ( \"Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks\"\n intersect \"Encounter with Singleton Delivery\" ) SingletonEncounterGE37Weeks\n where ( ( SingletonEncounterGE37Weeks.lastGravida ( ) = 1 )\n or ( SingletonEncounterGE37Weeks.lastParity ( ) = 0 )\n or ( ( SingletonEncounterGE37Weeks.lastHistoryPretermBirth ( ) = 0 )\n and ( SingletonEncounterGE37Weeks.lastHistoryTermBirth ( ) = 0 )\n )\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 10
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "Delivery Encounter with Cesarean Birth"
},
{
"url" : "statement",
"valueString" : "define \"Delivery Encounter with Cesarean Birth\":\n \"Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births\" ThirtysevenWeeksPlusEncounter\n with [\"Procedure\": \"Cesarean Birth\"] CSection\n such that CSection.performed.toInterval ( ) during ThirtysevenWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )\n and CSection.status = 'completed'"
},
{
"url" : "displaySequence",
"valueInteger" : 11
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "Numerator"
},
{
"url" : "statement",
"valueString" : "define \"Numerator\":\n \"Delivery Encounter with Cesarean Birth\""
},
{
"url" : "displaySequence",
"valueInteger" : 12
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "Denominator"
},
{
"url" : "statement",
"valueString" : "define \"Denominator\":\n \"Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births\""
},
{
"url" : "displaySequence",
"valueInteger" : 13
}
],
"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" : 14
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "SDE Payer"
},
{
"url" : "statement",
"valueString" : "define \"SDE Payer\":\n SDE.\"SDE Payer\""
},
{
"url" : "displaySequence",
"valueInteger" : 15
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "Initial Population"
},
{
"url" : "statement",
"valueString" : "define \"Initial Population\":\n PCMaternal.\"Delivery Encounter with Age Range\""
},
{
"url" : "displaySequence",
"valueInteger" : 16
}
],
"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" : 17
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "SDE Ethnicity"
},
{
"url" : "statement",
"valueString" : "define \"SDE Ethnicity\":\n SDE.\"SDE Ethnicity\""
},
{
"url" : "displaySequence",
"valueInteger" : 18
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "Encounter with Abnormal Presentation"
},
{
"url" : "statement",
"valueString" : "define \"Encounter with Abnormal Presentation\":\n \"Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births\" ThirtysevenWeeksPlusEncounter\n let LastAbnormalPresentation: Last([\"Observation\": \"Abnormal Presentation\"] AbnormalPresentation\n where AbnormalPresentation.effective.earliest() before or on ThirtysevenWeeksPlusEncounter.lastTimeOfDelivery()\n and AbnormalPresentation.status in { 'final', 'amended', 'corrected' }\n sort by effective.earliest()\n )\n where LastAbnormalPresentation.effective.earliest ( ) during ThirtysevenWeeksPlusEncounter.period\n or exists ( ( ThirtysevenWeeksPlusEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n where EncounterDiagnosis.code in \"Abnormal Presentation\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 19
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "Encounter with Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum"
},
{
"url" : "statement",
"valueString" : "define \"Encounter with Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum\":\n \"Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births\" ThirtysevenWeeksPlusEncounter\n where exists ( ( ThirtysevenWeeksPlusEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n where EncounterDiagnosis.code in \"Placenta Accreta Spectrum Previa or Vasa Previa\"\n or EncounterDiagnosis.code in \"Genital Herpes\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 20
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "Delivery Encounter with Abnormal Presentation, Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum"
},
{
"url" : "statement",
"valueString" : "define \"Delivery Encounter with Abnormal Presentation, Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum\":\n \"Encounter with Abnormal Presentation\"\n union \"Encounter with Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum\""
},
{
"url" : "displaySequence",
"valueInteger" : 21
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "Denominator Exclusions"
},
{
"url" : "statement",
"valueString" : "define \"Denominator Exclusions\":\n \"Delivery Encounter with Abnormal Presentation, Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum\""
},
{
"url" : "displaySequence",
"valueInteger" : 22
}
],
"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" : 23
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "SDE Race"
},
{
"url" : "statement",
"valueString" : "define \"SDE Race\":\n SDE.\"SDE Race\""
},
{
"url" : "displaySequence",
"valueInteger" : 24
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PCMaternal"
},
{
"url" : "name",
"valueString" : "Variable Calculated Gestational Age"
},
{
"url" : "statement",
"valueString" : "define \"Variable Calculated Gestational Age\":\n // This definition establishes a variable of CGA (Calculated Gestational Age). CGA is a supplemental data element to store the calculated gestational age result from the \"CalculatedGestationalAge\" function. The data element enables the capturing and saving of the CGA for data analysis post data receipt. Hospitals do not need to submit any additional data to comply with this definition\n \"Delivery Encounter with Age Range\" DeliveryEncounter\n let CGA: DeliveryEncounter.calculatedGestationalAge()\n // return { QualifyingEncounter, CGA }\n return {\n EncounterID: DeliveryEncounter.id,\n CalculatedCGA: CGA\n }"
},
{
"url" : "displaySequence",
"valueInteger" : 25
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "SDE Variable Calculated Gestational Age"
},
{
"url" : "statement",
"valueString" : "define \"SDE Variable Calculated Gestational Age\":\n PCMaternal.\"Variable Calculated Gestational Age\""
},
{
"url" : "displaySequence",
"valueInteger" : 26
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PCMaternal"
},
{
"url" : "name",
"valueString" : "hospitalizationWithEDOBTriageObservation"
},
{
"url" : "statement",
"valueString" : "/*define function \"HospitalizationWithEDOBTriageObservation\"(Encounter Encounter ):\n HospitalizationWithEDOBTriageObservation returns the total interval from the start of any immediately prior emergency department visit or OB Triage visit through the observation visit to the discharge of the given encounter\n Encounter Visit\n let ObsVisit: Last([\"Encounter\": \"Observation Services\"] LastObs\n where LastObs.period ends 1 hour or less on or before start of Visit.period\n and LastObs.status = 'finished'\n sort by \n end of period\n ),\n VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n EDOBTriageVisit: Last([\"Encounter\": \"ED Visit and OB Triage\"] LastEDOBTriage\n where LastEDOBTriage.period ends 1 hour or less on or before VisitStart\n and LastEDOBTriage.status = 'finished'\n sort by \n end of period\n )\n return Interval[Coalesce(start of EDOBTriageVisit.period, VisitStart), \n end of Visit.period]*/\n \n \ndefine fluent function hospitalizationWithEDOBTriageObservation (TheEncounter Encounter ):\n /*hospitalizationWithEDOBTriageObservation returns the total interval from the start of any immediately prior emergency department visit or OB Triage visit through the observation visit to the discharge of the given encounter*/\n TheEncounter Visit\n let ObsVisit: Last([\"Encounter\": \"Observation Services\"] LastObs\n where LastObs.period ends 1 hour or less on or before start of Visit.period\n and LastObs.status = 'finished'\n sort by \n end of period\n ),\n VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n EDOBTriageVisit: Last([\"Encounter\": \"ED Visit and OB Triage\"] LastEDOBTriage\n where LastEDOBTriage.period ends 1 hour or less on or before VisitStart\n and LastEDOBTriage.status = 'finished'\n sort by \n end of period\n )\n return Interval[Coalesce(start of EDOBTriageVisit.period, VisitStart), \n end of Visit.period]"
},
{
"url" : "displaySequence",
"valueInteger" : 27
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PCMaternal"
},
{
"url" : "name",
"valueString" : "calculatedGestationalAge"
},
{
"url" : "statement",
"valueString" : "define fluent function calculatedGestationalAge (TheEncounter Encounter ):\n //Gestational Age = (280-(Estimated Delivery Date minus Reference Date/Delivery Date))/7\n ( 280 - ( difference in days between TheEncounter.lastTimeOfDelivery () and TheEncounter.lastEstimatedDeliveryDate( )) ) div 7"
},
{
"url" : "displaySequence",
"valueInteger" : 28
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PCMaternal"
},
{
"url" : "name",
"valueString" : "lastTimeOfDelivery"
},
{
"url" : "statement",
"valueString" : "define fluent function lastTimeOfDelivery (TheEncounter Encounter ):\n Last([\"Observation\": \"Date and time of obstetric delivery\"] TimeOfDelivery\n where TimeOfDelivery.value as DateTime is not null\n and TimeOfDelivery.status in { 'final', 'amended', 'corrected' }\n and TimeOfDelivery.effective.earliest () during TheEncounter.hospitalizationWithEDOBTriageObservation ()\n and TimeOfDelivery.value as DateTime during TheEncounter.hospitalizationWithEDOBTriageObservation()\n sort by effective.earliest()\n ).value as DateTime"
},
{
"url" : "displaySequence",
"valueInteger" : 29
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "QICoreCommon"
},
{
"url" : "name",
"valueString" : "earliest"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Given an interval, return the starting point if the interval has a starting boundary specified,\notherwise, return the ending point\n*/\ndefine fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):\n (choice.toInterval()) period\n return\n if (period.\"hasStart\"()) then start of period\n else end of period"
},
{
"url" : "displaySequence",
"valueInteger" : 30
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PCMaternal"
},
{
"url" : "name",
"valueString" : "lastEstimatedDeliveryDate"
},
{
"url" : "statement",
"valueString" : "/*===============================================================*/\n /* 03/14/2022 from MATGlobalCommonFunctionsv7.000 - latest QDM */\n /* even though this PCMaternalFHIR was derived from */\n /* PCMaternal=2.1.000 cql, to make next update easier. */\n /* Will need to re-insert \"Global\". in front of these */\n /* function names later (whereever they are directly used.*/\n\ndefine fluent function lastEstimatedDeliveryDate (TheEncounter Encounter ):\n /*This function identifies the last time the EDD was assessed 42 weeks or less prior to or on delivery and stores the result of that assessment.*/\n Last([\"Observation\": \"Delivery date Estimated\"] EstimatedDateOfDelivery\n where EstimatedDateOfDelivery.value as DateTime is not null\n and EstimatedDateOfDelivery.status in { 'final', 'amended', 'corrected' }\n and EstimatedDateOfDelivery.effective.earliest ( ) 42 weeks or less before or on TheEncounter.lastTimeOfDelivery ()\n sort by effective.earliest ( )\n ).value as DateTime"
},
{
"url" : "displaySequence",
"valueInteger" : 31
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PCMaternal"
},
{
"url" : "name",
"valueString" : "lastEstimatedGestationalAge"
},
{
"url" : "statement",
"valueString" : "/*define fluent function lastEstimatedGestationalAge (TheEncounter Encounter ):\n Last([\"Observation\": \"Estimated Gestational Age at Delivery\"] EstimatedGestationalAge\n where EstimatedGestationalAge.value is not null\n and EstimatedGestationalAge.status in { 'final', 'amended', 'corrected' }\n and EstimatedGestationalAge.effective.earliest() 24 hours or less before or on TheEncounter.lastTimeOfDelivery ()\n sort by effective.earliest ()\n ).value as Quantity*/\n \n define fluent function lastEstimatedGestationalAge (TheEncounter Encounter ):\n Last([\"Observation\": \"Estimated Gestational Age at Delivery\"] EstimatedGestationalAge\n let EGATiming: EstimatedGestationalAge.effective.earliest() where \n (EGATiming 24 hours or less before or on TheEncounter.lastTimeOfDelivery () \n and EstimatedGestationalAge.value is not null \n and EstimatedGestationalAge.status in { 'final', 'amended', 'corrected' }) or \n (EGATiming same day as TheEncounter.lastTimeOfDelivery () \n and EGATiming during TheEncounter.hospitalizationWithEDOBTriageObservation() \n and EstimatedGestationalAge.value is not null)\n sort by effective.earliest ())\n .value as Quantity"
},
{
"url" : "displaySequence",
"valueInteger" : 32
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CQMCommon"
},
{
"url" : "name",
"valueString" : "encounterDiagnosis"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Returns the Condition resources referenced by the diagnosis element of the Encounter\n*/\ndefine fluent function encounterDiagnosis(Encounter Encounter ):\n Encounter.diagnosis D\n return singleton from ([Condition] C where C.id = D.condition.reference.getId())"
},
{
"url" : "displaySequence",
"valueInteger" : 33
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "QICoreCommon"
},
{
"url" : "name",
"valueString" : "getId"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).\n@comment: This function can be used to determine the logical id of a given resource. It can be used in\na single-server environment to trace references. However, this function does not attempt to resolve\nor distinguish the base of the given url, and so cannot be used safely in multi-server environments.\n*/\ndefine fluent function getId(uri String):\n Last(Split(uri, '/'))"
},
{
"url" : "displaySequence",
"valueInteger" : 34
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "lastGravida"
},
{
"url" : "statement",
"valueString" : "// and EncounterDiagnoses.verificationStatus ~ FHIRCommon.\"confirmed\"\n\n\ndefine fluent function lastGravida(TheEncounter Encounter):\n Last([\"Observation\": \"[#] Pregnancies\"] Gravida\n where Gravida.value is not null\n and Gravida.status in { 'final', 'amended', 'corrected' }\n and Gravida.effective.earliest() 42 weeks or less before TheEncounter.lastTimeOfDelivery()\n sort by effective.earliest()\n ).value as Integer"
},
{
"url" : "displaySequence",
"valueInteger" : 35
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "lastParity"
},
{
"url" : "statement",
"valueString" : "define fluent function lastParity(TheEncounter Encounter):\n Last([\"Observation\": \"[#] Parity\"] Parity\n where Parity.effective.earliest() 42 weeks or less before TheEncounter.lastTimeOfDelivery()\n and Parity.status in { 'final', 'amended', 'corrected' }\n and Parity.value is not null\n sort by effective.earliest()\n ).value as Integer"
},
{
"url" : "displaySequence",
"valueInteger" : 36
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CesareanBirthFHIR"
},
{
"url" : "name",
"valueString" : "lastHistoryPretermBirth"
},
{
"url" : "statement",
"valueString" : "define fluent function lastHistoryPretermBirth(TheEncounter Encounter):\n Last([\"Observation\": \"[#] Births.preterm\"] PretermBirth\n where PretermBirth.effective.earliest() 42 weeks or less before TheEncounter.lastTimeOfDelivery()\n and PretermBirth.status in { 'final', 'amended', 'corrected' }\n and PretermBirth.value is not null\n sort by effective.earliest()\n ).value as Integer"
},
{
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{
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"url" : "libraryName",
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},
{
"url" : "name",
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},
{
"url" : "statement",
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},
{
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{
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"valueString" : "FHIRHelpers"
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{
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{
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},
{
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{
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{
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},
{
"type" : "depends-on",
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},
{
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{
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},
{
"type" : "depends-on",
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},
{
"type" : "depends-on",
"display" : "Value set ED Visit and OB Triage",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.369"
},
{
"type" : "depends-on",
"display" : "Value set Estimated Gestational Age at Delivery",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.26"
},
{
"type" : "depends-on",
"display" : "Value set 37 to 42 Plus Weeks Gestation",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.68"
},
{
"type" : "depends-on",
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"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.99"
},
{
"type" : "depends-on",
"display" : "Value set Cesarean Birth",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.282"
},
{
"type" : "depends-on",
"display" : "Value set Payer Type",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
},
{
"type" : "depends-on",
"display" : "Value set Abnormal Presentation",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.105"
},
{
"type" : "depends-on",
"display" : "Value set Placenta Accreta Spectrum Previa or Vasa Previa",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.37"
},
{
"type" : "depends-on",
"display" : "Value set Genital Herpes",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1049"
}
],
"parameter" : [
{
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"use" : "in",
"min" : 0,
"max" : "1",
"type" : "Period"
},
{
"name" : "SDE Sex",
"use" : "out",
"min" : 0,
"max" : "1",
"type" : "Coding"
},
{
"name" : "Numerator",
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"type" : "Resource"
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{
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},
{
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{
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},
{
"name" : "SDE Ethnicity",
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"min" : 0,
"max" : "1",
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},
{
"name" : "Denominator Exclusions",
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"min" : 0,
"max" : "*",
"type" : "Resource"
},
{
"name" : "SDE Race",
"use" : "out",
"min" : 0,
"max" : "1",
"type" : "Resource"
},
{
"name" : "SDE Variable Calculated Gestational Age",
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"min" : 0,
"max" : "*",
"type" : "Resource"
}
],
"dataRequirement" : [
{
"type" : "Patient",
"profile" : [
🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
],
"mustSupport" : [
"ethnicity",
"race"
]
},
{
"type" : "Encounter",
"profile" : [
🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
],
"mustSupport" : [
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"period",
"status",
"status.value",
"condition",
"condition.reference",
"condition.reference.value",
"id",
"id.value"
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"codeFilter" : [
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},
{
"path" : "status.value",
"code" : [
{
"code" : "finished"
}
]
}
]
},
{
"type" : "Encounter",
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🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
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"condition",
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"id",
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},
{
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"code" : [
{
"code" : "finished"
}
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],
"dateFilter" : [
{
"path" : "period",
"valuePeriod" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/uv/crmi-analysisException",
"valueString" : "Error attempting to determine filter value: toFhirValue not implemented for Subtract"
}
]
}
}
]
},
{
"type" : "Encounter",
"profile" : [
🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
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{
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}
],
"dateFilter" : [
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}
}
]
},
{
"type" : "Procedure",
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{
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{
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],
"description" : "Nulliparous women with a term, singleton baby in a vertex position delivered by cesarean birth",
"purpose" : "UNKNOWN",
"usage" : "Vertex position is modeled implicitly, as the measure excludes deliveries with abnormal presentations.\n\nPatients who do not receive prenatal care and have no documented gestational age or estimated due date are implicitly excluded from the measure, as gestational age is required to meet denominator criteria. \n\nThis measure allows for 3 approaches to determine gestational age (GA) in the following order of precedence:\n\n1. The GA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.*\n2. The GA is obtained from a discrete field in the electronic health record. This option is only used when the calculated GA is not available.\n3. The GA is based on ICD10 or SNOMED codes indicative of weeks gestation. This option is only used when results from items #1 and #2 (see above) are not available.\n\nWherever gestational age is mentioned, relative to the delivery, the intent is to capture the last estimated gestational age prior to or at the time of delivery. \n \n*ACOG ReVITALize Guidelines for Calculating Gestational Age: \n \n Gestational Age = (280-(EDD minus Reference Date))/7\n\n--Estimated Due Date (EDD): The best obstetrical Estimated Due Date is determined by last menstrual period if confirmed by early ultrasound or no ultrasound performed, or early ultrasound if no known last menstrual period or the ultrasound is not consistent with last menstrual period, or known date of fertilization (e.g., assisted reproductive technology) \n--Reference Date is the date on which you are trying to determine gestational age. For purposes of this eCQM, Reference Date would be the Date of Delivery. \n\nNote however the calculation may yield a non-whole number and gestational age should be rounded off to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks.\n\nThe timing relationship of relevantDatetime 42 weeks or less before TimeOfDelivery is applied to the data elements of parity, gravida, preterm/term live births for which prenatal records may include relevant information. \n\nNote: The eCQM and chart-based measure slightly digress in the denominator and denominator exclusion logic. The chart-based measure excludes single stillbirth and patients with multiple gestations from the denominator. These concepts are mutually exclusive of the denominator requirement of live singleton newborn and therefore the logic does not address single stillbirth nor multiple gestation.\n\nParity, preterm and term live births may be updated by the electronic health record software or by clinicians during a delivery encounter. To capture the pre-delivery value, organizations may need to create a rule or calculation to capture the number prior to the delivery start time.\n\n\"Gravida\", \"PretermBirth\", \"TermBirth\" and \"Parity\" results should be submitted via QRDA I as integer and not as number or quantity.\n\nThis eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS334v6.1. \n\nPlease refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).\n\nDefinitions: \nParity: The number of pregnancies reaching 20 weeks gestation regardless of the number of fetuses or outcomes\nGravidity: The number of pregnancies, current and past, regardless of the pregnancy outcome \nPreterm Birth: The number of births >= 20 weeks and < 37 weeks gestation, regardless of outcome \nTerm Birth: The number of births >= 37 weeks gestation, regardless of outcome\nNulliparous: Parity = 0 or Gravidity = 1 or Preterm & Term Births both = 0.\n\nNote regarding Improvement Notation: Within Optimal Range. The Joint Commission does not want to encourage inappropriately low Cesarean rates that may be unsafe to patients. Acceptable PC-02 rates are 30% or lower, however there is not an established threshold for what rate may be too low. PC-06 serves as a balancing measure for PC-02 to guard against any unanticipated or unintended consequences and to identify unforeseen complications that might arise as a result of quality improvement activities and efforts for this measure. In order to identify areas for improvement, hospitals may want to review results based on specific ICD-10 codes or patient populations. Data could then be analyzed further determine specific patterns or trends to help reduce cesarean births.",
"copyright" : "Measure specifications are in the Public Domain.\n\nLOINC(R) copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2023 World Health Organization. All Rights Reserved.",
"effectivePeriod" : {
"start" : "2025-01-01",
"end" : "2025-12-31"
},
"author" : [
{
"name" : "The Joint Commission",
"telecom" : [
{
"system" : "url",
"value" : "https://www.jointcommission.org/"
}
]
}
],
"library" : [
🔗 "https://madie.cms.gov/Library/CesareanBirthFHIR"
],
"disclaimer" : "These performance measures are not clinical guidelines and do not establish a standard of medical care and have not been tested for all potential applications. The measures and specifications are provided without warranty.",
"scoring" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
"code" : "proportion",
"display" : "Proportion"
}
]
},
"rationale" : "The removal of any pressure to not perform a cesarean birth has led to a skyrocketing of hospital, state and national cesarean birth (CB) rates. Some hospitals’ CB rates were over 50%. Hospitals with CB rates at 15-20% have infant outcomes that are just as good and better maternal outcomes (Symum & Zayas-Castro, 2023). There is no data that higher rates improve any outcomes, yet the CB rates continue to rise (Bailit, Garrett, Miller, McMahon, & Cefalo, 2002; Main, Bloomfield, & Hunt, 2004). This measure seeks to focus attention on the most variable portion of the CB epidemic, the term labor CB in nulliparous women. This population segment accounts for the large majority of the variable portion of the CB rate and is the area most affected by subjectivity.\n\nAs compared to other CB measures, what is different about Nulliparous, Term, Singleton, Vertex (NTSV) CB rate is that there are clear cut quality improvement activities that can be done to address the differences. Main et al. (2012) found that over 60% of the variation among hospitals can be attributed to first birth labor induction rates and first birth early labor admission rates (Main et al., 2006). The results showed if labor was forced when the cervix was not ready the outcomes were poorer. Rosenstein et al. (2021) also showed that labor and delivery guidelines can make a difference in labor outcomes. Many authors have shown that physician factors, rather than patient characteristics or obstetric diagnoses are the major drivers for the difference in rates within a hospital (Berkowitz, Fiarman, Mojica, Bauman, & de Regt, 1989; Goyert, Bottoms, Treadwell, & Nehra, 1989; Luthy, Malmgren, Zingheim, & Leininger, 2003; Symum & Zayas-Castro, 2023; Main et al., 2006). The dramatic variation in cesarean rates seen in all populations studied is striking. Cesarean rates varied tenfold in US hospitals nationwide across hospitals (Agency for Healthcare Research and Quality [AHRQ], 2002), from 7.1% to 69.9%, and there was a 15-fold variation among low-risk women, from 2.4% to 36.5% (Kozhimannil, Law, & Virnig, 2013).\n\nA reduction in the number of NTSV patients delivering by cesarean birth will result in increased patient safety, a substantial decrease in maternal and neonatal morbidity and substantial savings in health care costs (Main et al., 2019). Successful quality improvement efforts incorporate audit and feedback strategies combined with provider and nurse education, guidelines and peer review.\n\nThe measure will assist health care organizations to track NTSV patients delivering by cesarean birth to reduce the occurrence. Nulliparous women have 4-6 times the cesarean birth rate than multiparous women thus the NTSV population is the largest driver of primary cesarean birth rate (Sakala, Belanoff, Declercq, 2020). NTSV has a large variation among facilities, thus identifying an important population on which to focus quality improvement efforts.\n\nIn accordance with the American College of Obstetricians and Gynecologists (ACOG) recommendations (2020), cesarean delivery is indicated for patients with active genital lesions of genital herpes or prodromal symptoms (i.e., vulvar pain or burning at delivery) that may indicate viral shedding. Therefore, the measure will exclude encounters with a diagnosis of active genital herpes.\n\nIn addition, the accepted approach to treat placenta accreta spectrum, or the range of pathologic adherence of the placenta that includes placenta increta, placenta percreta, and placenta accreta, as well as placenta previa, is cesarean delivery (ACOG & Society for Maternal-Fetal Medicine (SMFM), 2018). Vasa previa is an indication for cesarean delivery (SMFM Publications Committee, Sinkey, Odibo, & Dashe, 2015). Accordingly, placenta previa, vasa previa, and placenta accreta spectrum are all qualifying conditions to also be excluded from the measure. \n\nUltimately, a reduction in primary cesarean births will reduce the number of women having repeat cesarean births (almost 90% of mothers who have a primary cesarean birth will have subsequent cesarean birth (CDC, 2020)). Thus, improvement in the rates of cesarean delivery for the first birth will reduce the morbidity of all future births and avoid all the controversies with trial of labor after cesarean/elective repeat cesarean deliveries.",
"clinicalRecommendationStatement" : "The American College of Obstetrics and Gynecology (ACOG) report, Evaluation of Cesarean Delivery, recognizes the importance of the Nulliparous, Term Singleton Vertex (NTSV) population as the optimal focus for measurement and quality improvement action. A reduction in the number of nulliparous patients with live term singleton newborns in vertex position delivering by cesarean birth will result in increased patient safety, a substantial decrease in maternal and neonatal morbidity and substantial savings in health care costs.",
"group" : [
{
"id" : "64fb5619da013638e7b3da14",
"extension" : [
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"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
"code" : "proportion",
"display" : "Proportion"
}
]
}
},
{
"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"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
"valueCode" : "None"
}
],
"population" : [
{
"id" : "60C0D22D-2A87-4097-A44E-B3FDDCFB00AA",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "initial-population",
"display" : "Initial Population"
}
]
},
"description" : "Inpatient hospitalizations for patients age greater than or equal to 8 years and less than 65 admitted to the hospital for inpatient acute care who undergo a delivery procedure with a discharge date during the measurement period",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Initial Population"
}
},
{
"id" : "800E0BC8-6111-4D45-B4AD-4C6BBB6FC3E6",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "denominator",
"display" : "Denominator"
}
]
},
"description" : "Inpatient hospitalizations for nulliparous patients who delivered a live term singleton newborn greater than or equal to 37 weeks' gestation\n\nSee Guidance and Definition Sections for more details.",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Denominator"
}
},
{
"id" : "2ED5F574-6700-4E3C-9398-EFEC86809B32",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "denominator-exclusion",
"display" : "Denominator Exclusion"
}
]
},
"description" : "Inpatient hospitalizations for patients with any of the following conditions during the encounter:\n-abnormal presentation\n-genital herpes\n -placenta previa\n-vasa previa\n- placenta accreta\n-placenta increta\n-placenta percreta",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Denominator Exclusions"
}
},
{
"id" : "44114978-DA07-46CB-A1DE-8E49414CAF7D",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "numerator",
"display" : "Numerator"
}
]
},
"description" : "Inpatient hospitalizations for patients who deliver by cesarean section",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Numerator"
}
}
],
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{
"id" : "6204656a-7a48-46cc-bd5a-48fd1e4b6b91",
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"description" : "None",
"criteria" : {
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}
}
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],
"supplementalData" : [
{
"id" : "sde-ethnicity",
"usage" : [
{
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{
"system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code" : "supplemental-data"
}
]
}
],
"description" : "SDE Ethnicity",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "SDE Ethnicity"
}
},
{
"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-sex",
"usage" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code" : "supplemental-data"
}
]
}
],
"description" : "SDE Sex",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "SDE Sex"
}
},
{
"id" : "sde-payer",
"usage" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code" : "supplemental-data"
}
]
}
],
"description" : "SDE Payer",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "SDE Payer"
}
},
{
"id" : "sde-variable-calculated-gestational-age",
"usage" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code" : "supplemental-data"
}
]
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],
"description" : "SDE Variable Calculated Gestational Age",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "SDE Variable Calculated Gestational Age"
}
}
]
}
IG © 2023+ cqframework. Package gov.healthit.ecqi.ecqms#2024.0.0 based on FHIR 4.0.1. Generated 2024-11-07
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