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 |
<Measure xmlns="http://hl7.org/fhir">
<id value="CesareanBirthFHIR"/>
<meta>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"/>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm"/>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<table class="grid dict">
<tr>
<th scope="row"><b>Title: </b></th>
<td style="padding-left: 4px;">Cesarean BirthFHIR</td>
</tr>
<tr>
<th scope="row"><b>Id: </b></th>
<td style="padding-left: 4px;">CesareanBirthFHIR</td>
</tr>
<tr>
<th scope="row"><b>Version: </b></th>
<td style="padding-left: 4px;">0.2.000</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="Measure-CesareanBirthFHIR.html">Cesarean BirthFHIR</a></td>
</tr>
<tr>
<th scope="row">
<b>
short-name identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>CMS334FHIR</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
version-independent identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>urn:uuid:e5be4439-ce75-43cc-aabc-856aec66e841</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
version-specific identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>urn:uuid:b59bf22e-550d-4bb0-a530-4d5564dfa47a</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
endorser (CMS Consensus Based Entity) identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>0471e</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
publisher (CMS) identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>334FHIR</span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Effective Period: </b></th>
<td style="padding-left: 4px;">2025-01-01..2025-12-31</td>
</tr>
<tr>
<th scope="row"><b>Status: </b></th>
<td style="padding-left: 4px;">draft</td>
</tr>
<tr>
<th scope="row"><b>Publisher: </b></th>
<td style="padding-left: 4px;">The Joint Commission</td>
</tr>
<tr>
<th scope="row"><b>Author: </b></th>
<td style="padding-left: 4px;">The Joint Commission</td>
</tr>
<tr>
<th scope="row"><b>Description: </b></th>
<td style="padding-left: 4px;"><div><p>Nulliparous women with a term, singleton baby in a vertex position delivered by cesarean birth</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Purpose: </b></th>
<td style="padding-left: 4px;"><div><p>UNKNOWN</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Copyright: </b></th>
<td style="padding-left: 4px;"><div><p>Measure specifications are in the Public Domain.</p>
<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>
</div></td>
</tr>
<tr>
<th scope="row"><b>Disclaimer: </b></th>
<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>
</div></td>
</tr>
<tr>
<th scope="row"><b>Scoring: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>Proportion </span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Rationale: </b></th>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
</div></td>
</tr>
<tr>
<th scope="row"><b>Clinical recommendation statement: </b></th>
<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>
</div></td>
</tr>
<tr>
<th scope="row"><b>Guidance (Usage): </b></th>
<td style="padding-left: 4px;">Vertex position is modeled implicitly, as the measure excludes deliveries with abnormal presentations.
Patients 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.
This measure allows for 3 approaches to determine gestational age (GA) in the following order of precedence:
1. The GA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.*
2. 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.
3. 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.
Wherever 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.
*ACOG ReVITALize Guidelines for Calculating Gestational Age:
Gestational Age = (280-(EDD minus Reference Date))/7
--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)
--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.
Note 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.
The 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.
Note: 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.
Parity, 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.
"Gravida", "PretermBirth", "TermBirth" and "Parity" results should be submitted via QRDA I as integer and not as number or quantity.
This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.
This FHIR-based measure has been derived from the QDM-based measure: CMS334v6.1.
Please 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).
Definitions:
Parity: The number of pregnancies reaching 20 weeks gestation regardless of the number of fetuses or outcomes
Gravidity: The number of pregnancies, current and past, regardless of the pregnancy outcome
Preterm Birth: The number of births >= 20 weeks and < 37 weeks gestation, regardless of outcome
Term Birth: The number of births >= 37 weeks gestation, regardless of outcome
Nulliparous: Parity = 0 or Gravidity = 1 or Preterm & Term Births both = 0.
Note 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>
</tr>
<tr>
<th scope="row"><b>Population Criteria: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>64fb5619da013638e7b3da14</b></th>
</tr>
<tr>
<td>Initial Population:</td>
<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>
</tr>
<tr>
<td>Denominator:</td>
<td>Inpatient hospitalizations for nulliparous patients who delivered a live term singleton newborn greater than or equal to 37 weeks' gestation
See Guidance and Definition Sections for more details.</td>
</tr>
<tr>
<td>Denominator Exclusion:</td>
<td>Inpatient hospitalizations for patients with any of the following conditions during the encounter:
-abnormal presentation
-genital herpes
-placenta previa
-vasa previa
- placenta accreta
-placenta increta
-placenta percreta</td>
</tr>
<tr>
<td>Numerator:</td>
<td>Inpatient hospitalizations for patients who deliver by cesarean section</td>
</tr>
<tr><b>Stratifier Criteria: </b></tr>
<tr>
<td>Stratum:</td>
<td>None</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b> Supplemental Data Elements: </b></th>
<td style="padding-left: 4px;">
<p>SDE Ethnicity</p>
<p>SDE Race</p>
<p>SDE Sex</p>
<p>SDE Payer</p>
<p>SDE Variable Calculated Gestational Age</p>
</td>
</tr>
<tr>
<th scope="row">
<b> Supplemental Data Guidance
: </b></th>
<td style="padding-left: 4px;"> For every patient evaluated by this measure also identify payer, race, ethnicity, sex and calculated gestational age.; SDE Ethnicity
SDE Race
SDE Sex
SDE Payer
SDE Variable Calculated Gestational Age
</td>
</tr>
<tr>
<th scope="row"><b>Libraries: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td><a href="Library-CesareanBirthFHIR.html">CesareanBirthFHIR</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Terminology and Other Dependencies: </b></th>
<td style="padding-left: 4px;">
<li><code>Library/SupplementalDataElements|3.5.000</code></li>
<li><code>Library/PCMaternal|5.19.000</code></li>
<li><code>Library/CQMCommon|2.2.000</code></li>
<li><code>Library/FHIRHelpers|4.4.000</code></li>
<li><code>Library/QICoreCommon|2.1.000</code></li>
<li><a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">AdministrativeGender</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html">Logical Observation Identifiers, Names and Codes (LOINC)</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.59/expansion">Delivery Procedures</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion">Observation Services</a></li>
<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>
<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>
<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>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.99/expansion">Delivery of Singleton</a></li>
<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>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.105/expansion">Abnormal Presentation</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.37/expansion">Placenta Previa</a></li>
<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>
</td>
</tr>
<tr>
<th scope="row"><b>Parameters:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>name</b></th>
<th><b>use</b></th>
<th><b>min</b></th>
<th><b>max</b></th>
<th><b>type</b></th>
</tr>
<tr>
<td>Measurement Period</td>
<td>In</td>
<td>0</td>
<td>1</td>
<td>Period</td>
</tr>
<tr>
<td>SDE Sex</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>Coding</td>
</tr>
<tr>
<td>Numerator</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>Denominator</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>SDE Payer</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>Initial Population</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>SDE Ethnicity</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>Resource</td>
</tr>
<tr>
<td>Denominator Exclusions</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>SDE Race</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>Resource</td>
</tr>
<tr>
<td>SDE Variable Calculated Gestational Age</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>DataRequirements:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>Resource Type</b></th>
<th><b>Resource Elements</b></th>
<th><b>Valueset Name</b></th>
<th><b>Valueset</b></th>
</tr>
<tr>
<td>Patient(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html">QICorePatient</a>)</td>
<td>
ethnicity
race
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
condition
condition.reference
condition.reference.value
id
id.value
</td>
<td>
Observation Services
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion">Observation Services</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
condition
condition.reference
condition.reference.value
id
id.value
</td>
<td>
ED Visit and OB Triage
</td>
<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>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
status
status.value
period
condition
condition.reference
condition.reference.value
id
id.value
</td>
<td>
Encounter Inpatient
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
status
status.value
performed
</td>
<td>
Delivery Procedures
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.59/expansion">Delivery Procedures</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
performed
status
status.value
</td>
<td>
Cesarean Birth
</td>
<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>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
<td>
code
value
status
status.value
effective
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
<td>
code
value
status
status.value
effective
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
<td>
code
effective
value
status
status.value
</td>
<td>
Estimated Gestational Age at Delivery
</td>
<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>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
<td>
code
value
status
status.value
effective
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
<td>
code
effective
status
status.value
value
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
<td>
code
effective
status
status.value
value
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
<td>
code
effective
status
status.value
value
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
<td>
code
effective
status
status.value
</td>
<td>
Abnormal Presentation
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.105/expansion">Abnormal Presentation</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
id
id.value
code
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Coverage(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html">QICoreCoverage</a>)</td>
<td>
type
period
</td>
<td>
Payer Type
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Direct Reference Codes:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>display</b></th>
<th><b>code</b></th>
<th><b>system</b></th>
</tr>
<tr>
<td>Male</td>
<td>M</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">http://hl7.org/fhir/administrative-gender</a></td>
</tr>
<tr>
<td>Female</td>
<td>F</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">http://hl7.org/fhir/administrative-gender</a></td>
</tr>
<tr>
<td>Date and time of obstetric delivery</td>
<td>93857-1</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html">http://loinc.org</a></td>
</tr>
<tr>
<td>Delivery date Estimated</td>
<td>11778-8</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html">http://loinc.org</a></td>
</tr>
<tr>
<td>[#] Pregnancies</td>
<td>11996-6</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html">http://loinc.org</a></td>
</tr>
<tr>
<td>[#] Parity</td>
<td>11977-6</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html">http://loinc.org</a></td>
</tr>
<tr>
<td>[#] Births.preterm</td>
<td>11637-6</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html">http://loinc.org</a></td>
</tr>
<tr>
<td>[#] Births.term</td>
<td>11639-2</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html">http://loinc.org</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Logic Definitions:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>Group</b></th>
<th><b>Scoring</b></th>
<th><b>Population Criteria</b></th>
<th><b>Expression</b></th>
</tr>
<tr>
<td> 64fb5619da013638e7b3da14 </td>
<td colspan="3" style="padding-left: 4px;">
<b>Group scoring:</b>
<span> proportion </span>
<b>Measure scoring:</b>
<p style="margin-bottom: 5px;">
<span>Proportion</span>
</p>
<tr>
<th scope="row"><b>Type: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>Outcome </span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Rate Aggregation: </b></th>
<td colspan="3" style="padding-left: 4px;">None</td>
</tr>
</td>
<tr>
<td/>
<td/>
<td>Initial Population</td>
<td>
<pre><code class="language-cql">define "Initial Population":
PCMaternal."Delivery Encounter with Age Range"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator</td>
<td>
<pre><code class="language-cql">define "Denominator":
"Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exclusion</td>
<td>
<pre><code class="language-cql">define "Denominator Exclusions":
"Delivery Encounter with Abnormal Presentation, Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Numerator</td>
<td>
<pre><code class="language-cql">define "Numerator":
"Delivery Encounter with Cesarean Birth"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td/>
<td>
None
</td>
</tr>
</tr>
</table>
<table class="grid-dict">
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Sex</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Sex":
case
when Patient.gender = 'male' then "M"
when Patient.gender = 'female' then "F"
else null
end</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>SDE Sex</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Sex":
SDE."SDE Sex"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CQMCommon</td>
<td>Inpatient Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Inpatient Encounter":
[Encounter: "Encounter Inpatient"] EncounterInpatient
where EncounterInpatient.status = 'finished'
and EncounterInpatient.period ends during day of "Measurement Period"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>PCMaternal</td>
<td>Encounter with Age Range</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with Age Range":
CQMCommon."Inpatient Encounter" InpatientEncounter
where AgeInYearsAt(date from start of InpatientEncounter.period) in Interval[ 8, 65 )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>PCMaternal</td>
<td>Delivery Encounter with Age Range</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Delivery Encounter with Age Range":
"Encounter with Age Range" EncounterWithAge
with ["Procedure": "Delivery Procedures"] DeliveryProcedure
such that DeliveryProcedure.status = 'completed'
and DeliveryProcedure.performed.toInterval ( ) starts during EncounterWithAge.hospitalizationWithEDOBTriageObservation ()</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>Delivery Encounter with Calculated Gestational Age Greater than or Equal to 37 Weeks</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Delivery Encounter with Calculated Gestational Age Greater than or Equal to 37 Weeks":
PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
where DeliveryEncounter.calculatedGestationalAge ( ) >= 37</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>Delivery Encounter with Estimated Gestational Age Greater than or Equal to 37 Weeks</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Delivery Encounter with Estimated Gestational Age Greater than or Equal to 37 Weeks":
PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
where DeliveryEncounter.calculatedGestationalAge ( ) is null
and DeliveryEncounter.lastEstimatedGestationalAge ( ) >= 37 weeks</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks Based on Coding</td>
</tr>
<tr>
<td/>
<td>
<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":
PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
let CGA: DeliveryEncounter.calculatedGestationalAge ( ),
EGA: DeliveryEncounter.lastEstimatedGestationalAge ( )
where CGA is null
and EGA is null
and exists ( ( DeliveryEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
where EncounterDiagnosis.code in "37 to 42 Plus Weeks Gestation"
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks":
"Delivery Encounter with Calculated Gestational Age Greater than or Equal to 37 Weeks"
union "Delivery Encounter with Estimated Gestational Age Greater than or Equal to 37 Weeks"
union "Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks Based on Coding"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>Encounter with Singleton Delivery</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with Singleton Delivery":
PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
where exists ( ( DeliveryEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
where EncounterDiagnosis.code in "Delivery of Singleton"
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births":
( "Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks"
intersect "Encounter with Singleton Delivery" ) SingletonEncounterGE37Weeks
where ( ( SingletonEncounterGE37Weeks.lastGravida ( ) = 1 )
or ( SingletonEncounterGE37Weeks.lastParity ( ) = 0 )
or ( ( SingletonEncounterGE37Weeks.lastHistoryPretermBirth ( ) = 0 )
and ( SingletonEncounterGE37Weeks.lastHistoryTermBirth ( ) = 0 )
)
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>Delivery Encounter with Cesarean Birth</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Delivery Encounter with Cesarean Birth":
"Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births" ThirtysevenWeeksPlusEncounter
with ["Procedure": "Cesarean Birth"] CSection
such that CSection.performed.toInterval ( ) during ThirtysevenWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )
and CSection.status = 'completed'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>Numerator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Numerator":
"Delivery Encounter with Cesarean Birth"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>Denominator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator":
"Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Payer</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Payer":
[Coverage: type in "Payer Type"] Payer
return {
code: Payer.type,
period: Payer.period
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>SDE Payer</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Payer":
SDE."SDE Payer"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>Initial Population</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Initial Population":
PCMaternal."Delivery Encounter with Age Range"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Ethnicity</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Ethnicity":
Patient.ethnicity E
return Tuple {
codes: { E.ombCategory } union E.detailed,
display: E.text
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>SDE Ethnicity</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Ethnicity":
SDE."SDE Ethnicity"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>Encounter with Abnormal Presentation</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with Abnormal Presentation":
"Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births" ThirtysevenWeeksPlusEncounter
let LastAbnormalPresentation: Last(["Observation": "Abnormal Presentation"] AbnormalPresentation
where AbnormalPresentation.effective.earliest() before or on ThirtysevenWeeksPlusEncounter.lastTimeOfDelivery()
and AbnormalPresentation.status in { 'final', 'amended', 'corrected' }
sort by effective.earliest()
)
where LastAbnormalPresentation.effective.earliest ( ) during ThirtysevenWeeksPlusEncounter.period
or exists ( ( ThirtysevenWeeksPlusEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
where EncounterDiagnosis.code in "Abnormal Presentation"
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>Encounter with Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum":
"Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births" ThirtysevenWeeksPlusEncounter
where exists ( ( ThirtysevenWeeksPlusEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
where EncounterDiagnosis.code in "Placenta Accreta Spectrum Previa or Vasa Previa"
or EncounterDiagnosis.code in "Genital Herpes"
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>Delivery Encounter with Abnormal Presentation, Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum</td>
</tr>
<tr>
<td/>
<td>
<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":
"Encounter with Abnormal Presentation"
union "Encounter with Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>Denominator Exclusions</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator Exclusions":
"Delivery Encounter with Abnormal Presentation, Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Race</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Race":
Patient.race R
return Tuple {
codes: R.ombCategory union R.detailed,
display: R.text
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>SDE Race</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Race":
SDE."SDE Race"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>PCMaternal</td>
<td>Variable Calculated Gestational Age</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Variable Calculated Gestational Age":
// 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
"Delivery Encounter with Age Range" DeliveryEncounter
let CGA: DeliveryEncounter.calculatedGestationalAge()
// return { QualifyingEncounter, CGA }
return {
EncounterID: DeliveryEncounter.id,
CalculatedCGA: CGA
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>SDE Variable Calculated Gestational Age</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Variable Calculated Gestational Age":
PCMaternal."Variable Calculated Gestational Age"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>PCMaternal</td>
<td>hospitalizationWithEDOBTriageObservation</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*define function "HospitalizationWithEDOBTriageObservation"(Encounter Encounter ):
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
Encounter Visit
let ObsVisit: Last(["Encounter": "Observation Services"] LastObs
where LastObs.period ends 1 hour or less on or before start of Visit.period
and LastObs.status = 'finished'
sort by
end of period
),
VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
EDOBTriageVisit: Last(["Encounter": "ED Visit and OB Triage"] LastEDOBTriage
where LastEDOBTriage.period ends 1 hour or less on or before VisitStart
and LastEDOBTriage.status = 'finished'
sort by
end of period
)
return Interval[Coalesce(start of EDOBTriageVisit.period, VisitStart),
end of Visit.period]*/
define fluent function hospitalizationWithEDOBTriageObservation (TheEncounter Encounter ):
/*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*/
TheEncounter Visit
let ObsVisit: Last(["Encounter": "Observation Services"] LastObs
where LastObs.period ends 1 hour or less on or before start of Visit.period
and LastObs.status = 'finished'
sort by
end of period
),
VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
EDOBTriageVisit: Last(["Encounter": "ED Visit and OB Triage"] LastEDOBTriage
where LastEDOBTriage.period ends 1 hour or less on or before VisitStart
and LastEDOBTriage.status = 'finished'
sort by
end of period
)
return Interval[Coalesce(start of EDOBTriageVisit.period, VisitStart),
end of Visit.period]</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>PCMaternal</td>
<td>calculatedGestationalAge</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function calculatedGestationalAge (TheEncounter Encounter ):
//Gestational Age = (280-(Estimated Delivery Date minus Reference Date/Delivery Date))/7
( 280 - ( difference in days between TheEncounter.lastTimeOfDelivery () and TheEncounter.lastEstimatedDeliveryDate( )) ) div 7</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>PCMaternal</td>
<td>lastTimeOfDelivery</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function lastTimeOfDelivery (TheEncounter Encounter ):
Last(["Observation": "Date and time of obstetric delivery"] TimeOfDelivery
where TimeOfDelivery.value as DateTime is not null
and TimeOfDelivery.status in { 'final', 'amended', 'corrected' }
and TimeOfDelivery.effective.earliest () during TheEncounter.hospitalizationWithEDOBTriageObservation ()
and TimeOfDelivery.value as DateTime during TheEncounter.hospitalizationWithEDOBTriageObservation()
sort by effective.earliest()
).value as DateTime</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>QICoreCommon</td>
<td>earliest</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Given an interval, return the starting point if the interval has a starting boundary specified,
otherwise, return the ending point
*/
define fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
(choice.toInterval()) period
return
if (period."hasStart"()) then start of period
else end of period</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>PCMaternal</td>
<td>lastEstimatedDeliveryDate</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*===============================================================*/
/* 03/14/2022 from MATGlobalCommonFunctionsv7.000 - latest QDM */
/* even though this PCMaternalFHIR was derived from */
/* PCMaternal=2.1.000 cql, to make next update easier. */
/* Will need to re-insert "Global". in front of these */
/* function names later (whereever they are directly used.*/
define fluent function lastEstimatedDeliveryDate (TheEncounter Encounter ):
/*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.*/
Last(["Observation": "Delivery date Estimated"] EstimatedDateOfDelivery
where EstimatedDateOfDelivery.value as DateTime is not null
and EstimatedDateOfDelivery.status in { 'final', 'amended', 'corrected' }
and EstimatedDateOfDelivery.effective.earliest ( ) 42 weeks or less before or on TheEncounter.lastTimeOfDelivery ()
sort by effective.earliest ( )
).value as DateTime</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>PCMaternal</td>
<td>lastEstimatedGestationalAge</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*define fluent function lastEstimatedGestationalAge (TheEncounter Encounter ):
Last(["Observation": "Estimated Gestational Age at Delivery"] EstimatedGestationalAge
where EstimatedGestationalAge.value is not null
and EstimatedGestationalAge.status in { 'final', 'amended', 'corrected' }
and EstimatedGestationalAge.effective.earliest() 24 hours or less before or on TheEncounter.lastTimeOfDelivery ()
sort by effective.earliest ()
).value as Quantity*/
define fluent function lastEstimatedGestationalAge (TheEncounter Encounter ):
Last(["Observation": "Estimated Gestational Age at Delivery"] EstimatedGestationalAge
let EGATiming: EstimatedGestationalAge.effective.earliest() where
(EGATiming 24 hours or less before or on TheEncounter.lastTimeOfDelivery ()
and EstimatedGestationalAge.value is not null
and EstimatedGestationalAge.status in { 'final', 'amended', 'corrected' }) or
(EGATiming same day as TheEncounter.lastTimeOfDelivery ()
and EGATiming during TheEncounter.hospitalizationWithEDOBTriageObservation()
and EstimatedGestationalAge.value is not null)
sort by effective.earliest ())
.value as Quantity</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CQMCommon</td>
<td>encounterDiagnosis</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns the Condition resources referenced by the diagnosis element of the Encounter
*/
define fluent function encounterDiagnosis(Encounter Encounter ):
Encounter.diagnosis D
return singleton from ([Condition] C where C.id = D.condition.reference.getId())</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>QICoreCommon</td>
<td>getId</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).
@comment: This function can be used to determine the logical id of a given resource. It can be used in
a single-server environment to trace references. However, this function does not attempt to resolve
or distinguish the base of the given url, and so cannot be used safely in multi-server environments.
*/
define fluent function getId(uri String):
Last(Split(uri, '/'))</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>lastGravida</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">// and EncounterDiagnoses.verificationStatus ~ FHIRCommon."confirmed"
define fluent function lastGravida(TheEncounter Encounter):
Last(["Observation": "[#] Pregnancies"] Gravida
where Gravida.value is not null
and Gravida.status in { 'final', 'amended', 'corrected' }
and Gravida.effective.earliest() 42 weeks or less before TheEncounter.lastTimeOfDelivery()
sort by effective.earliest()
).value as Integer</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>lastParity</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function lastParity(TheEncounter Encounter):
Last(["Observation": "[#] Parity"] Parity
where Parity.effective.earliest() 42 weeks or less before TheEncounter.lastTimeOfDelivery()
and Parity.status in { 'final', 'amended', 'corrected' }
and Parity.value is not null
sort by effective.earliest()
).value as Integer</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>lastHistoryPretermBirth</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function lastHistoryPretermBirth(TheEncounter Encounter):
Last(["Observation": "[#] Births.preterm"] PretermBirth
where PretermBirth.effective.earliest() 42 weeks or less before TheEncounter.lastTimeOfDelivery()
and PretermBirth.status in { 'final', 'amended', 'corrected' }
and PretermBirth.value is not null
sort by effective.earliest()
).value as Integer</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CesareanBirthFHIR</td>
<td>lastHistoryTermBirth</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function lastHistoryTermBirth(TheEncounter Encounter):
Last(["Observation": "[#] Births.term"] TermBirth
where TermBirth.effective.earliest() 42 weeks or less before TheEncounter.lastTimeOfDelivery()
and TermBirth.status in { 'final', 'amended', 'corrected' }
and TermBirth.value is not null
sort by effective.earliest()
).value as Integer</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>FHIRHelpers</td>
<td>ToString</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define function ToString(value uri): value.value</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>FHIRHelpers</td>
<td>ToCode</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
if coding is null then
null
else
System.Code {
code: coding.code.value,
system: coding.system.value,
version: coding.version.value,
display: coding.display.value
}</code></pre>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</text>
<contained>
<Library>
<id value="effective-data-requirements"/>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://hl7.org/fhir/administrative-gender"/>
<code value="M"/>
<display value="Male"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://hl7.org/fhir/administrative-gender"/>
<code value="F"/>
<display value="Female"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://loinc.org"/>
<code value="93857-1"/>
<display value="Date and time of obstetric delivery"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://loinc.org"/>
<code value="11778-8"/>
<display value="Delivery date Estimated"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://loinc.org"/>
<code value="11996-6"/>
<display value="[#] Pregnancies"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://loinc.org"/>
<code value="11977-6"/>
<display value="[#] Parity"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://loinc.org"/>
<code value="11637-6"/>
<display value="[#] Births.preterm"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://loinc.org"/>
<code value="11639-2"/>
<display value="[#] Births.term"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Sex"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Sex":
case
when Patient.gender = 'male' then "M"
when Patient.gender = 'female' then "F"
else null
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="0"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString value="SDE Sex"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Sex":
SDE."SDE Sex""/>
</extension>
<extension url="displaySequence">
<valueInteger value="1"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CQMCommon"/>
</extension>
<extension url="name">
<valueString value="Inpatient Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Inpatient Encounter":
[Encounter: "Encounter Inpatient"] EncounterInpatient
where EncounterInpatient.status = 'finished'
and EncounterInpatient.period ends during day of "Measurement Period""/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="PCMaternal"/>
</extension>
<extension url="name">
<valueString value="Encounter with Age Range"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with Age Range":
CQMCommon."Inpatient Encounter" InpatientEncounter
where AgeInYearsAt(date from start of InpatientEncounter.period) in Interval[ 8, 65 )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="3"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="PCMaternal"/>
</extension>
<extension url="name">
<valueString value="Delivery Encounter with Age Range"/>
</extension>
<extension url="statement">
<valueString
value="define "Delivery Encounter with Age Range":
"Encounter with Age Range" EncounterWithAge
with ["Procedure": "Delivery Procedures"] DeliveryProcedure
such that DeliveryProcedure.status = 'completed'
and DeliveryProcedure.performed.toInterval ( ) starts during EncounterWithAge.hospitalizationWithEDOBTriageObservation ()"/>
</extension>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString
value="Delivery Encounter with Calculated Gestational Age Greater than or Equal to 37 Weeks"/>
</extension>
<extension url="statement">
<valueString
value="define "Delivery Encounter with Calculated Gestational Age Greater than or Equal to 37 Weeks":
PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
where DeliveryEncounter.calculatedGestationalAge ( ) >= 37"/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString
value="Delivery Encounter with Estimated Gestational Age Greater than or Equal to 37 Weeks"/>
</extension>
<extension url="statement">
<valueString
value="define "Delivery Encounter with Estimated Gestational Age Greater than or Equal to 37 Weeks":
PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
where DeliveryEncounter.calculatedGestationalAge ( ) is null
and DeliveryEncounter.lastEstimatedGestationalAge ( ) >= 37 weeks"/>
</extension>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString
value="Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks Based on Coding"/>
</extension>
<extension url="statement">
<valueString
value="define "Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks Based on Coding":
PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
let CGA: DeliveryEncounter.calculatedGestationalAge ( ),
EGA: DeliveryEncounter.lastEstimatedGestationalAge ( )
where CGA is null
and EGA is null
and exists ( ( DeliveryEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
where EncounterDiagnosis.code in "37 to 42 Plus Weeks Gestation"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="7"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString
value="Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks"/>
</extension>
<extension url="statement">
<valueString
value="define "Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks":
"Delivery Encounter with Calculated Gestational Age Greater than or Equal to 37 Weeks"
union "Delivery Encounter with Estimated Gestational Age Greater than or Equal to 37 Weeks"
union "Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks Based on Coding""/>
</extension>
<extension url="displaySequence">
<valueInteger value="8"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString value="Encounter with Singleton Delivery"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with Singleton Delivery":
PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
where exists ( ( DeliveryEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
where EncounterDiagnosis.code in "Delivery of Singleton"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString
value="Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births"/>
</extension>
<extension url="statement">
<valueString
value="define "Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births":
( "Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks"
intersect "Encounter with Singleton Delivery" ) SingletonEncounterGE37Weeks
where ( ( SingletonEncounterGE37Weeks.lastGravida ( ) = 1 )
or ( SingletonEncounterGE37Weeks.lastParity ( ) = 0 )
or ( ( SingletonEncounterGE37Weeks.lastHistoryPretermBirth ( ) = 0 )
and ( SingletonEncounterGE37Weeks.lastHistoryTermBirth ( ) = 0 )
)
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="10"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString value="Delivery Encounter with Cesarean Birth"/>
</extension>
<extension url="statement">
<valueString
value="define "Delivery Encounter with Cesarean Birth":
"Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births" ThirtysevenWeeksPlusEncounter
with ["Procedure": "Cesarean Birth"] CSection
such that CSection.performed.toInterval ( ) during ThirtysevenWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )
and CSection.status = 'completed'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="11"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString value="Numerator"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator":
"Delivery Encounter with Cesarean Birth""/>
</extension>
<extension url="displaySequence">
<valueInteger value="12"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator":
"Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births""/>
</extension>
<extension url="displaySequence">
<valueInteger value="13"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Payer"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Payer":
[Coverage: type in "Payer Type"] Payer
return {
code: Payer.type,
period: Payer.period
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="14"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString value="SDE Payer"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Payer":
SDE."SDE Payer""/>
</extension>
<extension url="displaySequence">
<valueInteger value="15"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString value="Initial Population"/>
</extension>
<extension url="statement">
<valueString
value="define "Initial Population":
PCMaternal."Delivery Encounter with Age Range""/>
</extension>
<extension url="displaySequence">
<valueInteger value="16"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Ethnicity"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Ethnicity":
Patient.ethnicity E
return Tuple {
codes: { E.ombCategory } union E.detailed,
display: E.text
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="17"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString value="SDE Ethnicity"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Ethnicity":
SDE."SDE Ethnicity""/>
</extension>
<extension url="displaySequence">
<valueInteger value="18"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString value="Encounter with Abnormal Presentation"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with Abnormal Presentation":
"Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births" ThirtysevenWeeksPlusEncounter
let LastAbnormalPresentation: Last(["Observation": "Abnormal Presentation"] AbnormalPresentation
where AbnormalPresentation.effective.earliest() before or on ThirtysevenWeeksPlusEncounter.lastTimeOfDelivery()
and AbnormalPresentation.status in { 'final', 'amended', 'corrected' }
sort by effective.earliest()
)
where LastAbnormalPresentation.effective.earliest ( ) during ThirtysevenWeeksPlusEncounter.period
or exists ( ( ThirtysevenWeeksPlusEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
where EncounterDiagnosis.code in "Abnormal Presentation"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="19"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum":
"Singleton Delivery Encounters at 37 Plus Weeks Gravida 1 Parity 0, No Previous Births" ThirtysevenWeeksPlusEncounter
where exists ( ( ThirtysevenWeeksPlusEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
where EncounterDiagnosis.code in "Placenta Accreta Spectrum Previa or Vasa Previa"
or EncounterDiagnosis.code in "Genital Herpes"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="20"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString
value="Delivery Encounter with Abnormal Presentation, Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum"/>
</extension>
<extension url="statement">
<valueString
value="define "Delivery Encounter with Abnormal Presentation, Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum":
"Encounter with Abnormal Presentation"
union "Encounter with Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum""/>
</extension>
<extension url="displaySequence">
<valueInteger value="21"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator Exclusions"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator Exclusions":
"Delivery Encounter with Abnormal Presentation, Genital Herpes, Placenta Previa, Vasa Previa or Placenta Accreta Spectrum""/>
</extension>
<extension url="displaySequence">
<valueInteger value="22"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Race"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Race":
Patient.race R
return Tuple {
codes: R.ombCategory union R.detailed,
display: R.text
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="23"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString value="SDE Race"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Race":
SDE."SDE Race""/>
</extension>
<extension url="displaySequence">
<valueInteger value="24"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="PCMaternal"/>
</extension>
<extension url="name">
<valueString value="Variable Calculated Gestational Age"/>
</extension>
<extension url="statement">
<valueString
value="define "Variable Calculated Gestational Age":
// 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
"Delivery Encounter with Age Range" DeliveryEncounter
let CGA: DeliveryEncounter.calculatedGestationalAge()
// return { QualifyingEncounter, CGA }
return {
EncounterID: DeliveryEncounter.id,
CalculatedCGA: CGA
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="25"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString value="SDE Variable Calculated Gestational Age"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Variable Calculated Gestational Age":
PCMaternal."Variable Calculated Gestational Age""/>
</extension>
<extension url="displaySequence">
<valueInteger value="26"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="PCMaternal"/>
</extension>
<extension url="name">
<valueString value="hospitalizationWithEDOBTriageObservation"/>
</extension>
<extension url="statement">
<valueString
value="/*define function "HospitalizationWithEDOBTriageObservation"(Encounter Encounter ):
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
Encounter Visit
let ObsVisit: Last(["Encounter": "Observation Services"] LastObs
where LastObs.period ends 1 hour or less on or before start of Visit.period
and LastObs.status = 'finished'
sort by
end of period
),
VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
EDOBTriageVisit: Last(["Encounter": "ED Visit and OB Triage"] LastEDOBTriage
where LastEDOBTriage.period ends 1 hour or less on or before VisitStart
and LastEDOBTriage.status = 'finished'
sort by
end of period
)
return Interval[Coalesce(start of EDOBTriageVisit.period, VisitStart),
end of Visit.period]*/
define fluent function hospitalizationWithEDOBTriageObservation (TheEncounter Encounter ):
/*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*/
TheEncounter Visit
let ObsVisit: Last(["Encounter": "Observation Services"] LastObs
where LastObs.period ends 1 hour or less on or before start of Visit.period
and LastObs.status = 'finished'
sort by
end of period
),
VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
EDOBTriageVisit: Last(["Encounter": "ED Visit and OB Triage"] LastEDOBTriage
where LastEDOBTriage.period ends 1 hour or less on or before VisitStart
and LastEDOBTriage.status = 'finished'
sort by
end of period
)
return Interval[Coalesce(start of EDOBTriageVisit.period, VisitStart),
end of Visit.period]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="27"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="PCMaternal"/>
</extension>
<extension url="name">
<valueString value="calculatedGestationalAge"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function calculatedGestationalAge (TheEncounter Encounter ):
//Gestational Age = (280-(Estimated Delivery Date minus Reference Date/Delivery Date))/7
( 280 - ( difference in days between TheEncounter.lastTimeOfDelivery () and TheEncounter.lastEstimatedDeliveryDate( )) ) div 7"/>
</extension>
<extension url="displaySequence">
<valueInteger value="28"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="PCMaternal"/>
</extension>
<extension url="name">
<valueString value="lastTimeOfDelivery"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function lastTimeOfDelivery (TheEncounter Encounter ):
Last(["Observation": "Date and time of obstetric delivery"] TimeOfDelivery
where TimeOfDelivery.value as DateTime is not null
and TimeOfDelivery.status in { 'final', 'amended', 'corrected' }
and TimeOfDelivery.effective.earliest () during TheEncounter.hospitalizationWithEDOBTriageObservation ()
and TimeOfDelivery.value as DateTime during TheEncounter.hospitalizationWithEDOBTriageObservation()
sort by effective.earliest()
).value as DateTime"/>
</extension>
<extension url="displaySequence">
<valueInteger value="29"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="earliest"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Given an interval, return the starting point if the interval has a starting boundary specified,
otherwise, return the ending point
*/
define fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
(choice.toInterval()) period
return
if (period."hasStart"()) then start of period
else end of period"/>
</extension>
<extension url="displaySequence">
<valueInteger value="30"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="PCMaternal"/>
</extension>
<extension url="name">
<valueString value="lastEstimatedDeliveryDate"/>
</extension>
<extension url="statement">
<valueString
value="/*===============================================================*/
/* 03/14/2022 from MATGlobalCommonFunctionsv7.000 - latest QDM */
/* even though this PCMaternalFHIR was derived from */
/* PCMaternal=2.1.000 cql, to make next update easier. */
/* Will need to re-insert "Global". in front of these */
/* function names later (whereever they are directly used.*/
define fluent function lastEstimatedDeliveryDate (TheEncounter Encounter ):
/*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.*/
Last(["Observation": "Delivery date Estimated"] EstimatedDateOfDelivery
where EstimatedDateOfDelivery.value as DateTime is not null
and EstimatedDateOfDelivery.status in { 'final', 'amended', 'corrected' }
and EstimatedDateOfDelivery.effective.earliest ( ) 42 weeks or less before or on TheEncounter.lastTimeOfDelivery ()
sort by effective.earliest ( )
).value as DateTime"/>
</extension>
<extension url="displaySequence">
<valueInteger value="31"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="PCMaternal"/>
</extension>
<extension url="name">
<valueString value="lastEstimatedGestationalAge"/>
</extension>
<extension url="statement">
<valueString
value="/*define fluent function lastEstimatedGestationalAge (TheEncounter Encounter ):
Last(["Observation": "Estimated Gestational Age at Delivery"] EstimatedGestationalAge
where EstimatedGestationalAge.value is not null
and EstimatedGestationalAge.status in { 'final', 'amended', 'corrected' }
and EstimatedGestationalAge.effective.earliest() 24 hours or less before or on TheEncounter.lastTimeOfDelivery ()
sort by effective.earliest ()
).value as Quantity*/
define fluent function lastEstimatedGestationalAge (TheEncounter Encounter ):
Last(["Observation": "Estimated Gestational Age at Delivery"] EstimatedGestationalAge
let EGATiming: EstimatedGestationalAge.effective.earliest() where
(EGATiming 24 hours or less before or on TheEncounter.lastTimeOfDelivery ()
and EstimatedGestationalAge.value is not null
and EstimatedGestationalAge.status in { 'final', 'amended', 'corrected' }) or
(EGATiming same day as TheEncounter.lastTimeOfDelivery ()
and EGATiming during TheEncounter.hospitalizationWithEDOBTriageObservation()
and EstimatedGestationalAge.value is not null)
sort by effective.earliest ())
.value as Quantity"/>
</extension>
<extension url="displaySequence">
<valueInteger value="32"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CQMCommon"/>
</extension>
<extension url="name">
<valueString value="encounterDiagnosis"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns the Condition resources referenced by the diagnosis element of the Encounter
*/
define fluent function encounterDiagnosis(Encounter Encounter ):
Encounter.diagnosis D
return singleton from ([Condition] C where C.id = D.condition.reference.getId())"/>
</extension>
<extension url="displaySequence">
<valueInteger value="33"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="getId"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).
@comment: This function can be used to determine the logical id of a given resource. It can be used in
a single-server environment to trace references. However, this function does not attempt to resolve
or distinguish the base of the given url, and so cannot be used safely in multi-server environments.
*/
define fluent function getId(uri String):
Last(Split(uri, '/'))"/>
</extension>
<extension url="displaySequence">
<valueInteger value="34"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString value="lastGravida"/>
</extension>
<extension url="statement">
<valueString
value="// and EncounterDiagnoses.verificationStatus ~ FHIRCommon."confirmed"
define fluent function lastGravida(TheEncounter Encounter):
Last(["Observation": "[#] Pregnancies"] Gravida
where Gravida.value is not null
and Gravida.status in { 'final', 'amended', 'corrected' }
and Gravida.effective.earliest() 42 weeks or less before TheEncounter.lastTimeOfDelivery()
sort by effective.earliest()
).value as Integer"/>
</extension>
<extension url="displaySequence">
<valueInteger value="35"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString value="lastParity"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function lastParity(TheEncounter Encounter):
Last(["Observation": "[#] Parity"] Parity
where Parity.effective.earliest() 42 weeks or less before TheEncounter.lastTimeOfDelivery()
and Parity.status in { 'final', 'amended', 'corrected' }
and Parity.value is not null
sort by effective.earliest()
).value as Integer"/>
</extension>
<extension url="displaySequence">
<valueInteger value="36"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString value="lastHistoryPretermBirth"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function lastHistoryPretermBirth(TheEncounter Encounter):
Last(["Observation": "[#] Births.preterm"] PretermBirth
where PretermBirth.effective.earliest() 42 weeks or less before TheEncounter.lastTimeOfDelivery()
and PretermBirth.status in { 'final', 'amended', 'corrected' }
and PretermBirth.value is not null
sort by effective.earliest()
).value as Integer"/>
</extension>
<extension url="displaySequence">
<valueInteger value="37"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CesareanBirthFHIR"/>
</extension>
<extension url="name">
<valueString value="lastHistoryTermBirth"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function lastHistoryTermBirth(TheEncounter Encounter):
Last(["Observation": "[#] Births.term"] TermBirth
where TermBirth.effective.earliest() 42 weeks or less before TheEncounter.lastTimeOfDelivery()
and TermBirth.status in { 'final', 'amended', 'corrected' }
and TermBirth.value is not null
sort by effective.earliest()
).value as Integer"/>
</extension>
<extension url="displaySequence">
<valueInteger value="38"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value uri): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="39"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToCode"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
if coding is null then
null
else
System.Code {
code: coding.code.value,
system: coding.system.value,
version: coding.version.value,
display: coding.display.value
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="40"/>
</extension>
</extension>
<name value="EffectiveDataRequirements"/>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/library-type"/>
<code value="module-definition"/>
</coding>
</type>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library SDE"/>
<resource value="Library/SupplementalDataElements|3.5.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library PCMaternal"/>
<resource value="Library/PCMaternal|5.19.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library CQMCommon"/>
<resource value="Library/CQMCommon|2.2.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource value="Library/FHIRHelpers|4.4.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library QICoreCommon"/>
<resource value="Library/QICoreCommon|2.1.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system AdministrativeGender"/>
<resource value="http://hl7.org/fhir/administrative-gender"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system LOINC"/>
<resource value="http://loinc.org"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Encounter Inpatient"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Delivery Procedures"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.59"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Observation Services"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set ED Visit and OB Triage"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.369"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Estimated Gestational Age at Delivery"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.26"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set 37 to 42 Plus Weeks Gestation"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.68"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Delivery of Singleton"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.99"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Cesarean Birth"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.282"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Payer Type"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Abnormal Presentation"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.105"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Placenta Accreta Spectrum Previa or Vasa Previa"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.37"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Genital Herpes"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1049"/>
</relatedArtifact>
<parameter>
<name value="Measurement Period"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="Period"/>
</parameter>
<parameter>
<name value="SDE Sex"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Coding"/>
</parameter>
<parameter>
<name value="Numerator"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Denominator"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="SDE Payer"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Initial Population"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="SDE Ethnicity"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Denominator Exclusions"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="SDE Race"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="SDE Variable Calculated Gestational Age"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<dataRequirement>
<type value="Patient"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
<mustSupport value="ethnicity"/>
<mustSupport value="race"/>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="condition"/>
<mustSupport value="condition.reference"/>
<mustSupport value="condition.reference.value"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"/>
</codeFilter>
<codeFilter>
<path value="status.value"/>
<code>
<code value="finished"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="condition"/>
<mustSupport value="condition.reference"/>
<mustSupport value="condition.reference.value"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.369"/>
</codeFilter>
<codeFilter>
<path value="status.value"/>
<code>
<code value="finished"/>
</code>
</codeFilter>
<dateFilter>
<path value="period"/>
<valuePeriod>
<extension url="http://hl7.org/fhir/uv/crmi-analysisException">
<valueString
value="Error attempting to determine filter value: toFhirValue not implemented for Subtract"/>
</extension>
</valuePeriod>
</dateFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
<mustSupport value="condition"/>
<mustSupport value="condition.reference"/>
<mustSupport value="condition.reference.value"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
</codeFilter>
<codeFilter>
<path value="status.value"/>
<code>
<code value="finished"/>
</code>
</codeFilter>
<dateFilter>
<path value="period"/>
<valuePeriod>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
<valueExpression>
<language value="text/cql-identifier"/>
<expression value="Measurement Period"/>
</valueExpression>
</extension>
</valuePeriod>
</dateFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"/>
<mustSupport value="code"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="performed"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.59"/>
</codeFilter>
<codeFilter>
<path value="status.value"/>
<code>
<code value="completed"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"/>
<mustSupport value="code"/>
<mustSupport value="performed"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.282"/>
</codeFilter>
<codeFilter>
<path value="status.value"/>
<code>
<code value="completed"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
<mustSupport value="code"/>
<mustSupport value="value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="effective"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://loinc.org"/>
<code value="93857-1"/>
<display value="Date and time of obstetric delivery"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
<mustSupport value="code"/>
<mustSupport value="value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="effective"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://loinc.org"/>
<code value="11778-8"/>
<display value="Delivery date Estimated"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
<mustSupport value="code"/>
<mustSupport value="effective"/>
<mustSupport value="value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.26"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
<mustSupport value="code"/>
<mustSupport value="value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="effective"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://loinc.org"/>
<code value="11996-6"/>
<display value="[#] Pregnancies"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
<mustSupport value="code"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://loinc.org"/>
<code value="11977-6"/>
<display value="[#] Parity"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
<mustSupport value="code"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://loinc.org"/>
<code value="11637-6"/>
<display value="[#] Births.preterm"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
<mustSupport value="code"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://loinc.org"/>
<code value="11639-2"/>
<display value="[#] Births.term"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
<mustSupport value="code"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.105"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<mustSupport value="code"/>
</dataRequirement>
<dataRequirement>
<type value="Coverage"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
</codeFilter>
</dataRequirement>
</Library>
</contained>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance" id="supplementalDataGuidance">
<extension url="guidance">
<valueString
value="For every patient evaluated by this measure also identify payer, race, ethnicity, sex and calculated gestational age.; SDE Ethnicity
SDE Race
SDE Sex
SDE Payer
SDE Variable Calculated Gestational Age
"/>
</extension>
<extension url="usage">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
<display value="Supplemental Data"/>
</coding>
<text value="Supplemental Data Guidance"/>
</valueCodeableConcept>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements" id="effective-data-requirements">
<valueReference>
<reference value="#effective-data-requirements"/>
</valueReference>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem">
<valueReference>
<reference value="Device/cqf-tooling"/>
</valueReference>
</extension>
<url value="https://madie.cms.gov/Measure/CesareanBirthFHIR"/>
<identifier>
<use value="usual"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="short-name"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/shortName"/>
<value value="CMS334FHIR"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="version-independent"/>
</coding>
</type>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:e5be4439-ce75-43cc-aabc-856aec66e841"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="version-specific"/>
</coding>
</type>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:b59bf22e-550d-4bb0-a530-4d5564dfa47a"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="endorser"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/cbeId"/>
<value value="0471e"/>
<assigner>
<display value="CMS Consensus Based Entity"/>
</assigner>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="publisher"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/cmsId"/>
<value value="334FHIR"/>
<assigner>
<display value="CMS"/>
</assigner>
</identifier>
<version value="0.2.000"/>
<name value="CesareanBirthFHIR"/>
<title value="Cesarean BirthFHIR"/>
<status value="draft"/>
<experimental value="false"/>
<date value="2024-07-09T14:53:56+00:00"/>
<publisher value="The Joint Commission"/>
<contact>
<telecom>
<system value="url"/>
<value value="https://www.jointcommission.org/"/>
</telecom>
</contact>
<description
value="Nulliparous women with a term, singleton baby in a vertex position delivered by cesarean birth"/>
<purpose value="UNKNOWN"/>
<usage
value="Vertex position is modeled implicitly, as the measure excludes deliveries with abnormal presentations.
Patients 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.
This measure allows for 3 approaches to determine gestational age (GA) in the following order of precedence:
1. The GA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.*
2. 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.
3. 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.
Wherever 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.
*ACOG ReVITALize Guidelines for Calculating Gestational Age:
Gestational Age = (280-(EDD minus Reference Date))/7
--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)
--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.
Note 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.
The 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.
Note: 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.
Parity, 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.
"Gravida", "PretermBirth", "TermBirth" and "Parity" results should be submitted via QRDA I as integer and not as number or quantity.
This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.
This FHIR-based measure has been derived from the QDM-based measure: CMS334v6.1.
Please 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).
Definitions:
Parity: The number of pregnancies reaching 20 weeks gestation regardless of the number of fetuses or outcomes
Gravidity: The number of pregnancies, current and past, regardless of the pregnancy outcome
Preterm Birth: The number of births >= 20 weeks and < 37 weeks gestation, regardless of outcome
Term Birth: The number of births >= 37 weeks gestation, regardless of outcome
Nulliparous: Parity = 0 or Gravidity = 1 or Preterm & Term Births both = 0.
Note 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
value="Measure specifications are in the Public Domain.
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."/>
<effectivePeriod>
<start value="2025-01-01"/>
<end value="2025-12-31"/>
</effectivePeriod>
<author>
<name value="The Joint Commission"/>
<telecom>
<system value="url"/>
<value value="https://www.jointcommission.org/"/>
</telecom>
</author>
<library value="https://madie.cms.gov/Library/CesareanBirthFHIR"/>
<disclaimer
value="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 value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</scoring>
<rationale
value="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.
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).
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.
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.
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.
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.
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."/>
<clinicalRecommendationStatement
value="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
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
<valueCode value="Encounter"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
<code value="outcome"/>
<display value="Outcome"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation">
<valueCode value="None"/>
</extension>
<population id="60C0D22D-2A87-4097-A44E-B3FDDCFB00AA">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="initial-population"/>
<display value="Initial Population"/>
</coding>
</code>
<description
value="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 value="text/cql-identifier"/>
<expression value="Initial Population"/>
</criteria>
</population>
<population id="800E0BC8-6111-4D45-B4AD-4C6BBB6FC3E6">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator"/>
<display value="Denominator"/>
</coding>
</code>
<description
value="Inpatient hospitalizations for nulliparous patients who delivered a live term singleton newborn greater than or equal to 37 weeks' gestation
See Guidance and Definition Sections for more details."/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator"/>
</criteria>
</population>
<population id="2ED5F574-6700-4E3C-9398-EFEC86809B32">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exclusion"/>
<display value="Denominator Exclusion"/>
</coding>
</code>
<description
value="Inpatient hospitalizations for patients with any of the following conditions during the encounter:
-abnormal presentation
-genital herpes
-placenta previa
-vasa previa
- placenta accreta
-placenta increta
-placenta percreta"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exclusions"/>
</criteria>
</population>
<population id="44114978-DA07-46CB-A1DE-8E49414CAF7D">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="numerator"/>
<display value="Numerator"/>
</coding>
</code>
<description
value="Inpatient hospitalizations for patients who deliver by cesarean section"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Numerator"/>
</criteria>
</population>
<stratifier id="6204656a-7a48-46cc-bd5a-48fd1e4b6b91">
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="initial-population"/>
<display value="Initial Population"/>
</coding>
</valueCodeableConcept>
</extension>
<description value="None"/>
<criteria>
<language value="text/cql-identifier"/>
</criteria>
</stratifier>
</group>
<supplementalData id="sde-ethnicity">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Ethnicity"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Ethnicity"/>
</criteria>
</supplementalData>
<supplementalData id="sde-race">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Race"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Race"/>
</criteria>
</supplementalData>
<supplementalData id="sde-sex">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Sex"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Sex"/>
</criteria>
</supplementalData>
<supplementalData id="sde-payer">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Payer"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Payer"/>
</criteria>
</supplementalData>
<supplementalData id="sde-variable-calculated-gestational-age">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Variable Calculated Gestational Age"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Variable Calculated Gestational Age"/>
</criteria>
</supplementalData>
</Measure>
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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