Proportion

Outcome

increase

define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists "Diabetic Retinopathy Encounter"

define "Denominator":
  "Initial Population"
    and exists "Macular Exam Performed"

define "Numerator":
  exists "Level of Severity of Retinopathy Findings Communicated"
    and ( exists "Macular Edema Absence Communicated"
        or exists "Macular Edema Presence Communicated"
    )

define "Denominator Exceptions":
  exists "Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy"
    or exists "Medical or Patient Reason for Not Communicating Absence of Macular Edema"
    or exists "Medical or Patient Reason for Not Communicating Presence of Macular Edema"

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

define "SDE Sex":
  SDE."SDE Sex"

define "Qualifying Encounter During Measurement Period":
  ( ["Encounter": "Office Visit"]
    union ["Encounter": "Ophthalmological Services"]
    union ["Encounter": "Outpatient Consultation"]
    union ["Encounter": "Care Services in Long-Term Residential Facility"]
    union ["Encounter": "Nursing Facility Visit"] ) QualifyingEncounter
    where QualifyingEncounter.period during "Measurement Period"
      and QualifyingEncounter.status = 'finished'
      and QualifyingEncounter.class !~ "virtual"

define "Diabetic Retinopathy Encounter":
  "Qualifying Encounter During Measurement Period" ValidQualifyingEncounter
    with ["Condition": "Diabetic Retinopathy"] DiabeticRetinopathy
      such that DiabeticRetinopathy.prevalenceInterval ( ) overlaps ValidQualifyingEncounter.period
        and DiabeticRetinopathy.isActive ( )
        and not ( DiabeticRetinopathy.verificationStatus ~ QICoreCommon."unconfirmed"
            or DiabeticRetinopathy.verificationStatus ~ QICoreCommon."refuted"
            or DiabeticRetinopathy.verificationStatus ~ QICoreCommon."entered-in-error"
        )

define "Level of Severity of Retinopathy Findings Communicated":
  ["Communication": "Level of Severity of Retinopathy Findings"] LevelOfSeverityCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that LevelOfSeverityCommunicated.sent after start of EncounterDiabeticRetinopathy.period
        and LevelOfSeverityCommunicated.sent during day of "Measurement Period"
    where LevelOfSeverityCommunicated.status = 'completed'

define "Macular Edema Absence Communicated":
  ["Communication": "Macular edema absent (situation)"] MacularEdemaAbsentCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that MacularEdemaAbsentCommunicated.sent after start of EncounterDiabeticRetinopathy.period
        and MacularEdemaAbsentCommunicated.sent during day of "Measurement Period"
    where MacularEdemaAbsentCommunicated.status = 'completed'

define "Macular Edema Presence Communicated":
  ["Communication": "Macular Edema Findings Present"] MacularEdemaPresentCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that MacularEdemaPresentCommunicated.sent after start of EncounterDiabeticRetinopathy.period
        and MacularEdemaPresentCommunicated.sent during day of "Measurement Period"
    where MacularEdemaPresentCommunicated.status = 'completed'

define "Numerator":
  exists "Level of Severity of Retinopathy Findings Communicated"
    and ( exists "Macular Edema Absence Communicated"
        or exists "Macular Edema Presence Communicated"
    )

define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists "Diabetic Retinopathy Encounter"

define "Macular Exam Performed":
  ["Observation": "Macular Exam"] MacularExam
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that MacularExam.effective.toInterval ( ) during EncounterDiabeticRetinopathy.period
    where MacularExam.value is not null
      and MacularExam.status in { 'final', 'amended', 'corrected', 'preliminary' }

define "Denominator":
  "Initial Population"
    and exists "Macular Exam Performed"

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

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

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

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

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

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

define "Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy":
  [CommunicationNotDone: "Level of Severity of Retinopathy Findings"] LevelOfSeverityNotCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that LevelOfSeverityNotCommunicated.sent during EncounterDiabeticRetinopathy.period
    where ( LevelOfSeverityNotCommunicated.statusReason in "Medical Reason"
        or LevelOfSeverityNotCommunicated.statusReason in "Patient Reason"
    )

/* Note: 
below definition workaround for 
https://oncprojectracking.healthit.gov/support/browse/CQLIT-371. Using value set workaround has been applied for now
but when QI Core STU 5 gets in the tool, it may be reverted back to a DRC */


define "Medical or Patient Reason for Not Communicating Absence of Macular Edema":
  [CommunicationNotDone: "Macular edema absent (situation)"] MacularEdemaAbsentNotCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that MacularEdemaAbsentNotCommunicated.sent during EncounterDiabeticRetinopathy.period
    where ( MacularEdemaAbsentNotCommunicated.statusReason in "Medical Reason"
        or MacularEdemaAbsentNotCommunicated.statusReason in "Patient Reason"
    )

define "Medical or Patient Reason for Not Communicating Presence of Macular Edema":
  [CommunicationNotDone: "Macular Edema Findings Present"] MacularEdemaPresentNotCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that MacularEdemaPresentNotCommunicated.sent during EncounterDiabeticRetinopathy.period
    where ( MacularEdemaPresentNotCommunicated.statusReason in "Medical Reason"
        or MacularEdemaPresentNotCommunicated.statusReason in "Patient Reason"
    )

define "Denominator Exceptions":
  exists "Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy"
    or exists "Medical or Patient Reason for Not Communicating Absence of Macular Edema"
    or exists "Medical or Patient Reason for Not Communicating Presence of Macular Edema"

/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting 
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
  or condition.clinicalStatus ~ "recurrence"
  or condition.clinicalStatus ~ "relapse" then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
    (end of condition.abatementInterval()) abatementDate
    return if abatementDate is null then
      Interval[start of condition.onset.toInterval(), abatementDate)
    else
      Interval[start of condition.onset.toInterval(), abatementDate]

/* Candidates for FHIRCommon */

/*
@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse
*/
define fluent function isActive(condition Condition):
  condition.clinicalStatus ~ "active"
    or condition.clinicalStatus ~ "recurrence"
    or condition.clinicalStatus ~ "relapse"

define function ToString(value uri): value.value

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