Proportion

Process

increase

define "Initial Population":
  exists "Dementia Encounter During Measurement Period"
    and ( Count("Qualifying Encounter During Measurement Period") >= 2 )

define "Denominator":
  "Initial Population"

define "Numerator":
  exists "Assessment of Cognition Using Standardized Tools or Alternate Methods"

define "Denominator Exceptions":
  exists "Patient Reason for Not Performing Assessment of Cognition Using Standardized Tools or Alternate Methods"

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 "Encounter to Assess Cognition":
  ["Encounter": "Psych Visit Diagnostic Evaluation"]
    union ["Encounter": "Nursing Facility Visit"]
    union ["Encounter": "Care Services in Long Term Residential Facility"]
    union ["Encounter": "Home Healthcare Services"]
    union ["Encounter": "Psych Visit Psychotherapy"]
    union ["Encounter": "Behavioral/Neuropsych Assessment"]
    union ["Encounter": "Occupational Therapy Evaluation"]
    union ["Encounter": "Office Visit"]
    union ["Encounter": "Outpatient Consultation"]

define "Dementia Encounter During Measurement Period":
  "Encounter to Assess Cognition" EncounterAssessCognition
    with [Condition: "Dementia & Mental Degenerations"] Dementia
      such that EncounterAssessCognition.period during day of "Measurement Period"
        and Dementia.prevalenceInterval ( ) overlaps day of EncounterAssessCognition.period
        and Dementia.isActive ( )
        and not ( Dementia.verificationStatus ~ QICoreCommon."unconfirmed"
            or Dementia.verificationStatus ~ QICoreCommon."refuted"
            or Dementia.verificationStatus ~ QICoreCommon."entered-in-error"
        )

define "Assessment of Cognition Using Standardized Tools or Alternate Methods":
  ( ["Observation": "Standardized Tools Score for Assessment of Cognition"]
    union ["Observation": "Cognitive Assessment"] ) CognitiveAssessment
    with "Dementia Encounter During Measurement Period" EncounterDementia
      such that CognitiveAssessment.effective.toInterval ( ) starts 12 months or less on or before day of end of EncounterDementia.period
    where CognitiveAssessment.value is not null
      and CognitiveAssessment.status in { 'final', 'amended', 'corrected', 'preliminary' }

define "Numerator":
  exists "Assessment of Cognition Using Standardized Tools or Alternate Methods"

define "Qualifying Encounter During Measurement Period":
  ( "Encounter to Assess Cognition"
    union ["Encounter": "Patient Provider Interaction"] ) ValidEncounter
    where ValidEncounter.period during day of "Measurement Period"
      and ValidEncounter.status = 'finished'

define "Initial Population":
  exists "Dementia Encounter During Measurement Period"
    and ( Count("Qualifying Encounter During Measurement Period") >= 2 )

define "Denominator":
  "Initial Population"

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 "Patient Reason for Not Performing Assessment of Cognition Using Standardized Tools or Alternate Methods":
/*8/09/2023: Negation issue as outlined in BonnieMat-1455 and ticket https://github.com/cqframework/cql-execution/issues/296 */
  
  ( [ObservationNotDone: code in "Standardized Tools Score for Assessment of Cognition"]
    union [ObservationNotDone: code in "Cognitive Assessment"] ) NoCognitiveAssessment
    with "Dementia Encounter During Measurement Period" EncounterDementia
      such that NoCognitiveAssessment.issued during EncounterDementia.period
    where NoCognitiveAssessment.notDoneReason in "Patient Reason"

define "Denominator Exceptions":
  exists "Patient Reason for Not Performing Assessment of Cognition Using Standardized Tools or Alternate Methods"

/*
@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
        }