Proportion

Process

increase

define "Initial Population":
  "Has Qualifying Encounter"
    and exists ( "Total Hip Arthroplasty Procedure" )
    and AgeInYearsAt(date from start of "Measurement Period") >= 19

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  Hospice."Has Hospice Services"
    or "Has Severe Cognitive Impairment"
    or "Has Total Hip Arthroplasty with 1 or More Lower Body Fractures"
    or "Has Partial Hip Arthroplasty Procedure"
    or "Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure"
    or "Has Malignant Neoplasm of Lower and Unspecified Limbs"
    or "Has Mechanical Complication"
    or "Has More Than One Elective Primary Total Hip Arthroplasty Performed"
    or "Death Within 300 Days of the THA Procedure"

define "Numerator":
  ( "Has THA with Initial and Follow Up HOOS Assessments" )
    or ( "Has THA with Initial and Follow Up HOOSJr Assessments" )
    or ( "Has THA with Initial and Follow Up PROMIS10 Assessments" )
    or ( "Has THA with Initial and Follow Up VR12 Oblique Assessments" )
    or ( "Has THA with Initial and Follow Up VR12 Orthogonal Assessments" )

define "November 1 Two Years Prior to the Measurement Period":
  DateTime((year from start of "Measurement Period" - 2), 11, 1, 0, 0, 0, 0, 0)

define "October 31 Year Prior to the Measurement Period":
  DateTime((year from start of "Measurement Period" - 1), 10, 31, 23, 59, 59, 0, 0)

define "Total Hip Arthroplasty Procedure":
  ( ( [Procedure: "Primary THA Procedure"] ).isProcedurePerformed ( ) ) THAProcedure
    where THAProcedure.performed.toInterval ( ) starts during day of Interval["November 1 Two Years Prior to the Measurement Period", "October 31 Year Prior to the Measurement Period"]

define "Date HOOS Total Assessment Completed":
  from
    ( ( [Observation: "Quality of life score [HOOS]"] ).isAssessmentPerformed ( ) ) HOOSLifeQuality,
    ( ( [Observation: "Sport-recreation score [HOOS]"] ).isAssessmentPerformed ( ) ) HOOSSport,
    ( ( [Observation: "Activities of daily living score [HOOS]"] ).isAssessmentPerformed ( ) ) HOOSActivityScore,
    ( ( [Observation: "Symptoms score [HOOS]"] ).isAssessmentPerformed ( ) ) HOOSSymptoms,
    ( ( [Observation: "Pain score [HOOS]"] ).isAssessmentPerformed ( ) ) HOOSPain
    let HOOSLifeQualityDate: date from start of HOOSLifeQuality.effective.toInterval ( ),
    HOOSSportDate: date from start of HOOSSport.effective.toInterval ( ),
    HOOSActivityScoreDate: date from start of HOOSActivityScore.effective.toInterval ( ),
    HOOSSymptomsDate: date from start of HOOSSymptoms.effective.toInterval ( ),
    HOOSPainDate: date from start of HOOSPain.effective.toInterval ( )
    where HOOSLifeQualityDate same day as HOOSSportDate
      and HOOSSport.value is not null
      and HOOSLifeQualityDate same day as HOOSActivityScoreDate
      and HOOSActivityScore.value is not null
      and HOOSLifeQualityDate same day as HOOSSymptomsDate
      and HOOSSymptoms.value is not null
      and HOOSLifeQualityDate same day as HOOSPainDate
      and HOOSPain.value is not null
      and HOOSLifeQuality.value is not null
    return Max({ HOOSLifeQualityDate, HOOSSportDate, HOOSActivityScoreDate, HOOSSymptomsDate, HOOSPainDate })

define "Has THA with Initial and Follow Up HOOS Assessments":
  exists ( ( "Total Hip Arthroplasty Procedure" THAProcedure
      return THAProcedure.performed.toInterval ( ) ) TotalHip
      with "Date HOOS Total Assessment Completed" InitialHipAssessmentHOOS
        such that TotalHip starts 90 days or less on or after day of InitialHipAssessmentHOOS
      with "Date HOOS Total Assessment Completed" FollowUpHipAssessmentHOOS
        such that date from FollowUpHipAssessmentHOOS during day of Interval[date from end of TotalHip + 300 days, date from end of TotalHip + 425 days]
  )

define "Date HOOSJr Total Assessment Completed":
  ( ( ( [Observation: "Total interval score [HOOSJR]"] ).isAssessmentPerformed ( ) ) HOOSJr
    where HOOSJr.value is not null ) DocumentedHOOSJr
    return date from start of DocumentedHOOSJr.effective.toInterval ( )

define "Has THA with Initial and Follow Up HOOSJr Assessments":
  exists ( ( "Total Hip Arthroplasty Procedure" THAProcedure
      return THAProcedure.performed.toInterval ( ) ) TotalHip
      with "Date HOOSJr Total Assessment Completed" InitialHipAssessment
        such that TotalHip starts 90 days or less on or after day of InitialHipAssessment
      with "Date HOOSJr Total Assessment Completed" FollowUpHipAssessment
        such that date from FollowUpHipAssessment during day of Interval[date from end of TotalHip + 300 days, date from end of TotalHip + 425 days]
  )

define "Date PROMIS10 Total Assessment Completed":
  from
    ( ( [Observation: "PROMIS-10 Global Mental Health (GMH) score T-score"] ).isAssessmentPerformed ( ) ) PROMIS10MentalScore,
    ( ( [Observation: "PROMIS-10 Global Physical Health (GPH) score T-score"] ).isAssessmentPerformed ( ) ) PROMIS10PhysicalScore
    let PROMIS10MentalScoreDate: date from start of PROMIS10MentalScore.effective.toInterval ( ),
    PROMIS10PhysicalScoreDate: date from start of PROMIS10PhysicalScore.effective.toInterval ( )
    where PROMIS10MentalScoreDate same day as PROMIS10PhysicalScoreDate
      and PROMIS10PhysicalScore.value is not null
      and PROMIS10MentalScore.value is not null
    return Max({ PROMIS10MentalScoreDate, PROMIS10PhysicalScoreDate })

define "Has THA with Initial and Follow Up PROMIS10 Assessments":
  exists ( ( "Total Hip Arthroplasty Procedure" THAProcedure
      return THAProcedure.performed.toInterval ( ) ) TotalHip
      with "Date PROMIS10 Total Assessment Completed" InitialHipAssessmentPROMIS10
        such that TotalHip starts 90 days or less on or after day of InitialHipAssessmentPROMIS10
      with "Date PROMIS10 Total Assessment Completed" FollowUpHipAssessmentPROMIS10
        such that date from FollowUpHipAssessmentPROMIS10 during day of Interval[date from end of TotalHip + 300 days, date from end of TotalHip + 425 days]
  )

define "Date VR12 Oblique Total Assessment Completed":
  from
    ( ( [Observation: "VR-12 Mental component summary (MCS) score - oblique method T-score"] ).isAssessmentPerformed ( ) ) VR12MentalAssessment,
    ( ( [Observation: "VR-12 Physical component summary (PCS) score - oblique method T-score"] ).isAssessmentPerformed ( ) ) VR12PhysicalAssessment
    let VR12MentalAssessmentDate: date from start of VR12MentalAssessment.effective.toInterval ( ),
    VR12PhysicalAssessmentDate: date from start of VR12PhysicalAssessment.effective.toInterval ( )
    where VR12MentalAssessmentDate same day as VR12PhysicalAssessmentDate
      and VR12MentalAssessment.value is not null
      and VR12PhysicalAssessment.value is not null
    return Max({ VR12MentalAssessmentDate, VR12PhysicalAssessmentDate })

define "Has THA with Initial and Follow Up VR12 Oblique Assessments":
  exists ( ( "Total Hip Arthroplasty Procedure" THAProcedure
      return THAProcedure.performed.toInterval ( ) ) TotalHip
      with "Date VR12 Oblique Total Assessment Completed" InitialHipAssessmentOblique
        such that TotalHip starts 90 days or less on or after day of InitialHipAssessmentOblique
      with "Date VR12 Oblique Total Assessment Completed" FollowUpHipAssessmentOblique
        such that date from FollowUpHipAssessmentOblique during day of Interval[date from end of TotalHip + 300 days, date from end of TotalHip + 425 days]
  )

define "Date VR12 Orthogonal Total Assessment Completed":
  from
    ( ( [Observation: "VR-12 Mental component summary (MCS) score - orthogonal method T-score"] ).isAssessmentPerformed ( ) ) VR12MentalAssessment,
    ( ( [Observation: "VR-12 Physical component summary (PCS) score - orthogonal method T-score"] ).isAssessmentPerformed ( ) ) VR12PhysicalAssessment
    let VR12MentalAssessmentDate: date from start of VR12MentalAssessment.effective.toInterval ( ),
    VR12PhysicalAssessmentDate: date from start of VR12PhysicalAssessment.effective.toInterval ( )
    where VR12MentalAssessmentDate same day as VR12PhysicalAssessmentDate
      and VR12MentalAssessment.value is not null
      and VR12PhysicalAssessment.value is not null
    return Max({ VR12MentalAssessmentDate, VR12PhysicalAssessmentDate })

define "Has THA with Initial and Follow Up VR12 Orthogonal Assessments":
  exists ( ( "Total Hip Arthroplasty Procedure" THAProcedure
      return THAProcedure.performed.toInterval ( ) ) TotalHip
      with "Date VR12 Orthogonal Total Assessment Completed" InitialHipAssessmentOrthogonal
        such that TotalHip starts 90 days or less on or after day of InitialHipAssessmentOrthogonal
      with "Date VR12 Orthogonal Total Assessment Completed" FollowUpHipAssessmentOrthogonal
        such that date from FollowUpHipAssessmentOrthogonal during day of Interval[date from end of TotalHip + 300 days, date from end of TotalHip + 425 days]
  )

define "Numerator":
  ( "Has THA with Initial and Follow Up HOOS Assessments" )
    or ( "Has THA with Initial and Follow Up HOOSJr Assessments" )
    or ( "Has THA with Initial and Follow Up PROMIS10 Assessments" )
    or ( "Has THA with Initial and Follow Up VR12 Oblique Assessments" )
    or ( "Has THA with Initial and Follow Up VR12 Orthogonal Assessments" )

define "August 1 Year Prior to the Measurement Period":
  DateTime((year from start of "Measurement Period" - 1), 8, 1, 0, 0, 0, 0, 0)

define "Has Qualifying Encounter":
  exists ( ( ( [Encounter: "Outpatient Consultation"]
        union [Encounter: "Office Visit"]
        union ( [Encounter] E
            where exists ( ( E.type ) T
                where T ~ "Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure"
            )
        )
        union [Encounter: "Telephone Visits"]
        union [Encounter: "Virtual Encounter"]
    ).isEncounterPerformed ( ) ) ValidEncounters
      where ValidEncounters.period.toInterval ( ) during day of Interval["August 1 Year Prior to the Measurement Period", end of "Measurement Period"]
  )

define "Initial Population":
  "Has Qualifying Encounter"
    and exists ( "Total Hip Arthroplasty Procedure" )
    and AgeInYearsAt(date from start of "Measurement Period") >= 19

define "Denominator":
  "Initial Population"

define "Has Hospice Services":
  exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter
      where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
          or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
      )
        and InpatientEncounter.period.toInterval() ends during day of "Measurement Period"
  )
    or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter
        where HospiceEncounter.period.toInterval() overlaps day of "Measurement Period"
    )
    or exists ((([Observation: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment
        where HospiceAssessment.value ~ "Yes (qualifier value)"
          and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period"
    )
    or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder
        where HospiceOrder.authoredOn.toInterval() during day of "Measurement Period"
        // and HospiceOrder.doNotPerform is not true
        // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447
    )
    or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed
        where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period"
    )
    or exists (([Condition: "Hospice Diagnosis"]) HospiceCareDiagnosis
        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
    )

define "Has Severe Cognitive Impairment":
  exists [Condition: "Severe cognitive impairment (finding)"] Dementia
    where Dementia.prevalenceInterval ( ) overlaps day of "Measurement Period"

define "Has Total Hip Arthroplasty with 1 or More Lower Body Fractures":
  exists ( "Total Hip Arthroplasty Procedure" THAProcedure
      with [Condition: "Lower Body Fractures Excluding Ankle and Foot"] LowerBodyFracture
        such that LowerBodyFracture.prevalenceInterval ( ) starts 24 hours or less on or before start of THAProcedure.performed."toInterval" ( )
  )

define "Has Partial Hip Arthroplasty Procedure":
  exists ( ( ( [Procedure: "Partial Arthroplasty of Hip"] ).isProcedurePerformed ( ) ) PartialTHAProcedure
      with "Total Hip Arthroplasty Procedure" THAProcedure
        such that PartialTHAProcedure.performed.toInterval ( ) during day of THAProcedure.performed.toInterval ( )
  )

define "Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure":
  exists ( "Total Hip Arthroplasty Procedure" THAProcedure
      with ( ( [Procedure: "Removal, Revision and Supplement Procedures of the Lower Body and Spine"] ).isProcedurePerformed ( ) ) RevisionTHAProcedure
        such that RevisionTHAProcedure.performed.toInterval ( ) during day of THAProcedure.performed.toInterval ( )
  )

define "Has Malignant Neoplasm of Lower and Unspecified Limbs":
  exists ( [Condition: "Malignant Neoplasms of Lower and Unspecified Limbs"] MalignantNeoplasm
      with "Total Hip Arthroplasty Procedure" THAProcedure
        such that MalignantNeoplasm.prevalenceInterval ( ) overlaps day of THAProcedure.performed.toInterval ( )
  )

define "Has Mechanical Complication":
  exists ( [Condition: "Mechanical Complications Excluding Upper Body"] MechanicalComplications
      with "Total Hip Arthroplasty Procedure" THAProcedure
        such that MechanicalComplications.prevalenceInterval ( ) overlaps day of THAProcedure.performed.toInterval ( )
  )

define "Has More Than One Elective Primary Total Hip Arthroplasty Performed":
  exists ( "Total Hip Arthroplasty Procedure" THAProcedure
      with ( ( [Procedure: "Primary THA Procedure"] ).isProcedurePerformed ( ) ) ElectiveTHAProcedure
        such that THAProcedure.id !~ ElectiveTHAProcedure.id
          and start of ElectiveTHAProcedure.performed.toInterval ( ) during day of Interval[( start of THAProcedure.performed.toInterval ( ) ) - 1 year, ( start of THAProcedure.performed.toInterval ( ) ) + 1 year]
  )

define "Death Within 300 Days of the THA Procedure":
  exists "Total Hip Arthroplasty Procedure" THAProcedure
    where date from Patient.deceased during day of Interval[date from start of THAProcedure.performed.toInterval ( ), date from start of THAProcedure.performed.toInterval ( ) + 300 days]

define "Denominator Exclusions":
  Hospice."Has Hospice Services"
    or "Has Severe Cognitive Impairment"
    or "Has Total Hip Arthroplasty with 1 or More Lower Body Fractures"
    or "Has Partial Hip Arthroplasty Procedure"
    or "Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure"
    or "Has Malignant Neoplasm of Lower and Unspecified Limbs"
    or "Has Mechanical Complication"
    or "Has More Than One Elective Primary Total Hip Arthroplasty Performed"
    or "Death Within 300 Days of the THA Procedure"

//Procedure, Performed
define fluent function isProcedurePerformed(Proc List<Procedure>):
  Proc P
    where P.status ~ 'completed'

//This library contains functions that are based on QDM 5.6 to QICore 4.1.1 March 2023 (https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1). The functions may appear similar to some QICoreCommon functions but different in that they have constraints that are relevant for measures authored by NCQA.

//Assessment, Performed
define fluent function isAssessmentPerformed(Obs List<Observation>):
  Obs O
    where O.status in { 'final', 'amended', 'corrected' }
          and exists ( O.category ObservationCategory
          where ( ObservationCategory ) ~ "survey"
      )

/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }

//Encounter, Performed
//General usage unless required otherwise by measure intent (e.g., follow-up encounters)
define fluent function isEncounterPerformed(Enc List<Encounter>):
  Enc E
    where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}

/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
  case
	  when choice is DateTime then
    	Interval[choice as DateTime, choice as DateTime]
		when choice is Interval<DateTime> then
  		choice as Interval<DateTime>
		when choice is Quantity then
		  Interval[Patient.birthDate + (choice as Quantity),
			  Patient.birthDate + (choice as Quantity) + 1 year)
		when choice is Interval<Quantity> then
		  Interval[Patient.birthDate + (choice.low as Quantity),
			  Patient.birthDate + (choice.high as Quantity) + 1 year)
		when choice is Timing then
      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
		else
			null as Interval<DateTime>
	end

//Intervention, Order: active and completed only    
define fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):
  ServiceRequest S
    where S.status in { 'active', 'completed' }
      and S.intent = 'order'

//Intervention, Performed
define fluent function isInterventionPerformed(Proc List<Procedure>):
  Proc P
    where P.status ~ 'completed'

/*
@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]