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="HospitalHarmPressureInjuryFHIR"/>
<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;">Hospital Harm - Pressure InjuryFHIR</td>
</tr>
<tr>
<th scope="row"><b>Id: </b></th>
<td style="padding-left: 4px;">HospitalHarmPressureInjuryFHIR</td>
</tr>
<tr>
<th scope="row"><b>Version: </b></th>
<td style="padding-left: 4px;">0.1.000</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="Measure-HospitalHarmPressureInjuryFHIR.html">Hospital Harm - Pressure InjuryFHIR</a></td>
</tr>
<tr>
<th scope="row">
<b>
short-name identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>CMS826FHIR</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:75ae89cd-c418-4de1-98c3-0230c72402b6</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:843c90b5-adbe-4ab7-9dcb-67527ce20fa7</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>826FHIR</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;">Centers for Medicare & Medicaid Services (CMS)</td>
</tr>
<tr>
<th scope="row"><b>Author: </b></th>
<td style="padding-left: 4px;">American Institutes for Research (AIR)</td>
</tr>
<tr>
<th scope="row"><b>Description: </b></th>
<td style="padding-left: 4px;"><div><p>The proportion of inpatient hospitalizations for patients aged 18 and older who suffer the harm of developing a new stage 2, stage 3, stage 4, deep tissue, or unstageable pressure injury</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>Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. American Institutes for Research (R), formerly IMPAQ International, disclaims all liability for use or accuracy of any third party codes contained in the specifications.</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>This performance measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.</p>
<p>THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.</p>
<p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</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>This safety eCQM captures the number of patients who experience harm in the form of a pressure injury, during their inpatient hospitalization. The incidence of pressure injuries in hospitalized patients has been estimated at 5.4 per 10,000 patient-days and the rate of hospital-acquired pressure injuries has been estimated at 8.4% (Li et al., 2020). Over 50% of reported pressure injuries in hospitals were stage 2 or higher (Li et al., 2020). Hospital-acquired pressure injuries are serious events and one of the most common patient harms. Pressure injuries commonly cause local infection, osteomyelitis, anemia, and sepsis, in addition to causing significant depression, pain, and discomfort to patients (Shui et al., 2021). Pressure injury is considered a serious reportable event by the National Quality Forum (NQF) (Centers for Medicare and Medicaid Services, 2015).</p>
<p>Studies have shown that age, severity of illness, comorbidity indexes, and Braden scores are predictors of hospital-acquired pressure injuries (HAPI) (Rondinelli et al., 2018). However, even after risk adjustment for patient risk factors, significant variation in rates of HAPI exist between hospitals (Rondinelli et al., 2018). It is widely accepted that the risk of developing a pressure injury can be reduced through best practices. Hospital controlled factors that have been found to be significantly associated with an increase in pressure ulcer risk include infrequent repositioning (p=0.005) and number of days to bed change (OR, 2.89 [95% CI, 1.26-6.63]) (Tayyib, Coyer, and Lewis, 2016; Bly et al., 2016). Nurse staffing, measured as hours per patient day (HPPD), skill mix and expertise, are also significant predictors of HAPI development. Higher HPPD was negatively associated with HAPI, while higher skill mix was associated with a lower risk for HAPIs (Tschannen et al., 2020). Systematically measuring patients who develop new pressure injuries while in the hospital setting will provide hospitals with a reliable and timely measurement, to more reliably assess harm reduction efforts and modify their improvement efforts in near real-time. This eCQM will fill a gap in measurement and provide incentives for hospitals’ quality improvement. Although several pressure injury measures are currently in use, there are no electronic health record (EHR)-based measures intended for use in acute care hospitals. In addition, the intent of this measure is to incentivize greater achievements in reducing harms and enhance hospital performance on patient safety outcomes.</p>
<p>Stage 2 pressure injuries carry a less serious burden in terms of patient harm than stage 3, stage 4, unstageable, and deep tissue pressure injuries (DTPI). Partial thickness wounds heal primarily as a result of epidermal regeneration and often heal without untoward consequences, loss of skin function or scar tissue formation. Based on the healing capabilities inherent in these partial thickness wounds, it is the expert opinion of the NPUAP that the presentation of a stage 2 pressure injuries does not carry the same potential longstanding negative consequences to patients as do full thickness pressure injuries. Stage 2 pressure injuries constitute a very real patient harm that should be monitored and addressed; however, the relative level of harm is less than with stage 3, stage 4, unstageable pressure injuries and potentially DTPI (National Pressure Ulcer Advisory Panel, 2019).</p>
<p>The accurate and timely identification of DTPI is important for several reasons. Early discovery of DTPI allows prompt identification of possible causes, initiation of treatment, and potential development of preventive strategies. In addition, 24 to 72 hours can lapse between the precipitating pressure event and the onset of purple or maroon skin. This delayed manifestation becomes particularly important when the precipitating event occurred before the patient’s admission, yet the DTPI appears beyond the 24-hour window for present-on-admission status (Wound Management and Prevention, 2018).</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Clinical recommendation statement: </b></th>
<td style="padding-left: 4px;"><div><p>The Clinical Guidelines Committee for the American College of Physicians (ACP) presents the available evidence on the comparative effectiveness of various risk assessment instruments and benefits and harms of strategies to prevent pressure ulcers (Qaseem et al., 2015).</p>
<p>Recommendation 1: ACP recommends that clinicians should perform a risk assessment to identify patients who are at risk of developing pressure ulcers.</p>
<p>Recommendation 2: ACP recommends that clinicians should choose advanced static mattresses or advanced static overlays in patients who are at an increased risk of developing pressure ulcers.</p>
<p>Recommendation 3: ACP recommends against using alternating-air mattresses or alternating-air overlays in patients who are at an increased risk of developing pressure ulcers.</p>
<p>The European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance (Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. EPUAP/NPIAP/PPPIA:2019) provide guidance for categorizing pressure injuries and recommendations for structured skin and risk assessment.</p>
<p>Guidelines focused on risk factors and risk assessment:
1.1: Consider individuals with limited mobility, limited activity and a high potential for friction and shear to be at risk of pressure injuries.
1.2: Consider individuals with a category/stage I pressure injury to be at risk of developing a category/stage II or greater pressure injury.
1.7: Consider the impact of diabetes mellitus on the risk of pressure injuries.
1.8: Consider the impact of perfusion and circulation deficits on the risk of pressure injuries.
1.12: Consider the impact of increased body temperature on the risk of pressure injuries.
1.17: Consider the impact of time spent immobilized before surgery, the duration of surgery and the American Society of Anesthesiologists (ASA) Physical Status Classification on surgery-related pressure injury risk.</p>
<p>Guidelines focused on skin and tissue assessment:
2.2: Inspect the skin of individuals at risk of pressure injuries to identify presence of erythema.
2.3: Differentiate blanchable from non-blanchable erythema using either finger pressure or the transparent disk method and evaluate the extent of erythema.</p>
<p>Guidelines focused on preventative skin care:
3.1: Implement a skin care regimen that includes:</p>
<ul>
<li>Keeping skin clean and appropriately hydrated</li>
<li>Cleansing the skin promptly after episodes of incontinence</li>
<li>Avoiding use of alkaline soaps and cleansers</li>
<li>Protecting the skin from moisture with a barrier product
3.3: Use high absorbency incontinence products to protect the skin in individuals with or at risk of pressure injuries who have urinary incontinence.
3.4: Consider using textiles with low friction coefficients for individuals with or at risk of pressure injuries.<br/>
3.5: Use a soft silicone multi-layered foam dressing to protect the skin for individuals at risk of pressure injuries.</li>
</ul>
<p>Guidelines focused on nutrition screening:<br/>
4.1: Conduct nutritional screening for individuals at risk of a pressure injury.
4.2: Conduct a comprehensive nutrition assessment for adults at risk of a pressure injury who are screened to be at risk of malnutrition and for all adults with a pressure injury.<br/>
4.3: Develop and implement an individualized nutrition care plan for individuals with or at risk of a pressure injury who are malnourished or who are at risk of malnutrition.<br/>
4.4: Optimize energy intake for individuals at risk of pressure injuries who are malnourished or at risk of malnutrition.<br/>
4.6: Provide 30 to 35 kcalories/kg body weight/day for adults with a pressure injury who are malnourished or at risk of malnutrition.<br/>
4.7: Provide 1.25 to 1.5 g protein/kg body weight/day for adults with a pressure injury who are malnourished or at risk of malnutrition.<br/>
4.9: Offer high calorie, high protein nutritional supplements in addition to the usual diet for adults with a pressure injury who are malnourished or at risk of malnutrition, if nutritional requirements cannot be achieved by normal dietary intake.<br/>
4.12: Discuss the benefits and harms of enteral or parenteral feeding to support pressure injury treatment in light of preferences and goals of care for individuals with pressure injuries who cannot meet their nutritional requirements through oral intake despite nutritional interventions.</p>
<p>Guidelines focused on repositioning and early mobilization:
5.1: Reposition all individuals with or at risk of pressure injuries on an individualized schedule, unless contraindicated.
5.2: Determine repositioning frequency with consideration to the individual’s level of activity and ability to independently reposition.</p>
<p>Guidelines focused on heel pressure injury:
6.1: Assess the vascular/perfusion status of the lower limbs, heels and feet when performing a skin and tissue assessment, and as part of a risk assessment.
6.2: For individuals at risk of heel pressure injuries and/or with category/stage I or II pressure injuries, elevate the heels using a specifically designed heel suspension device or a pillow/ foam cushion. Offload the heel completely in such a way as to distribute the weight of the leg along the calf without placing pressure on the Achilles tendon and the popliteal vein.
6.4: Use a prophylactic dressing as an adjunct to heel offloading and other strategies to prevent heel pressure injuries.</p>
<p>Guidelines focused on support surfaces:
7.4: Use a high specification reactive single layer foam mattress or overlay in preference to a foam mattress without high specification qualities for individuals at risk of developing pressure injuries.
7.7: Assess the relative benefits of using an alternating pressure air mattress or overlay for individuals at risk of pressure injuries.
7.8: Use a pressure redistribution support surface on the operating table for all individuals with or at risk of pressure injuries who are undergoing surgery.
7.12: Use a pressure redistribution cushion for preventing pressure injuries in people at high risk who are seated in a chair/wheelchair for prolonged periods, particularly if the individual is unable to perform pressure relieving maneuvers.
7.13: Assess the relative benefits of using an alternating pressure air cushion for supporting pressure injury healing in individuals who are seated in a chair/wheelchair for prolonged periods, particularly if the individual is unable to perform pressure relieving maneuvers.</p>
<p>Guidelines focused on device related pressure injury:
8.1: To reduce the risk of medical device related pressure injuries, review and select medical devices with consideration to:</p>
<ul>
<li>The device's ability to minimize tissue damage</li>
<li>Correct sizing/shape of the device for the individual</li>
<li>Ability to correctly apply the device according to manufacturer's instructions</li>
<li>Ability to correctly secure the device
8.5: Use a prophylactic dressing beneath a medical device to reduce the risk of medical device related pressure injuries.</li>
</ul>
<p>Guidelines focused on implementing best practices:
20.2: At the organizational level, assess the knowledge health professionals have about pressure injuries to facilitate implementation of an education program and a quality improvement program.<br/>
20.4: At an organizational level, assess and maximize the availability and quality of equipment and standards for its use as part of a quality improvement plan to reduce the incidence of pressure injuries.<br/>
20.5: At an organizational level, develop and implement a structured, tailored and multi-faceted quality improvement program to reduce the incidence of pressure injuries.<br/>
20.6: At an organizational level, engage all key stakeholders in oversight and implementation of the quality improvement program to reduce the incidence of pressure injuries.<br/>
20.7: At an organizational level, include evidence-based policies, procedures and protocols and standardized documentation systems to reduce the incidence of pressure injuries.<br/>
20.8: At an organizational level, provide clinical decision support tools as part of a quality improvement plan to reduce the incidence of pressure injuries.<br/>
20.9: Provide clinical leadership in pressure injury prevention and treatment as part of a quality improvement plan to reduce pressure injuries.<br/>
20.10: At a professional level, provide education in pressure injury prevention and treatment as part of a quality improvement plan to reduce the incidence of pressure injuries.<br/>
20.11: At an organizational level, regularly monitor, analyze and evaluate performance against quality indicators for pressure injury prevention and treatment.
20.12: At an organizational level, use feedback and reminder systems to promote the quality improvement program and its outcomes to stakeholders.</p>
<p>Guidelines focused on health professional education:
21.1: At the organizational level, assess the knowledge health professionals have about pressure injuries to facilitate implementation of an education program and a quality improvement program.<br/>
21.2: At an organizational level, develop and implement a multi-faceted education program for pressure injury prevention and treatment.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Guidance (Usage): </b></th>
<td style="padding-left: 4px;">Only one harm (new qualifying pressure injury) is counted per encounter.
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: CMS826v2.2.
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-Core4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).</td>
</tr>
<tr>
<th scope="row"><b>Population Criteria: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>65020280da013638e7b3dc1f</b></th>
</tr>
<tr>
<td>Initial Population:</td>
<td>Inpatient hospitalizations for patients aged 18 and older</td>
</tr>
<tr>
<td>Denominator:</td>
<td>Equals Initial Population</td>
</tr>
<tr>
<td>Denominator Exclusion:</td>
<td>Inpatient hospitalizations for patients with a DTPI or stage 2, 3, 4 or unstageable pressure injury diagnosis present on admission, i.e., the diagnosis of pressure injury has a Present on Admission indicator = Y yes (Diagnosis was present at time of inpatient admission) or W (clinically undetermined)
Inpatient hospitalizations for patients with a DTPI found on exam within 72 hours after the start of the encounter
Inpatient hospitalizations for patients with a stage 2, 3, 4, or unstageable pressure injury found on exam within 24 hours after the start of the encounter
Inpatient hospitalizations for patients with diagnosis of a COVID-19 infection during the encounter</td>
</tr>
<tr>
<td>Numerator:</td>
<td>Inpatient hospitalizations for patients with a new deep tissue pressure injury (DTPI) or stage 2, 3, 4, or unstageable pressure injury, as evidenced by any of the following:
A diagnosis of DTPI with the DTPI not present on admission, i.e., the diagnosis of DTPI has a Present on Admission indicator = N no (Diagnosis was not present at time of inpatient admission) or U (documentation insufficient to determine if the condition was present at the time of inpatient admission)
A diagnosis of stage 2, 3, 4 or unstageable pressure injury with the pressure injury diagnosis not present on admission, i.e., the diagnosis of pressure injury has a Present on Admission indicator = N no (Diagnosis was not present at time of inpatient admission) or U (documentation insufficient to determine if the condition was present at the time of inpatient admission)
A DTPI found on exam greater than 72 hours after the start of the encounter
A stage 2, 3, 4 or unstageable pressure injury found on exam greater than 24 hours after the start of the encounter</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 Payer</p>
<p>SDE Race</p>
<p>SDE Sex</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 and sex; SDE Ethnicity
SDE Payer
SDE Race
SDE Sex
</td>
</tr>
<tr>
<th scope="row"><b>Libraries: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td><a href="Library-HospitalHarmPressureInjuryFHIR.html">HospitalHarmPressureInjuryFHIR</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/FHIRHelpers|4.4.000</code></li>
<li><code>Library/CQMCommon|2.2.000</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/2.16.840.1.113762.1.4.1147.194/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1147.194</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1147.198/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1147.198</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/2.16.840.1.113883.3.117.1.7.1.292/expansion">Emergency Department Visit</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1147.112/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1147.112</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1147.196/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1147.196</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1147.113/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1147.113</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/2.16.840.1.113762.1.4.1147.197/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1147.197</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1248.140/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.140</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>
</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
status
status.value
period
condition
condition.reference
condition.reference.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
status
status.value
period
condition
condition.reference
condition.reference.value
</td>
<td>
Emergency Department Visit
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion">Emergency Department Visit</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
diagnosis
condition
condition.reference
condition.reference.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>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
diagnosis
condition
condition.reference
condition.reference.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>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
</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>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>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
component
</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>
</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>
</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>Physical findings of Skin</td>
<td>8709-8</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> 65020280da013638e7b3dc1f </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>
<tr>
<th scope="row"><b>Improvement Notation: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>decrease </span>
</p>
</td>
</tr>
</td>
<tr>
<td/>
<td/>
<td>Initial Population</td>
<td>
<pre><code class="language-cql">define "Initial Population":
"Encounter with Age 18 and Older"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator</td>
<td>
<pre><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exclusion</td>
<td>
<pre><code class="language-cql">define "Denominator Exclusions":
"Encounter with Deep Tissue Pressure Injury POA"
union "Encounter with Stage 2, 3, 4 or Unstageable Pressure Injury POA"
union "Encounter with Diagnosis of COVID19 Infection"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Numerator</td>
<td>
<pre><code class="language-cql">define "Numerator":
"Encounter with New Deep Tissue Pressure Injury Not POA"
union "Encounter with New Stage 2, 3, 4 or Unstageable Pressure Injury Not POA"</code></pre>
</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>HospitalHarmPressureInjuryFHIR</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>HospitalHarmPressureInjuryFHIR</td>
<td>Encounter with Age 18 and Older</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with Age 18 and Older":
["Encounter": "Encounter Inpatient"] InpatientEncounter
where AgeInYearsAt(date from start of InpatientEncounter.period) >= 18
and InpatientEncounter.period ends during day of "Measurement Period"
and InpatientEncounter.status = 'finished'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>HospitalHarmPressureInjuryFHIR</td>
<td>Encounter with New Deep Tissue Pressure Injury Not POA by Indicator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with New Deep Tissue Pressure Injury Not POA by Indicator":
"Encounter with Age 18 and Older" InpatientHospitalization
where exists ( InpatientHospitalization.diagnosis EncounterDiag
where EncounterDiag.condition.getCondition ( ).code in "Pressure Injury Deep Tissue Diagnoses"
and ( EncounterDiag.diagnosisPresentOnAdmission in "Not Present On Admission or Documentation Insufficient to Determine" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>HospitalHarmPressureInjuryFHIR</td>
<td>Encounter with New Deep Tissue Pressure Injury by Skin Exam after First 72 Hours</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with New Deep Tissue Pressure Injury by Skin Exam after First 72 Hours":
"Encounter with Age 18 and Older" InpatientHospitalization
let hospitalizationPeriod: CQMCommon."HospitalizationWithObservation" ( InpatientHospitalization )
with ["Observation": "Physical findings of Skin"] SkinExam
such that QICoreCommon."ToInterval" ( SkinExam.effective ) starts during Interval[start of hospitalizationPeriod + 72 hours, end of hospitalizationPeriod]
and SkinExam.status in { 'final', 'amended', 'corrected' }
and ( SkinExam.value as Concept in "Pressure Injury Deep Tissue"
or SkinExam.component.code in "Pressure Injury Deep Tissue"
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>HospitalHarmPressureInjuryFHIR</td>
<td>Encounter with New Deep Tissue Pressure Injury Not POA</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with New Deep Tissue Pressure Injury Not POA":
"Encounter with New Deep Tissue Pressure Injury Not POA by Indicator"
union "Encounter with New Deep Tissue Pressure Injury by Skin Exam after First 72 Hours"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>HospitalHarmPressureInjuryFHIR</td>
<td>Encounter with New Stage 2, 3, 4 or Unstageable Pressure Injury Not POA by Indicator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with New Stage 2, 3, 4 or Unstageable Pressure Injury Not POA by Indicator":
"Encounter with Age 18 and Older" InpatientHospitalization
where exists ( InpatientHospitalization.diagnosis Stage234UnstageablePressureInjury
where Stage234UnstageablePressureInjury.condition.getCondition ( ).code in "Pressure Injury Stage 2, 3, 4, or Unstageable Diagnoses"
and ( Stage234UnstageablePressureInjury.diagnosisPresentOnAdmission in "Not Present On Admission or Documentation Insufficient to Determine" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>HospitalHarmPressureInjuryFHIR</td>
<td>Encounter with New Stage 2, 3, 4 or Unstageable Pressure Injury by Skin Exam after First 24 Hours</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with New Stage 2, 3, 4 or Unstageable Pressure Injury by Skin Exam after First 24 Hours":
"Encounter with Age 18 and Older" InpatientHospitalization
let hospitalizationPeriod: CQMCommon."HospitalizationWithObservation" ( InpatientHospitalization )
with ["Observation": "Physical findings of Skin"] SkinExam
such that QICoreCommon."ToInterval" ( SkinExam.effective ) starts during Interval[start of hospitalizationPeriod + 24 hours, end of hospitalizationPeriod]
and SkinExam.status in { 'final', 'amended', 'corrected' }
and ( SkinExam.value as Concept in "Pressure Injury Stage 2, 3, 4 or Unstageable"
or SkinExam.component.code in "Pressure Injury Stage 2, 3, 4 or Unstageable"
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>HospitalHarmPressureInjuryFHIR</td>
<td>Encounter with New Stage 2, 3, 4 or Unstageable Pressure Injury Not POA</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with New Stage 2, 3, 4 or Unstageable Pressure Injury Not POA":
"Encounter with New Stage 2, 3, 4 or Unstageable Pressure Injury Not POA by Indicator"
union "Encounter with New Stage 2, 3, 4 or Unstageable Pressure Injury by Skin Exam after First 24 Hours"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>HospitalHarmPressureInjuryFHIR</td>
<td>Numerator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Numerator":
"Encounter with New Deep Tissue Pressure Injury Not POA"
union "Encounter with New Stage 2, 3, 4 or Unstageable Pressure Injury Not POA"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>HospitalHarmPressureInjuryFHIR</td>
<td>Initial Population</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Initial Population":
"Encounter with Age 18 and Older"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>HospitalHarmPressureInjuryFHIR</td>
<td>Denominator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator":
"Initial Population"</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>HospitalHarmPressureInjuryFHIR</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>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>HospitalHarmPressureInjuryFHIR</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>HospitalHarmPressureInjuryFHIR</td>
<td>Encounter with Deep Tissue Pressure Injury POA by Indicator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with Deep Tissue Pressure Injury POA by Indicator":
"Encounter with Age 18 and Older" InpatientHospitalization
where exists ( InpatientHospitalization.diagnosis EncounterDiag
where EncounterDiag.condition.getCondition ( ).code in "Pressure Injury Deep Tissue Diagnoses"
and ( EncounterDiag.diagnosisPresentOnAdmission in "Present on Admission or Clinically Undetermined" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>HospitalHarmPressureInjuryFHIR</td>
<td>Encounter with Deep Tissue Pressure Injury POA by Skin Exam within First 72 Hours</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with Deep Tissue Pressure Injury POA by Skin Exam within First 72 Hours":
"Encounter with Age 18 and Older" InpatientHospitalization
let hospitalizationPeriod: CQMCommon."HospitalizationWithObservation" ( InpatientHospitalization )
with ["Observation": "Physical findings of Skin"] SkinExam
such that QICoreCommon."ToInterval" ( SkinExam.effective ) starts during Interval[start of hospitalizationPeriod, start of hospitalizationPeriod + 72 hours]
and SkinExam.status in { 'final', 'amended', 'corrected' }
and SkinExam.code in "Pressure Injury Deep Tissue"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>HospitalHarmPressureInjuryFHIR</td>
<td>Encounter with Deep Tissue Pressure Injury POA</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with Deep Tissue Pressure Injury POA":
"Encounter with Deep Tissue Pressure Injury POA by Indicator"
union "Encounter with Deep Tissue Pressure Injury POA by Skin Exam within First 72 Hours"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>HospitalHarmPressureInjuryFHIR</td>
<td>Encounter with Stage 2, 3, 4, or Unstageable Pressure Injury Present on Admission by POA Indicator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with Stage 2, 3, 4, or Unstageable Pressure Injury Present on Admission by POA Indicator":
"Encounter with Age 18 and Older" InpatientHospitalization
where exists ( InpatientHospitalization.diagnosis Stage234UnstageablePressureInjury
where Stage234UnstageablePressureInjury.condition.getCondition ( ).code in "Pressure Injury Stage 2, 3, 4, or Unstageable Diagnoses"
and ( Stage234UnstageablePressureInjury.diagnosisPresentOnAdmission in "Present on Admission or Clinically Undetermined" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>HospitalHarmPressureInjuryFHIR</td>
<td>Encounter with Stage 2, 3, 4 or Unstageable Pressure Injury POA by Skin Exam within 24 Hours</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with Stage 2, 3, 4 or Unstageable Pressure Injury POA by Skin Exam within 24 Hours":
"Encounter with Age 18 and Older" InpatientHospitalization
let hospitalizationPeriod: CQMCommon."HospitalizationWithObservation" ( InpatientHospitalization )
with ["Observation": "Physical findings of Skin"] SkinExam
such that QICoreCommon."ToInterval" ( SkinExam.effective ) starts during Interval[start of hospitalizationPeriod, start of hospitalizationPeriod + 24 hours]
and SkinExam.status in { 'final', 'amended', 'corrected' }
and SkinExam.code in "Pressure Injury Stage 2, 3, 4 or Unstageable"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>HospitalHarmPressureInjuryFHIR</td>
<td>Encounter with Stage 2, 3, 4 or Unstageable Pressure Injury POA</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with Stage 2, 3, 4 or Unstageable Pressure Injury POA":
"Encounter with Stage 2, 3, 4, or Unstageable Pressure Injury Present on Admission by POA Indicator"
union "Encounter with Stage 2, 3, 4 or Unstageable Pressure Injury POA by Skin Exam within 24 Hours"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>HospitalHarmPressureInjuryFHIR</td>
<td>Encounter with Diagnosis of COVID19 Infection</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with Diagnosis of COVID19 Infection":
"Encounter with Age 18 and Older" InpatientHospitalization
where exists ( CQMCommon."EncounterDiagnosis" ( InpatientHospitalization ) ) EncounterDiag
where EncounterDiag.code in "COVID 19"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>HospitalHarmPressureInjuryFHIR</td>
<td>Denominator Exclusions</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator Exclusions":
"Encounter with Deep Tissue Pressure Injury POA"
union "Encounter with Stage 2, 3, 4 or Unstageable Pressure Injury POA"
union "Encounter with Diagnosis of COVID19 Infection"</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>HospitalHarmPressureInjuryFHIR</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>CQMCommon</td>
<td>getCondition</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns the Condition resource for the given reference
*/
define fluent function getCondition(reference Reference):
singleton from ([Condition] C where C.id = reference.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>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>CQMCommon</td>
<td>HospitalizationWithObservation</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter
@deprecated: This function is deprecated. Use the fluent function `hospitalizationWithObservation()` instead.
*/
define function "HospitalizationWithObservation"(TheEncounter Encounter ):
TheEncounter Visit
let ObsVisit: Last([Encounter: "Observation Services"] LastObs
where LastObs.status = 'finished'
and LastObs.period ends 1 hour or less on or before start of Visit.period
sort by end of period
),
VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
EDVisit: Last([Encounter: "Emergency Department Visit"] LastED
where LastED.status = 'finished'
and LastED.period ends 1 hour or less on or before VisitStart
sort by end of period
)
return Interval[Coalesce(start of EDVisit.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>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>
<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 resource referenced by the `diagnosis.condition` element of the Encounter
@deprecated: This function is deprecated. Use the fluent function `encounterDiagnosis()` instead.
*/
define function "EncounterDiagnosis"(Encounter Encounter ):
Encounter.diagnosis D
return singleton from ([Condition] C where C.id = D.condition.reference.getId())</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="8709-8"/>
<display value="Physical findings of Skin"/>
</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="HospitalHarmPressureInjuryFHIR"/>
</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="HospitalHarmPressureInjuryFHIR"/>
</extension>
<extension url="name">
<valueString value="Encounter with Age 18 and Older"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with Age 18 and Older":
["Encounter": "Encounter Inpatient"] InpatientEncounter
where AgeInYearsAt(date from start of InpatientEncounter.period) >= 18
and InpatientEncounter.period ends during day of "Measurement Period"
and InpatientEncounter.status = 'finished'"/>
</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="HospitalHarmPressureInjuryFHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with New Deep Tissue Pressure Injury Not POA by Indicator"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with New Deep Tissue Pressure Injury Not POA by Indicator":
"Encounter with Age 18 and Older" InpatientHospitalization
where exists ( InpatientHospitalization.diagnosis EncounterDiag
where EncounterDiag.condition.getCondition ( ).code in "Pressure Injury Deep Tissue Diagnoses"
and ( EncounterDiag.diagnosisPresentOnAdmission in "Not Present On Admission or Documentation Insufficient to Determine" )
)"/>
</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="HospitalHarmPressureInjuryFHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with New Deep Tissue Pressure Injury by Skin Exam after First 72 Hours"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with New Deep Tissue Pressure Injury by Skin Exam after First 72 Hours":
"Encounter with Age 18 and Older" InpatientHospitalization
let hospitalizationPeriod: CQMCommon."HospitalizationWithObservation" ( InpatientHospitalization )
with ["Observation": "Physical findings of Skin"] SkinExam
such that QICoreCommon."ToInterval" ( SkinExam.effective ) starts during Interval[start of hospitalizationPeriod + 72 hours, end of hospitalizationPeriod]
and SkinExam.status in { 'final', 'amended', 'corrected' }
and ( SkinExam.value as Concept in "Pressure Injury Deep Tissue"
or SkinExam.component.code in "Pressure Injury Deep Tissue"
)"/>
</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="HospitalHarmPressureInjuryFHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with New Deep Tissue Pressure Injury Not POA"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with New Deep Tissue Pressure Injury Not POA":
"Encounter with New Deep Tissue Pressure Injury Not POA by Indicator"
union "Encounter with New Deep Tissue Pressure Injury by Skin Exam after First 72 Hours""/>
</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="HospitalHarmPressureInjuryFHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with New Stage 2, 3, 4 or Unstageable Pressure Injury Not POA by Indicator"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with New Stage 2, 3, 4 or Unstageable Pressure Injury Not POA by Indicator":
"Encounter with Age 18 and Older" InpatientHospitalization
where exists ( InpatientHospitalization.diagnosis Stage234UnstageablePressureInjury
where Stage234UnstageablePressureInjury.condition.getCondition ( ).code in "Pressure Injury Stage 2, 3, 4, or Unstageable Diagnoses"
and ( Stage234UnstageablePressureInjury.diagnosisPresentOnAdmission in "Not Present On Admission or Documentation Insufficient to Determine" )
)"/>
</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="HospitalHarmPressureInjuryFHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with New Stage 2, 3, 4 or Unstageable Pressure Injury by Skin Exam after First 24 Hours"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with New Stage 2, 3, 4 or Unstageable Pressure Injury by Skin Exam after First 24 Hours":
"Encounter with Age 18 and Older" InpatientHospitalization
let hospitalizationPeriod: CQMCommon."HospitalizationWithObservation" ( InpatientHospitalization )
with ["Observation": "Physical findings of Skin"] SkinExam
such that QICoreCommon."ToInterval" ( SkinExam.effective ) starts during Interval[start of hospitalizationPeriod + 24 hours, end of hospitalizationPeriod]
and SkinExam.status in { 'final', 'amended', 'corrected' }
and ( SkinExam.value as Concept in "Pressure Injury Stage 2, 3, 4 or Unstageable"
or SkinExam.component.code in "Pressure Injury Stage 2, 3, 4 or Unstageable"
)"/>
</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="HospitalHarmPressureInjuryFHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with New Stage 2, 3, 4 or Unstageable Pressure Injury Not POA"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with New Stage 2, 3, 4 or Unstageable Pressure Injury Not POA":
"Encounter with New Stage 2, 3, 4 or Unstageable Pressure Injury Not POA by Indicator"
union "Encounter with New Stage 2, 3, 4 or Unstageable Pressure Injury by Skin Exam after First 24 Hours""/>
</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="HospitalHarmPressureInjuryFHIR"/>
</extension>
<extension url="name">
<valueString value="Numerator"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator":
"Encounter with New Deep Tissue Pressure Injury Not POA"
union "Encounter with New Stage 2, 3, 4 or Unstageable Pressure Injury Not POA""/>
</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="HospitalHarmPressureInjuryFHIR"/>
</extension>
<extension url="name">
<valueString value="Initial Population"/>
</extension>
<extension url="statement">
<valueString
value="define "Initial Population":
"Encounter with Age 18 and Older""/>
</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="HospitalHarmPressureInjuryFHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator":
"Initial Population""/>
</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="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="12"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="HospitalHarmPressureInjuryFHIR"/>
</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="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 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="14"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="HospitalHarmPressureInjuryFHIR"/>
</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="15"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="HospitalHarmPressureInjuryFHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with Deep Tissue Pressure Injury POA by Indicator"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with Deep Tissue Pressure Injury POA by Indicator":
"Encounter with Age 18 and Older" InpatientHospitalization
where exists ( InpatientHospitalization.diagnosis EncounterDiag
where EncounterDiag.condition.getCondition ( ).code in "Pressure Injury Deep Tissue Diagnoses"
and ( EncounterDiag.diagnosisPresentOnAdmission in "Present on Admission or Clinically Undetermined" )
)"/>
</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="HospitalHarmPressureInjuryFHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with Deep Tissue Pressure Injury POA by Skin Exam within First 72 Hours"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with Deep Tissue Pressure Injury POA by Skin Exam within First 72 Hours":
"Encounter with Age 18 and Older" InpatientHospitalization
let hospitalizationPeriod: CQMCommon."HospitalizationWithObservation" ( InpatientHospitalization )
with ["Observation": "Physical findings of Skin"] SkinExam
such that QICoreCommon."ToInterval" ( SkinExam.effective ) starts during Interval[start of hospitalizationPeriod, start of hospitalizationPeriod + 72 hours]
and SkinExam.status in { 'final', 'amended', 'corrected' }
and SkinExam.code in "Pressure Injury Deep Tissue""/>
</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="HospitalHarmPressureInjuryFHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with Deep Tissue Pressure Injury POA"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with Deep Tissue Pressure Injury POA":
"Encounter with Deep Tissue Pressure Injury POA by Indicator"
union "Encounter with Deep Tissue Pressure Injury POA by Skin Exam within First 72 Hours""/>
</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="HospitalHarmPressureInjuryFHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with Stage 2, 3, 4, or Unstageable Pressure Injury Present on Admission by POA Indicator"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with Stage 2, 3, 4, or Unstageable Pressure Injury Present on Admission by POA Indicator":
"Encounter with Age 18 and Older" InpatientHospitalization
where exists ( InpatientHospitalization.diagnosis Stage234UnstageablePressureInjury
where Stage234UnstageablePressureInjury.condition.getCondition ( ).code in "Pressure Injury Stage 2, 3, 4, or Unstageable Diagnoses"
and ( Stage234UnstageablePressureInjury.diagnosisPresentOnAdmission in "Present on Admission or Clinically Undetermined" )
)"/>
</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="HospitalHarmPressureInjuryFHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with Stage 2, 3, 4 or Unstageable Pressure Injury POA by Skin Exam within 24 Hours"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with Stage 2, 3, 4 or Unstageable Pressure Injury POA by Skin Exam within 24 Hours":
"Encounter with Age 18 and Older" InpatientHospitalization
let hospitalizationPeriod: CQMCommon."HospitalizationWithObservation" ( InpatientHospitalization )
with ["Observation": "Physical findings of Skin"] SkinExam
such that QICoreCommon."ToInterval" ( SkinExam.effective ) starts during Interval[start of hospitalizationPeriod, start of hospitalizationPeriod + 24 hours]
and SkinExam.status in { 'final', 'amended', 'corrected' }
and SkinExam.code in "Pressure Injury Stage 2, 3, 4 or Unstageable""/>
</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="HospitalHarmPressureInjuryFHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with Stage 2, 3, 4 or Unstageable Pressure Injury POA"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with Stage 2, 3, 4 or Unstageable Pressure Injury POA":
"Encounter with Stage 2, 3, 4, or Unstageable Pressure Injury Present on Admission by POA Indicator"
union "Encounter with Stage 2, 3, 4 or Unstageable Pressure Injury POA by Skin Exam within 24 Hours""/>
</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="HospitalHarmPressureInjuryFHIR"/>
</extension>
<extension url="name">
<valueString value="Encounter with Diagnosis of COVID19 Infection"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with Diagnosis of COVID19 Infection":
"Encounter with Age 18 and Older" InpatientHospitalization
where exists ( CQMCommon."EncounterDiagnosis" ( InpatientHospitalization ) ) EncounterDiag
where EncounterDiag.code in "COVID 19""/>
</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="HospitalHarmPressureInjuryFHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator Exclusions"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator Exclusions":
"Encounter with Deep Tissue Pressure Injury POA"
union "Encounter with Stage 2, 3, 4 or Unstageable Pressure Injury POA"
union "Encounter with Diagnosis of COVID19 Infection""/>
</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="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="24"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="HospitalHarmPressureInjuryFHIR"/>
</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="25"/>
</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="getCondition"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns the Condition resource for the given reference
*/
define fluent function getCondition(reference Reference):
singleton from ([Condition] C where C.id = reference.reference.getId())"/>
</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="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="27"/>
</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="28"/>
</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="HospitalizationWithObservation"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter
@deprecated: This function is deprecated. Use the fluent function `hospitalizationWithObservation()` instead.
*/
define function "HospitalizationWithObservation"(TheEncounter Encounter ):
TheEncounter Visit
let ObsVisit: Last([Encounter: "Observation Services"] LastObs
where LastObs.status = 'finished'
and LastObs.period ends 1 hour or less on or before start of Visit.period
sort by end of period
),
VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
EDVisit: Last([Encounter: "Emergency Department Visit"] LastED
where LastED.status = 'finished'
and LastED.period ends 1 hour or less on or before VisitStart
sort by end of period
)
return Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]"/>
</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="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="30"/>
</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 resource referenced by the `diagnosis.condition` element of the Encounter
@deprecated: This function is deprecated. Use the fluent function `encounterDiagnosis()` instead.
*/
define 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="31"/>
</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 FHIRHelpers"/>
<resource value="Library/FHIRHelpers|4.4.000"/>
</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 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 Pressure Injury Deep Tissue Diagnoses"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1147.194"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Not Present On Admission or Documentation Insufficient to Determine"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1147.198"/>
</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 Emergency Department Visit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Pressure Injury Deep Tissue"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1147.112"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Pressure Injury Stage 2, 3, 4, or Unstageable Diagnoses"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1147.196"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Pressure Injury Stage 2, 3, 4 or Unstageable"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1147.113"/>
</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 Present on Admission or Clinically Undetermined"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1147.197"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set COVID 19"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.140"/>
</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>
<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="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
<mustSupport value="condition"/>
<mustSupport value="condition.reference"/>
<mustSupport value="condition.reference.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="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
<mustSupport value="condition"/>
<mustSupport value="condition.reference"/>
<mustSupport value="condition.reference.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"/>
</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="period"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="diagnosis"/>
<mustSupport value="condition"/>
<mustSupport value="condition.reference"/>
<mustSupport value="condition.reference.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>
<codeFilter>
<path value="diagnosis.condition.code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1147.194"/>
</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="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="diagnosis"/>
<mustSupport value="condition"/>
<mustSupport value="condition.reference"/>
<mustSupport value="condition.reference.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>
<codeFilter>
<path value="diagnosis.condition.code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1147.196"/>
</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="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"/>
<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="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="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"/>
<mustSupport value="component"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://loinc.org"/>
<code value="8709-8"/>
<display value="Physical findings of Skin"/>
</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"/>
<code>
<system value="http://loinc.org"/>
<code value="8709-8"/>
<display value="Physical findings of Skin"/>
</code>
</codeFilter>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1147.112"/>
</codeFilter>
<dateFilter>
<path value="effective"/>
<valuePeriod>
<extension url="http://hl7.org/fhir/uv/crmi-analysisException">
<valueString
value="Error attempting to determine filter value: toFhirValue not implemented for QueryLetRef"/>
</extension>
</valuePeriod>
</dateFilter>
</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"/>
<code>
<system value="http://loinc.org"/>
<code value="8709-8"/>
<display value="Physical findings of Skin"/>
</code>
</codeFilter>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1147.113"/>
</codeFilter>
<dateFilter>
<path value="effective"/>
<valuePeriod>
<extension url="http://hl7.org/fhir/uv/crmi-analysisException">
<valueString
value="Error attempting to determine filter value: toFhirValue not implemented for QueryLetRef"/>
</extension>
</valuePeriod>
</dateFilter>
</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 and sex; SDE Ethnicity
SDE Payer
SDE Race
SDE Sex
"/>
</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/HospitalHarmPressureInjuryFHIR"/>
<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="CMS826FHIR"/>
</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:75ae89cd-c418-4de1-98c3-0230c72402b6"/>
</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:843c90b5-adbe-4ab7-9dcb-67527ce20fa7"/>
</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="826FHIR"/>
<assigner>
<display value="CMS"/>
</assigner>
</identifier>
<version value="0.1.000"/>
<name value="HospitalHarmPressureInjuryFHIR"/>
<title value="Hospital Harm - Pressure InjuryFHIR"/>
<status value="draft"/>
<experimental value="false"/>
<date value="2024-07-09T14:53:56+00:00"/>
<publisher value="Centers for Medicare & Medicaid Services (CMS)"/>
<contact>
<telecom>
<system value="url"/>
<value value="https://www.cms.gov/"/>
</telecom>
</contact>
<description
value="The proportion of inpatient hospitalizations for patients aged 18 and older who suffer the harm of developing a new stage 2, stage 3, stage 4, deep tissue, or unstageable pressure injury"/>
<purpose value="UNKNOWN"/>
<usage
value="Only one harm (new qualifying pressure injury) is counted per encounter.
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: CMS826v2.2.
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-Core4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html)."/>
<copyright
value="Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. American Institutes for Research (R), formerly IMPAQ International, disclaims all liability for use or accuracy of any third party codes contained in the specifications.
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="American Institutes for Research (AIR)"/>
<telecom>
<system value="url"/>
<value value="https://www.air.org"/>
</telecom>
</author>
<library
value="https://madie.cms.gov/Library/HospitalHarmPressureInjuryFHIR"/>
<disclaimer
value="This performance measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.
THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.
Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]."/>
<scoring>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</scoring>
<rationale
value="This safety eCQM captures the number of patients who experience harm in the form of a pressure injury, during their inpatient hospitalization. The incidence of pressure injuries in hospitalized patients has been estimated at 5.4 per 10,000 patient-days and the rate of hospital-acquired pressure injuries has been estimated at 8.4% (Li et al., 2020). Over 50% of reported pressure injuries in hospitals were stage 2 or higher (Li et al., 2020). Hospital-acquired pressure injuries are serious events and one of the most common patient harms. Pressure injuries commonly cause local infection, osteomyelitis, anemia, and sepsis, in addition to causing significant depression, pain, and discomfort to patients (Shui et al., 2021). Pressure injury is considered a serious reportable event by the National Quality Forum (NQF) (Centers for Medicare and Medicaid Services, 2015).
Studies have shown that age, severity of illness, comorbidity indexes, and Braden scores are predictors of hospital-acquired pressure injuries (HAPI) (Rondinelli et al., 2018). However, even after risk adjustment for patient risk factors, significant variation in rates of HAPI exist between hospitals (Rondinelli et al., 2018). It is widely accepted that the risk of developing a pressure injury can be reduced through best practices. Hospital controlled factors that have been found to be significantly associated with an increase in pressure ulcer risk include infrequent repositioning (p=0.005) and number of days to bed change (OR, 2.89 [95% CI, 1.26-6.63]) (Tayyib, Coyer, and Lewis, 2016; Bly et al., 2016). Nurse staffing, measured as hours per patient day (HPPD), skill mix and expertise, are also significant predictors of HAPI development. Higher HPPD was negatively associated with HAPI, while higher skill mix was associated with a lower risk for HAPIs (Tschannen et al., 2020). Systematically measuring patients who develop new pressure injuries while in the hospital setting will provide hospitals with a reliable and timely measurement, to more reliably assess harm reduction efforts and modify their improvement efforts in near real-time. This eCQM will fill a gap in measurement and provide incentives for hospitals’ quality improvement. Although several pressure injury measures are currently in use, there are no electronic health record (EHR)-based measures intended for use in acute care hospitals. In addition, the intent of this measure is to incentivize greater achievements in reducing harms and enhance hospital performance on patient safety outcomes.
Stage 2 pressure injuries carry a less serious burden in terms of patient harm than stage 3, stage 4, unstageable, and deep tissue pressure injuries (DTPI). Partial thickness wounds heal primarily as a result of epidermal regeneration and often heal without untoward consequences, loss of skin function or scar tissue formation. Based on the healing capabilities inherent in these partial thickness wounds, it is the expert opinion of the NPUAP that the presentation of a stage 2 pressure injuries does not carry the same potential longstanding negative consequences to patients as do full thickness pressure injuries. Stage 2 pressure injuries constitute a very real patient harm that should be monitored and addressed; however, the relative level of harm is less than with stage 3, stage 4, unstageable pressure injuries and potentially DTPI (National Pressure Ulcer Advisory Panel, 2019).
The accurate and timely identification of DTPI is important for several reasons. Early discovery of DTPI allows prompt identification of possible causes, initiation of treatment, and potential development of preventive strategies. In addition, 24 to 72 hours can lapse between the precipitating pressure event and the onset of purple or maroon skin. This delayed manifestation becomes particularly important when the precipitating event occurred before the patient’s admission, yet the DTPI appears beyond the 24-hour window for present-on-admission status (Wound Management and Prevention, 2018)."/>
<clinicalRecommendationStatement
value="The Clinical Guidelines Committee for the American College of Physicians (ACP) presents the available evidence on the comparative effectiveness of various risk assessment instruments and benefits and harms of strategies to prevent pressure ulcers (Qaseem et al., 2015).
Recommendation 1: ACP recommends that clinicians should perform a risk assessment to identify patients who are at risk of developing pressure ulcers.
Recommendation 2: ACP recommends that clinicians should choose advanced static mattresses or advanced static overlays in patients who are at an increased risk of developing pressure ulcers.
Recommendation 3: ACP recommends against using alternating-air mattresses or alternating-air overlays in patients who are at an increased risk of developing pressure ulcers.
The European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance (Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. EPUAP/NPIAP/PPPIA:2019) provide guidance for categorizing pressure injuries and recommendations for structured skin and risk assessment.
Guidelines focused on risk factors and risk assessment:
1.1: Consider individuals with limited mobility, limited activity and a high potential for friction and shear to be at risk of pressure injuries.
1.2: Consider individuals with a category/stage I pressure injury to be at risk of developing a category/stage II or greater pressure injury.
1.7: Consider the impact of diabetes mellitus on the risk of pressure injuries.
1.8: Consider the impact of perfusion and circulation deficits on the risk of pressure injuries.
1.12: Consider the impact of increased body temperature on the risk of pressure injuries.
1.17: Consider the impact of time spent immobilized before surgery, the duration of surgery and the American Society of Anesthesiologists (ASA) Physical Status Classification on surgery-related pressure injury risk.
Guidelines focused on skin and tissue assessment:
2.2: Inspect the skin of individuals at risk of pressure injuries to identify presence of erythema.
2.3: Differentiate blanchable from non-blanchable erythema using either finger pressure or the transparent disk method and evaluate the extent of erythema.
Guidelines focused on preventative skin care:
3.1: Implement a skin care regimen that includes:
- Keeping skin clean and appropriately hydrated
- Cleansing the skin promptly after episodes of incontinence
- Avoiding use of alkaline soaps and cleansers
- Protecting the skin from moisture with a barrier product
3.3: Use high absorbency incontinence products to protect the skin in individuals with or at risk of pressure injuries who have urinary incontinence.
3.4: Consider using textiles with low friction coefficients for individuals with or at risk of pressure injuries.
3.5: Use a soft silicone multi-layered foam dressing to protect the skin for individuals at risk of pressure injuries.
Guidelines focused on nutrition screening:
4.1: Conduct nutritional screening for individuals at risk of a pressure injury.
4.2: Conduct a comprehensive nutrition assessment for adults at risk of a pressure injury who are screened to be at risk of malnutrition and for all adults with a pressure injury.
4.3: Develop and implement an individualized nutrition care plan for individuals with or at risk of a pressure injury who are malnourished or who are at risk of malnutrition.
4.4: Optimize energy intake for individuals at risk of pressure injuries who are malnourished or at risk of malnutrition.
4.6: Provide 30 to 35 kcalories/kg body weight/day for adults with a pressure injury who are malnourished or at risk of malnutrition.
4.7: Provide 1.25 to 1.5 g protein/kg body weight/day for adults with a pressure injury who are malnourished or at risk of malnutrition.
4.9: Offer high calorie, high protein nutritional supplements in addition to the usual diet for adults with a pressure injury who are malnourished or at risk of malnutrition, if nutritional requirements cannot be achieved by normal dietary intake.
4.12: Discuss the benefits and harms of enteral or parenteral feeding to support pressure injury treatment in light of preferences and goals of care for individuals with pressure injuries who cannot meet their nutritional requirements through oral intake despite nutritional interventions.
Guidelines focused on repositioning and early mobilization:
5.1: Reposition all individuals with or at risk of pressure injuries on an individualized schedule, unless contraindicated.
5.2: Determine repositioning frequency with consideration to the individual’s level of activity and ability to independently reposition.
Guidelines focused on heel pressure injury:
6.1: Assess the vascular/perfusion status of the lower limbs, heels and feet when performing a skin and tissue assessment, and as part of a risk assessment.
6.2: For individuals at risk of heel pressure injuries and/or with category/stage I or II pressure injuries, elevate the heels using a specifically designed heel suspension device or a pillow/ foam cushion. Offload the heel completely in such a way as to distribute the weight of the leg along the calf without placing pressure on the Achilles tendon and the popliteal vein.
6.4: Use a prophylactic dressing as an adjunct to heel offloading and other strategies to prevent heel pressure injuries.
Guidelines focused on support surfaces:
7.4: Use a high specification reactive single layer foam mattress or overlay in preference to a foam mattress without high specification qualities for individuals at risk of developing pressure injuries.
7.7: Assess the relative benefits of using an alternating pressure air mattress or overlay for individuals at risk of pressure injuries.
7.8: Use a pressure redistribution support surface on the operating table for all individuals with or at risk of pressure injuries who are undergoing surgery.
7.12: Use a pressure redistribution cushion for preventing pressure injuries in people at high risk who are seated in a chair/wheelchair for prolonged periods, particularly if the individual is unable to perform pressure relieving maneuvers.
7.13: Assess the relative benefits of using an alternating pressure air cushion for supporting pressure injury healing in individuals who are seated in a chair/wheelchair for prolonged periods, particularly if the individual is unable to perform pressure relieving maneuvers.
Guidelines focused on device related pressure injury:
8.1: To reduce the risk of medical device related pressure injuries, review and select medical devices with consideration to:
- The device's ability to minimize tissue damage
- Correct sizing/shape of the device for the individual
- Ability to correctly apply the device according to manufacturer's instructions
- Ability to correctly secure the device
8.5: Use a prophylactic dressing beneath a medical device to reduce the risk of medical device related pressure injuries.
Guidelines focused on implementing best practices:
20.2: At the organizational level, assess the knowledge health professionals have about pressure injuries to facilitate implementation of an education program and a quality improvement program.
20.4: At an organizational level, assess and maximize the availability and quality of equipment and standards for its use as part of a quality improvement plan to reduce the incidence of pressure injuries.
20.5: At an organizational level, develop and implement a structured, tailored and multi-faceted quality improvement program to reduce the incidence of pressure injuries.
20.6: At an organizational level, engage all key stakeholders in oversight and implementation of the quality improvement program to reduce the incidence of pressure injuries.
20.7: At an organizational level, include evidence-based policies, procedures and protocols and standardized documentation systems to reduce the incidence of pressure injuries.
20.8: At an organizational level, provide clinical decision support tools as part of a quality improvement plan to reduce the incidence of pressure injuries.
20.9: Provide clinical leadership in pressure injury prevention and treatment as part of a quality improvement plan to reduce pressure injuries.
20.10: At a professional level, provide education in pressure injury prevention and treatment as part of a quality improvement plan to reduce the incidence of pressure injuries.
20.11: At an organizational level, regularly monitor, analyze and evaluate performance against quality indicators for pressure injury prevention and treatment.
20.12: At an organizational level, use feedback and reminder systems to promote the quality improvement program and its outcomes to stakeholders.
Guidelines focused on health professional education:
21.1: At the organizational level, assess the knowledge health professionals have about pressure injuries to facilitate implementation of an education program and a quality improvement program.
21.2: At an organizational level, develop and implement a multi-faceted education program for pressure injury prevention and treatment."/>
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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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