Outcome

decrease

define "Initial Population":
  "Inpatient Encounters"

define "Inpatient Encounters":
  [Encounter: "Encounter Inpatient"] InpatientEncounter
    with ( [Coverage: "Medicare FFS payer"]
      union [Coverage: "Medicare Advantage payer"] ) MedicarePayer
      such that ( InpatientEncounter.hospitalizationWithObservationAndOutpatientSurgeryService ( ).lengthInDays ( ) ) < 365
        and InpatientEncounter.status = 'finished'
        and AgeInYearsAt(date from start of InpatientEncounter.period) >= 65
        and InpatientEncounter.period ends during day of "Measurement Period"

define "Encounter with First Bicarbonate Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstBicarbonateLab: First(["US Core Laboratory Result Observation Profile": "Bicarbonate lab test"] bicarbonatelab
        where bicarbonatelab.issued.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
          and bicarbonatelab.status in { 'final', 'amended', 'corrected' }
          and bicarbonatelab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstResult: FirstBicarbonateLab.value as Quantity,
      Timing: FirstBicarbonateLab.issued
    }

define "Encounter with First Heart Rate":
  "Inpatient Encounters" EncounterInpatient
    let FirstHeartRate: First(["observation-heartrate"] HeartRate
        where HeartRate.effective.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 120 minutes]
          and HeartRate.status in { 'final', 'amended', 'corrected' }
          and HeartRate.value is not null
        sort by effective.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstHeartRateResult: FirstHeartRate.value as Quantity,
      Timing: FirstHeartRate.effective.earliest ( )
    }

define "Encounter with First White Blood Cells Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstWhiteBloodCellLab: First(["US Core Laboratory Result Observation Profile": "White blood cells count lab test"] WhiteBloodCellLab
        where WhiteBloodCellLab.issued.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
          and WhiteBloodCellLab.status in { 'final', 'amended', 'corrected' }
          and WhiteBloodCellLab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstResult: FirstWhiteBloodCellLab.value as Quantity,
      Timing: FirstWhiteBloodCellLab.issued
    }

define "Encounter with First Hematocrit Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstHematocritLab: First(["US Core Laboratory Result Observation Profile": "Hematocrit lab test"] HematocritLab
        where HematocritLab.issued.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
          and HematocritLab.status in { 'final', 'amended', 'corrected' }
          and HematocritLab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstResult: FirstHematocritLab.value as Quantity,
      Timing: FirstHematocritLab.issued
    }

define "Encounter with First Weight Recorded During Stay":
  "Inpatient Encounters" EncounterInpatient
    let FirstWeight: First(["observation-bodyweight"] WeightExam
        where WeightExam.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and WeightExam.status in { 'final', 'amended', 'corrected' }
          and WeightExam.value is not null
        sort by effective.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstResult: FirstWeight.value as Quantity,
      Timing: FirstWeight.effective.earliest ( )
    }

define "Encounter with First Glucose Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstGlucoseLab: First(["US Core Laboratory Result Observation Profile": "Glucose lab test"] GlucoseLab
        where GlucoseLab.issued.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
          and GlucoseLab.status in { 'final', 'amended', 'corrected' }
          and GlucoseLab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstResult: FirstGlucoseLab.value as Quantity,
      Timing: FirstGlucoseLab.issued
    }

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

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

define "Blood Pressure Reading":
  ["observation-bp"] BloodPressure
    where BloodPressure.status in { 'final', 'amended', 'corrected' }

define "Encounter with First Systolic Blood Pressure":
  "Inpatient Encounters" EncounterInpatient
    let FirstSystolicBP: First("Blood Pressure Reading" SBPReading
        where SBPReading.effective.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 120 minutes]
        return singleton from(SBPReading.component SBPComponent
            where SBPComponent.code ~ "Systolic blood pressure"
            return SBPComponent.value as Quantity
        )
        sort ascending
    )
    return EncounterInpatient.id

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

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

define "Encounter with First Respiratory Rate":
  "Inpatient Encounters" EncounterInpatient
    let FirstRespRate: First(["observation-resprate"] RespRate
        where RespRate.effective.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 120 minutes]
          and RespRate.status in { 'final', 'amended', 'corrected' }
          and RespRate.value is not null
        sort by effective.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstRespRateResult: FirstRespRate.value as Quantity,
      Timing: FirstRespRate.effective.earliest ( )
    }

define "Encounter with First Creatinine Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstCreatinineLab: First(["US Core Laboratory Result Observation Profile": "Creatinine lab test"] CreatinineLab
        where CreatinineLab.issued.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
          and CreatinineLab.status in { 'final', 'amended', 'corrected' }
          and CreatinineLab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstResult: FirstCreatinineLab.value as Quantity,
      Timing: FirstCreatinineLab.issued
    }

define "Encounter with First Body Temperature":
  "Inpatient Encounters" EncounterInpatient
    let FirstTemperature: First(["observation-bodytemp"] temperature
        where temperature.effective.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 120 minutes]
          and temperature.status in { 'final', 'amended', 'corrected' }
          and temperature.value is not null
        sort by effective.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstTemperatureResult: FirstTemperature.value as Quantity,
      Timing: FirstTemperature.effective.earliest ( )
    }

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

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

define "Initial Population":
  "Inpatient Encounters"

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

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

define "Encounter with First Oxygen Saturation":
  "Inpatient Encounters" EncounterInpatient
    let FirstOxygenSat: First([Observation: "Oxygen Saturation by Pulse Oximetry"] O2Saturation
        where O2Saturation.effective.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 120 minutes]
          and O2Saturation.status in { 'final', 'amended', 'corrected' }
          and O2Saturation.value is not null
        sort by effective.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstOxygenSatResult: FirstOxygenSat.value as Quantity,
      Timing: FirstOxygenSat.effective.earliest ( )
    }

define "Encounter with First Potassium Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstPotassiumLab: First(["US Core Laboratory Result Observation Profile": "Potassium lab test"] PotassiumLab
        where PotassiumLab.issued.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
          and PotassiumLab.status in { 'final', 'amended', 'corrected' }
          and PotassiumLab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstResult: FirstPotassiumLab.value as Quantity,
      Timing: FirstPotassiumLab.issued
    }

define "Encounter with First Sodium Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstSodiumLab: First(["US Core Laboratory Result Observation Profile": "Sodium lab test"] SodiumLab
        where SodiumLab.issued.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
          and SodiumLab.status in { 'final', 'amended', 'corrected' }
          and SodiumLab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstResult: FirstSodiumLab.value as Quantity,
      Timing: FirstSodiumLab.issued
    }

/*
@description: Calculates the difference in calendar days between the start and end of the given interval.
*/
define fluent function lengthInDays(Value Interval<DateTime> ):
  difference in days between start of Value and end of Value

/*
@description: Hospitalization with Observation and Outpatient Surgery Service returns the total interval from the start of any immediately prior emergency department visit, outpatient surgery visit or observation visit to the discharge of the given encounter.
*/
define fluent function hospitalizationWithObservationAndOutpatientSurgeryService(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
    	),
    	VisitStartWithED: Coalesce(start of EDVisit.period, VisitStart),
    	OutpatientSurgeryVisit: Last([Encounter: "Outpatient Surgery Service"] LastSurgeryOP
			  where LastSurgeryOP.period ends 1 hour or less on or before VisitStartWithED
			  sort by	end of period
    	)
  	return Interval[Coalesce(start of OutpatientSurgeryVisit.period, VisitStartWithED), end of Visit.period]

/*
@description: Given an interval, return the starting point if the interval has a starting boundary specified,
otherwise, return the ending point
*/
define fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
  (choice.toInterval()) period
    return
      if (period."hasStart"()) then start of period
      else end of period

define function ToString(value uri): value.value

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