Proportion

Process

increase

define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 13
    and "First SUD Episode During Measurement Period" is not null
    and not exists "History of SUD Diagnosis or Treatment"

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  Hospice."Has Hospice Services"

define "Numerator 1":
  exists "Treatment Initiation With Non Medication Intervention Dates"
    or exists "Treatment Initiation With Medication Order Dates"

Proportion

Process

increase

define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 13
    and "First SUD Episode During Measurement Period" is not null
    and not exists "History of SUD Diagnosis or Treatment"

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  Hospice."Has Hospice Services"

define "Numerator 2":
  "Has Treatment Engagement With Long Acting Medication"
    or "Has Two or More Treatment Engagements With Short Acting Medication or Non Medication Intervention"

define "Stratification 3":
  AgeInYearsAt(date from start of "Measurement Period") >= 65

define "Stratification 2":
  AgeInYearsAt(date from start of "Measurement Period") in Interval[18, 64]

define "Stratification 1":
  AgeInYearsAt(date from start of "Measurement Period") in Interval[13, 17]

define "Qualifying Encounters":
  ( [Encounter: "Office Visit"]
      union [Encounter: "Emergency Department Evaluation and Management Visit"]
      union [Encounter: "Detoxification Visit"]
      union [Encounter: "Initial Hospital Inpatient Visit"]
      union [Encounter: "Discharge Services Hospital Inpatient Same Day Discharge"]
      union [Encounter: "Discharge Services Hospital Inpatient"]
      union [Encounter: "Telephone Visits"]
      union [Encounter: "Virtual Encounter"]
  ).isEncounterPerformed ( )

define "First SUD Episode During Measurement Period":
  First(("Qualifying Encounters") ValidEncounters
      with [Condition: "Substance Use Disorder"] SUDDiagnosis
        such that ValidEncounters.period.toInterval() during "Measurement Period"
          and SUDDiagnosis.prevalenceInterval() starts during ValidEncounters.period.toInterval()
          and SUDDiagnosis.prevalenceInterval() starts 47 days or more before day of 
          end of "Measurement Period"
      return {
        ValidEncounterDate: date from start of ValidEncounters.period.toInterval(),
        ValidEncounter: ValidEncounters
      }
      sort by ValidEncounterDate
  ).ValidEncounter

define "Emergency Department or Detoxification Visit":
  ( [Encounter: "Emergency Department Evaluation and Management Visit"]
      union [Encounter: "Detoxification Visit"]
  ).isEncounterPerformed ( )

define "History of SUD Diagnosis or Treatment":
  ( ( ( [Procedure: "Substance Use Disorder Treatment"]
        union [Procedure: "Psych Visit Psychotherapy"]
        union [Procedure: "Substance Use Disorder Long Acting Medication Administration"]
        union [Procedure: "Substance Use Disorder Short Acting Medication Administration"]
    ).isInterventionPerformed ( ) ) Interventions
      with "First SUD Episode During Measurement Period" FirstSUDEpisode
        such that Interventions.performed.toInterval ( ) starts 60 days or less before day of date from start of FirstSUDEpisode.period.toInterval ( )
  )
    union ( ( ( ( "Qualifying Encounters"
          except "Emergency Department or Detoxification Visit" ) QualifyingEncounter
          where exists ( ( QualifyingEncounter.encounterDiagnosis ( ) ) SUDDiagnosis
              where SUDDiagnosis.code in "Substance Use Disorder"
          )
      ) ) SUDEncounterDx
        with "First SUD Episode During Measurement Period" FirstSUDEpisode
          such that SUDEncounterDx.period.toInterval ( ) starts 60 days or less before day of date from start of FirstSUDEpisode.period.toInterval ( )
    )
    union ( ( ( [MedicationRequest: "Substance Use Disorder Long Acting Medication"]
          union [MedicationRequest: "Substance Use Disorder Short Acting Medication"]
      ).isMedicationOrder ( ) ) SUDMedication
        with "First SUD Episode During Measurement Period" FirstSUDEpisode
          such that SUDMedication.authoredOn.toInterval ( ) 60 days or less before day of date from start of FirstSUDEpisode.period.toInterval ( )
    )

define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 13
    and "First SUD Episode During Measurement Period" is not null
    and not exists "History of SUD Diagnosis or Treatment"

define "Denominator":
  "Initial Population"

define "Psychosocial Visit":
  ( ( [Procedure: "Substance Use Disorder Treatment"]
        union [Procedure: "Psych Visit Psychotherapy"]
    ).isInterventionPerformed ( )
  )
    union ( ( [Encounter: "Telephone Visits"]
        union [Encounter: "Virtual Encounter"]
    ).isEncounterPerformed ( ) ) TelehealthEncounter
      where exists ( ( TelehealthEncounter.encounterDiagnosis ( ) ) SUDDiagnosis
          where SUDDiagnosis.code in "Substance Use Disorder"
      )

define "Treatment Initiation With Non Medication Intervention Dates":
  ( "Psychosocial Visit" PsychosocialVisitProcedure
      let treatmentDate: date from start of PsychosocialVisitProcedure.performed.toInterval ( )
      with "First SUD Episode During Measurement Period" FirstSUDEpisode
        such that treatmentDate during Interval[date from start of FirstSUDEpisode.period.toInterval ( ), date from start of FirstSUDEpisode.period.toInterval ( ) + 14 days )
          and PsychosocialVisitProcedure.id !~ FirstSUDEpisode.id
      return all treatmentDate
  )
    union ( "Psychosocial Visit" PsychosocialVisitEncounter
        let treatmentDate: date from start of PsychosocialVisitEncounter.period.toInterval ( )
        with "First SUD Episode During Measurement Period" FirstSUDEpisode
          such that treatmentDate during Interval[date from start of FirstSUDEpisode.period.toInterval ( ), date from start of FirstSUDEpisode.period.toInterval ( ) + 14 days )
            and PsychosocialVisitEncounter.id !~ FirstSUDEpisode.id
        return all treatmentDate
    )

define "Treatment Initiation With Medication Order Dates":
  ( ( ( [MedicationRequest: "Substance Use Disorder Short Acting Medication"]
        union [MedicationRequest: "Substance Use Disorder Long Acting Medication"]
    ).isMedicationOrder ( ) ) SUDMedication
      let treatmentDate: date from start of SUDMedication.authoredOn.toInterval ( )
      with "First SUD Episode During Measurement Period" FirstSUDEpisode
        such that treatmentDate during Interval[date from start of FirstSUDEpisode.period.toInterval ( ), date from start of FirstSUDEpisode.period.toInterval ( ) + 14 days )
      return all treatmentDate
  )
    union ( ( ( [Procedure: "Substance Use Disorder Short Acting Medication Administration"]
          union [Procedure: "Substance Use Disorder Long Acting Medication Administration"]
      ).isInterventionPerformed ( ) ) SUDMedAdministration
        let treatmentDate: date from start of SUDMedAdministration.performed.toInterval ( )
        with "First SUD Episode During Measurement Period" FirstSUDEpisode
          such that treatmentDate during Interval[date from start of FirstSUDEpisode.period.toInterval ( ), date from start of FirstSUDEpisode.period.toInterval ( ) + 14 days )
        return all treatmentDate
    )

define "Numerator 1":
  exists "Treatment Initiation With Non Medication Intervention Dates"
    or exists "Treatment Initiation With Medication Order Dates"

define "Has Treatment Engagement With Long Acting Medication":
  exists ( ( ( ( [MedicationRequest: "Substance Use Disorder Long Acting Medication"] ).isMedicationOrder ( ) ) LongActingMedOrder
        with ( Min("Treatment Initiation With Non Medication Intervention Dates"
            union "Treatment Initiation With Medication Order Dates"
        ) ) InitiationTreatmentDate
          such that date from start of LongActingMedOrder.authoredOn.toInterval ( ) 34 days or less after InitiationTreatmentDate
    )
      union ( ( ( [Procedure: "Substance Use Disorder Long Acting Medication Administration"] ).isInterventionPerformed ( ) ) LongActingTreatment
          with ( Min("Treatment Initiation With Non Medication Intervention Dates"
              union "Treatment Initiation With Medication Order Dates"
          ) ) InitiationTreatmentDate
            such that date from start of LongActingTreatment.performed.toInterval ( ) 34 days or less after InitiationTreatmentDate
      )
  )

define "Has Two or More Treatment Engagements With Short Acting Medication or Non Medication Intervention":
  Count((("Psychosocial Visit"
        union(([Procedure: "Substance Use Disorder Short Acting Medication Administration"]).isInterventionPerformed())) ShortActingTreatment
        with(Min("Treatment Initiation With Non Medication Intervention Dates"
            union "Treatment Initiation With Medication Order Dates"
        )) InitiationTreatmentDate
          such that date from start of ShortActingTreatment.performed.toInterval() 34 days or less after InitiationTreatmentDate
            or date from start of ShortActingTreatment.period.toInterval() 34 days or less after InitiationTreatmentDate
        return all ShortActingTreatment
    )
      union((([MedicationRequest: "Substance Use Disorder Short Acting Medication"]).isMedicationOrder()) ShortActingMedOrder
          with(Min("Treatment Initiation With Non Medication Intervention Dates"
              union "Treatment Initiation With Medication Order Dates"
          )) InitiationTreatmentDate
            such that date from start of ShortActingMedOrder.authoredOn.toInterval() 34 days or less after InitiationTreatmentDate
          return all ShortActingMedOrder
      )
  ) >= 2

define "Numerator 2":
  "Has Treatment Engagement With Long Acting Medication"
    or "Has Two or More Treatment Engagements With Short Acting Medication or Non Medication Intervention"

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

define "Denominator Exclusions":
  Hospice."Has Hospice Services"

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

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

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

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

/*
@description: Returns the Condition resources referenced by the diagnosis element of the Encounter
*/
define fluent function encounterDiagnosis(Encounter Encounter ):
  Encounter.diagnosis D
    return singleton from ([Condition] C where C.id = D.condition.reference.getId())

/*
@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, '/'))

//Medication, Order: active and completed only
define fluent function isMedicationOrder(MedicationRequest List<MedicationRequest>):
  MedicationRequest M
    where M.status in { 'active', 'completed' }
      and M.intent = 'order'

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

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

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

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