Proportion

Process

increase

define "Initial Population":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    where AgeInYearsAt(start of "Measurement Period") >= 18

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    with [Condition: "Diagnosis of Hypertension"] Hypertension
      such that ( Hypertension.isProblemListItem ( )
          or Hypertension.isHealthConcern ( )
      )
        and Hypertension.prevalenceInterval ( ) starts before or on day of QualifyingEncounter.period

define "Numerator":
  "Encounter with Normal Blood Pressure Reading"
    union ( "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80 and Interventions" )
    union ( "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80 and Interventions" )
    union ( "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions" )
    union ( "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 and Interventions" )

define "Denominator Exceptions":
  "Encounter with Medical Reason for Not Obtaining or Patient Declined Blood Pressure Measurement"
    union "Encounter with Order for Hypertension Follow Up Declined by Patient"

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 "Qualifying Encounter during Measurement Period":
  [Encounter: "Encounter to Screen for Blood Pressure"] ValidEncounter
    where ValidEncounter.period during day of "Measurement Period"
      and ValidEncounter.status ~ 'finished'
      and ValidEncounter.class !~ "virtual"

define "Encounter with Normal Blood Pressure Reading":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    let EncounterLastBP: Last(["observation-bp"] BloodPressure
        where BloodPressure.effective.toInterval() ends during QualifyingEncounter.period
          and BloodPressure.status in { 'final', 'amended', 'corrected' }
        sort by start of effective.toInterval()
    )
    where EncounterLastBP.SystolicBP.value in Interval[1 'mm[Hg]', 120 'mm[Hg]' )
      and EncounterLastBP.DiastolicBP.value in Interval[1 'mm[Hg]', 80 'mm[Hg]' )

define "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    let EncounterLastBP: Last(["observation-bp"] BloodPressure
        where BloodPressure.effective.toInterval() ends during QualifyingEncounter.period
          and BloodPressure.status in { 'final', 'amended', 'corrected' }
        sort by start of effective.toInterval()
    )
    where ( EncounterLastBP.SystolicBP.value in Interval[120 'mm[Hg]', 129 'mm[Hg]']
        and EncounterLastBP.DiastolicBP.value in Interval[1 'mm[Hg]', 80 'mm[Hg]' )
    )

define "Follow up with Rescreen Within 6 Months":
  [ServiceRequest: "Follow Up Within 6 Months"] FollowUp
    where FollowUp.intent ~ 'order'

define "NonPharmacological Interventions":
  ( [ServiceRequest: "Lifestyle Recommendation"]
    union [ServiceRequest: "Weight Reduction Recommended"]
    union [ServiceRequest: "Dietary Recommendations"]
    union [ServiceRequest: "Recommendation to Increase Physical Activity"]
    union [ServiceRequest: "Referral or Counseling for Alcohol Consumption"] ) NonPharmaInterventions
    where NonPharmaInterventions.intent ~ 'order'

define "Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading":
  [ServiceRequest: "Referral to Primary Care or Alternate Provider"] Referral
    where Referral.reasonCode in "Finding of Elevated Blood Pressure or Hypertension"
      and Referral.intent ~ 'order'

define "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80 and Interventions":
  ( "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80" ElevatedEncounter
      with "Follow up with Rescreen Within 6 Months" Twoto6MonthRescreen
        such that Twoto6MonthRescreen.authoredOn during day of ElevatedEncounter.period
      with "NonPharmacological Interventions" NonPharmInterventions
        such that NonPharmInterventions.authoredOn during day of ElevatedEncounter.period
  )
    union ( "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80" ElevatedEncounter
        with "Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading" Referral
          such that Referral.authoredOn during day of ElevatedEncounter.period
    )

define "Encounter with Hypertensive Reading Within Year Prior":
  ( "Qualifying Encounter during Measurement Period" QualifyingEncounter
      let EncounterLastBP: Last(["observation-bp"] BloodPressure
          where BloodPressure.effective.toInterval() ends 1 year or less before or on start of QualifyingEncounter.period
            and BloodPressure.status in { 'final', 'amended', 'corrected' }
          sort by start of effective.toInterval()
      )
      where ( EncounterLastBP.SystolicBP.value > 0 'mm[Hg]'
          and EncounterLastBP.DiastolicBP.value > 0 'mm[Hg]'
          and ( EncounterLastBP.SystolicBP.value >= 130 'mm[Hg]'
              or EncounterLastBP.DiastolicBP.value >= 80 'mm[Hg]'
          )
      )
  )

define "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80":
  ( "Qualifying Encounter during Measurement Period" QualifyingEncounter
      let EncounterLastBP: Last(["observation-bp"] BloodPressure
          where BloodPressure.effective.toInterval() ends during day of QualifyingEncounter.period
          sort by start of effective.toInterval()
      )
      where ( ( EncounterLastBP.SystolicBP.value > 0 'mm[Hg]'
            and EncounterLastBP.DiastolicBP.value > 0 'mm[Hg]'
        )
          and ( EncounterLastBP.SystolicBP.value >= 130 'mm[Hg]'
              or EncounterLastBP.DiastolicBP.value >= 80 'mm[Hg]'
          )
      )
  )
    except "Encounter with Hypertensive Reading Within Year Prior"

define "First Hypertensive Reading Interventions or Referral to Alternate Professional":
  ( [ServiceRequest: "Follow Up Within 4 Weeks"] FourWeekRescreen
      with "NonPharmacological Interventions" NonPharmInterventionsHTN
        such that FourWeekRescreen.authoredOn during day of "Measurement Period"
          and NonPharmInterventionsHTN.authoredOn during day of "Measurement Period"
          and FourWeekRescreen.intent ~ 'order'
  )
    union ( "Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading" )

define "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80 and Interventions":
  "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80" FirstHTNEncounter
    with "First Hypertensive Reading Interventions or Referral to Alternate Professional" FirstHTNIntervention
      such that FirstHTNIntervention.authoredOn during day of FirstHTNEncounter.period

define "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89":
  ( "Qualifying Encounter during Measurement Period" QualifyingEncounter
      let EncounterLastBP: Last(["observation-bp"] BloodPressure
          where BloodPressure.effective.toInterval() ends during day of QualifyingEncounter.period
            and BloodPressure.status in { 'final', 'amended', 'corrected' }
          sort by start of effective.toInterval()
      )
      where ( ( EncounterLastBP.SystolicBP.value in Interval[130 'mm[Hg]', 139 'mm[Hg]']
            or EncounterLastBP.DiastolicBP.value in Interval[80 'mm[Hg]', 89 'mm[Hg]']
        )
          and not ( EncounterLastBP.SystolicBP.value >= 140 'mm[Hg]'
              or EncounterLastBP.DiastolicBP.value >= 90 'mm[Hg]'
          )
      )
        and ( exists "Encounter with Hypertensive Reading Within Year Prior" )
  )

define "Laboratory Test or ECG for Hypertension":
  ( [ServiceRequest: "12 lead EKG panel"]
    union [ServiceRequest: "EKG study"]
    union [ServiceRequest: "Laboratory Tests for Hypertension"] ) EKGLab
    where EKGLab.intent ~ 'order'

define "Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions":
  "Follow up with Rescreen Within 6 Months" Rescreen2to6
    with "Laboratory Test or ECG for Hypertension" LabECGIntervention
      such that Rescreen2to6.authoredOn during day of "Measurement Period"
        and LabECGIntervention.authoredOn during day of "Measurement Period"
    with "NonPharmacological Interventions" NonPharmSecondIntervention
      such that NonPharmSecondIntervention.authoredOn during day of "Measurement Period"

define "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions":
  ( "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89" SecondHTNEncounterReading
      with "Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions" EncounterInterventions
        such that EncounterInterventions.authoredOn during day of SecondHTNEncounterReading.period
  )
    union ( "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89" SecondHTNEncounterReading
        with "Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading" ReferralForHTN
          such that ReferralForHTN.authoredOn during day of SecondHTNEncounterReading.period
    )

define "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90":
  ( "Qualifying Encounter during Measurement Period" QualifyingEncounter
      let EncounterLastBP: Last(["observation-bp"] BloodPressure
          where BloodPressure.effective.toInterval() ends during QualifyingEncounter.period
            and BloodPressure.status in { 'final', 'amended', 'corrected' }
          sort by start of effective.toInterval()
      )
      where ( EncounterLastBP.SystolicBP.value > 0 'mm[Hg]'
          and EncounterLastBP.DiastolicBP.value > 0 'mm[Hg]'
          and ( EncounterLastBP.SystolicBP.value >= 140 'mm[Hg]'
              or EncounterLastBP.DiastolicBP.value >= 90 'mm[Hg]'
          )
      )
        and ( exists "Encounter with Hypertensive Reading Within Year Prior" )
  )

define "Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 Interventions":
  ( [ServiceRequest: "Follow Up Within 4 Weeks"] WeeksRescreen
      with "Laboratory Test or ECG for Hypertension" ECGLabTest
        such that WeeksRescreen.authoredOn during day of "Measurement Period"
          and ECGLabTest.authoredOn during day of "Measurement Period"
          and WeeksRescreen.intent ~ 'order'
          and ECGLabTest.intent ~ 'order'
      with "NonPharmacological Interventions" HTNInterventions
        such that HTNInterventions.authoredOn during day of "Measurement Period"
      with ["MedicationRequest": "Pharmacologic Therapy for Hypertension"] Medications
        such that Medications.authoredOn during day of "Measurement Period"
          and Medications.status ~ 'active'
  )

define "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 and Interventions":
  ( "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90" SecondHTNEncounterReading140Over90
      with "Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 Interventions" SecondHTN140Over90Interventions
        such that SecondHTN140Over90Interventions.authoredOn during day of SecondHTNEncounterReading140Over90.period
  )
    union "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90" SecondHTNEncounterReading140Over90
      with "Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading" ReferralToProfessional
        such that ReferralToProfessional.authoredOn during day of SecondHTNEncounterReading140Over90.period

define "Numerator":
  "Encounter with Normal Blood Pressure Reading"
    union ( "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80 and Interventions" )
    union ( "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80 and Interventions" )
    union ( "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions" )
    union ( "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 and Interventions" )

define "Initial Population":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    where AgeInYearsAt(start of "Measurement Period") >= 18

define "Denominator":
  "Initial Population"

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

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

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

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

define "Denominator Exclusions":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    with [Condition: "Diagnosis of Hypertension"] Hypertension
      such that ( Hypertension.isProblemListItem ( )
          or Hypertension.isHealthConcern ( )
      )
        and Hypertension.prevalenceInterval ( ) starts before or on day of QualifyingEncounter.period

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

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

define "Encounter with Medical Reason for Not Obtaining or Patient Declined Blood Pressure Measurement":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    with ( [ObservationNotDone: code ~ "Systolic blood pressure"]
      union [ObservationNotDone: code ~ "Diastolic blood pressure"] ) NoBPScreen
      such that NoBPScreen.issued during day of QualifyingEncounter.period
        and ( NoBPScreen.notDoneReason in "Patient Declined"
            or NoBPScreen.notDoneReason in "Medical Reason"
        )
        and NoBPScreen.status = 'cancelled'

define "NonPharmacological Intervention Not Ordered":
  ( [ServiceNotRequested: "Lifestyle Recommendation"]
    union [ServiceNotRequested: "Weight Reduction Recommended"]
    union [ServiceNotRequested: "Dietary Recommendations"]
    union [ServiceNotRequested: "Recommendation to Increase Physical Activity"]
    union [ServiceNotRequested: "Referral or Counseling for Alcohol Consumption"] ) NonPharmIntervention
    where NonPharmIntervention.reasonRefused in "Patient Declined"
      and NonPharmIntervention.status = 'completed'

define "Laboratory Test or ECG for Hypertension Not Ordered":
  ( [ServiceNotRequested: code = "12 lead EKG panel"]
    union [ServiceNotRequested: code = "EKG study"]
    union [ServiceNotRequested: "Laboratory Tests for Hypertension"] ) LabECGNotDone
    where LabECGNotDone.reasonRefused in "Patient Declined"

define "Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 Interventions Declined":
  ( ( ( [ServiceNotRequested: "Referral to Primary Care or Alternate Provider"]
        union [ServiceNotRequested: "Follow Up Within 6 Months"] ) SecondHTNDeclinedReferralAndFollowUp
        where SecondHTNDeclinedReferralAndFollowUp.reasonRefused in "Patient Declined"
          and SecondHTNDeclinedReferralAndFollowUp.status = 'completed'
    )
      union "Laboratory Test or ECG for Hypertension Not Ordered"
      union "NonPharmacological Intervention Not Ordered"
  )

define "Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 Interventions Declined":
  ( ( ( [ServiceNotRequested: "Referral to Primary Care or Alternate Provider"]
        union [ServiceNotRequested: "Follow Up Within 4 Weeks"] ) SecondHTN140Over90ReferralFollowUpNotDone
        where SecondHTN140Over90ReferralFollowUpNotDone.reasonRefused in "Patient Declined"
          and SecondHTN140Over90ReferralFollowUpNotDone.status = 'completed'
    )
      union ( [MedicationNotRequested: "Pharmacologic Therapy for Hypertension"] MedicationRequestNotOrdered
          where MedicationRequestNotOrdered.status = 'completed'
      )
      union "Laboratory Test or ECG for Hypertension Not Ordered"
      union "NonPharmacological Intervention Not Ordered"
  )

define "Encounter with Order for Hypertension Follow Up Declined by Patient":
  ( ( "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80" ElevatedBPEncounter
        with ( [ServiceNotRequested: "Referral to Primary Care or Alternate Provider"]
          union [ServiceNotRequested: "Follow Up Within 6 Months"] ) ElevatedBPDeclinedInterventions
          such that ElevatedBPDeclinedInterventions.reasonRefused in "Patient Declined"
            and ElevatedBPDeclinedInterventions.authoredOn during day of ElevatedBPEncounter.period
            and ElevatedBPDeclinedInterventions.status = 'completed'
    )
      union ( "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80" ElevatedBPEncounter
          with "NonPharmacological Intervention Not Ordered" NotOrdered
            such that NotOrdered.authoredOn during day of ElevatedBPEncounter.period
      )
      union ( "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80" FirstHTNEncounter
          with ( [ServiceNotRequested: "Follow Up Within 4 Weeks"]
            union [ServiceNotRequested: "Referral to Primary Care or Alternate Provider"] ) FirstHTNDeclinedInterventions
            such that FirstHTNDeclinedInterventions.reasonRefused in "Patient Declined"
              and FirstHTNDeclinedInterventions.authoredOn during day of FirstHTNEncounter.period
              and FirstHTNDeclinedInterventions.status = 'completed'
      )
      union ( "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80" FirstHTNEncounter
          with "NonPharmacological Intervention Not Ordered" NoNonPharm
            such that NoNonPharm.authoredOn during day of FirstHTNEncounter.period
      )
      union ( "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89" SecondHTNEncounter
          with "Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 Interventions Declined" SecondHTNDeclinedInterventions
            such that SecondHTNDeclinedInterventions.authoredOn during day of SecondHTNEncounter.period
      )
      union ( "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90" SecondHTN140Over90Encounter
          with "Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 Interventions Declined" SecondHTN140Over90DeclinedInterventions
            such that SecondHTN140Over90DeclinedInterventions.authoredOn during day of SecondHTN140Over90Encounter.period
      )
  )

define "Denominator Exceptions":
  "Encounter with Medical Reason for Not Obtaining or Patient Declined Blood Pressure Measurement"
    union "Encounter with Order for Hypertension Follow Up Declined by Patient"

/*
@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
value to a CQL DateTime Interval
@comment: If the start value of the given period is unspecified, the starting
boundary of the resulting interval will be open (meaning the start of the interval
is unknown, as opposed to interpreted as the beginning of time).
*/
define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period."start" is null then
            Interval(period."start".value, period."end".value]
        else
            Interval[period."start".value, period."end".value]

define function ToString(value uri): value.value

define function ToString(value string): value.value

/*
@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
        }

/*
@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
        }

/*
@description: Returns true if the given condition is a problem list item.
*/
define fluent function isProblemListItem(condition Condition):
  exists (condition.category C
    where C ~ "problem-list-item"
  )

/*
@description: Returns true if the given condition is a health concern
*/
define fluent function isHealthConcern(condition Condition):
  exists (condition.category C
    where C ~ "health-concern"
  )

/*
@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]

/*
@description: Returns an interval representing the normalized abatement of a given Condition.
@comment: If the abatement element of the Condition is represented as a DateTime, the result
is an interval beginning and ending on that DateTime.
If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The
result is an interval from the date the patient turned that age to immediately before one year later.
If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during
which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately
before one year later than the date the patient turned the ending age of the quantity interval.
*/
define fluent function abatementInterval(condition Condition):
	if condition.abatement is DateTime then
	  Interval[condition.abatement as DateTime, condition.abatement as DateTime]
	else if condition.abatement is Quantity then
		Interval[Patient.birthDate + (condition.abatement as Quantity),
			Patient.birthDate + (condition.abatement as Quantity) + 1 year)
	else if condition.abatement is Interval<Quantity> then
	  Interval[Patient.birthDate + (condition.abatement.low as Quantity),
		  Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)
	else if condition.abatement is Interval<DateTime> then
	  Interval[condition.abatement.low, condition.abatement.high)
	else null as Interval<DateTime>