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 |
{
"resourceType" : "Measure",
"id" : "PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR",
"meta" : {
"profile" : [
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"http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm"🔗 ,
"http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"
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},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <table class=\"grid dict\">\n \n <tr>\n <th scope=\"row\"><b>Title: </b></th>\n <td style=\"padding-left: 4px;\">Preventive Care and Screening: Tobacco Use: Screening and Cessation InterventionFHIR</td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Id: </b></th>\n <td style=\"padding-left: 4px;\">PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Version: </b></th>\n <td style=\"padding-left: 4px;\">0.0.001</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Url: </b></th>\n <td style=\"padding-left: 4px;\"><a href=\"Measure-PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR.html\">Preventive Care and Screening: Tobacco Use: Screening and Cessation InterventionFHIR</a></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\">\n <b>\n \n \n short-name identifier:\n \n \n </b>\n </th>\n\n <td style=\"padding-left: 4px;\">\n \n <p style=\"margin-bottom: 5px;\">\n <span>CMS138FHIR</span>\n </p>\n \n </td>\n </tr>\n \n <tr>\n <th scope=\"row\">\n <b>\n \n \n version-independent identifier:\n \n \n </b>\n </th>\n\n <td style=\"padding-left: 4px;\">\n \n <p style=\"margin-bottom: 5px;\">\n <span>urn:uuid:d77f147d-5ccc-4ff3-8739-3aa5dc0aea12</span>\n </p>\n \n </td>\n </tr>\n \n <tr>\n <th scope=\"row\">\n <b>\n \n \n version-specific identifier:\n \n \n </b>\n </th>\n\n <td style=\"padding-left: 4px;\">\n \n <p style=\"margin-bottom: 5px;\">\n <span>urn:uuid:93a0c3c5-922d-4ac6-a3ef-41fdcd52a1fc</span>\n </p>\n \n </td>\n </tr>\n \n <tr>\n <th scope=\"row\">\n <b>\n \n \n publisher (CMS) identifier:\n \n \n </b>\n </th>\n\n <td style=\"padding-left: 4px;\">\n \n <p style=\"margin-bottom: 5px;\">\n <span>138FHIR</span>\n </p>\n \n </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Effective Period: </b></th>\n <td style=\"padding-left: 4px;\">2025-01-01..2025-12-31</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Status: </b></th>\n <td style=\"padding-left: 4px;\">draft</td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Publisher: </b></th>\n <td style=\"padding-left: 4px;\">National Committee for Quality Assurance</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Author: </b></th>\n <td style=\"padding-left: 4px;\">American Medical Association (AMA), American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), National Committee for Quality Assurance</td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Description: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>Percentage of patients aged 12 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period if identified as a tobacco user. Three rates are reported: a. Percentage of patients aged 12 years and older who were screened for tobacco use one or more times during the measurement period b. Percentage of patients aged 12 years and older who were identified as a tobacco user during the measurement period who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period c. Percentage of patients aged 12 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period if identified as a tobacco user</p>\n</div></td>\n </tr>\n \n\n \n\n \n\n \n\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Purpose: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>UNKNOWN</p>\n</div></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Copyright: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>This Physician Performance Measure (Measure) and related data specifications are owned by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. The Physician Consortium for Performance Improvement’s (PCPI) and American Medical Association’s (AMA) significant past efforts and contributions to the development and updating of the measure are acknowledged. (C) 2012-2024 National Committee for Quality Assurance. All Rights Reserved. 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. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications. CPT(R) codes, descriptions and other data are copyright 2024. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Some measure specifications contain coding from LOINC(R) (http://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2024 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at http://loinc.org/terms-of-use. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2024 World Health Organization. All Rights Reserved. Some measures use RxNorm, a standardized nomenclature and coding for clinical drugs and drug delivery devices, which is made publicly available courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services. NLM is not responsible for the measures and does not endorse or recommend this or any other product. “HL7” is the registered trademark of Health Level Seven International.</p>\n</div></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Disclaimer: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE 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].</p>\n</div></td>\n </tr>\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Rationale: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>This measure is intended to promote adult tobacco screening and tobacco cessation interventions for those who use tobacco products. There is good evidence that tobacco screening and brief cessation intervention (including counseling and/or pharmacotherapy) is successful in helping tobacco users quit. Tobacco users who are able to stop using tobacco lower their risk for heart disease, lung disease, and stroke.</p>\n</div></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Clinical recommendation statement: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and U.S. Food and Drug Administration (FDA)-approved pharmacotherapy for cessation to nonpregnant adults who use tobacco (Grade A Recommendation) (U.S. Preventive Services Task Force, 2021). The USPSTF recommends that clinicians ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant persons who use tobacco (Grade A Recommendation) (U.S. Preventive Services Task Force, 2021). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of pharmacotherapy interventions for tobacco cessation in pregnant women (Grade I Statement) (U.S. Preventive Services Task Force, 2021). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of electronic cigarettes (e-cigarettes) for tobacco cessation in adults, including pregnant persons. The USPSTF recommends that clinicians direct patients who use tobacco to other tobacco cessation interventions with proven effectiveness and established safety (Grade I Statement) (U.S. Preventive Services Task Force, 2021). The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents (Grade B Statement) (U.S. Preventive Services Task Force, 2020). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care--feasible interventions for the cessation of tobacco use among school-aged children and adolescents (Grade I Statement) (U.S. Preventive Services Task Force, 2020). All patients should be asked if they use tobacco and should have their tobacco use status documented on a regular basis. Evidence has shown that clinic screening systems, such as expanding the vital signs to include tobacco use status or the use of other reminder systems such as chart stickers or computer prompts, significantly increase rates of clinician intervention. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008). All physicians should strongly advise every patient who smokes to quit because evidence shows that physician advice to quit smoking increases abstinence rates. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008). Minimal interventions lasting less than 3 minutes increase overall tobacco abstinence rates. Every tobacco user should be offered at least a minimal intervention, whether or not he or she is referred to an intensive intervention. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008). The combination of counseling and medication is more effective for smoking cessation than either medication or counseling alone. Therefore, whenever feasible and appropriate, both counseling and medication should be provided to patients trying to quit smoking. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008).</p>\n</div></td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Guidance (Usage): </b></th>\n <td style=\"padding-left: 4px;\">The requirement of two or more visits is to establish that the eligible clinician has an existing relationship with the patient for certain types of encounters. To satisfy the intent of this measure, a patient must have at least one tobacco use screening during the measurement period. If a patient has multiple tobacco use screenings during the measurement period, only the most recent screening, which has a documented status of tobacco user or tobacco non-user, will be used to satisfy the measure requirements. If a patient uses any type of tobacco (i.e., smokes or uses smokeless tobacco), the expectation is that they should receive tobacco cessation intervention: either counseling and/or pharmacotherapy. As noted above in the 2021 USPSTF recommendation statement, the current evidence is insufficient to recommend electronic cigarettes (e-cigarettes) for tobacco cessation. However, as noted above in the Definition section, the 2021 USPSTF recommendation also references the US Food and Drug Administration definition of tobacco, which includes e-cigarettes, hookah pens and other electronic nicotine delivery systems. Therefore, the measure does consider the use of e-cigarettes and other electronic nicotine delivery systems to be tobacco use. If a patient's tobacco use status is unknown, the patient does not meet the screening requirement and does not meet the numerator for populations 1 or 3. Instances where tobacco use status of "unknown" include: 1) the patient was not screened; or 2) the patient was screened and the patient (or caregiver) was unable to provide a definitive answer. In order to promote a team-based approach to patient care, the tobacco cessation intervention can be performed by another healthcare provider; therefore, the tobacco use screening and tobacco cessation intervention do not need to be performed by the same provider or clinician. This measure contains three reporting rates which aim to identify patients who were screened for tobacco use (rate/population 1), patients who were identified as tobacco users and who received a tobacco cessation intervention (rate/population 2), and a comprehensive look at the overall performance on tobacco screening and cessation intervention (rate/population 3). By separating this measure into various reporting rates, the eligible clinician will be able to better ascertain where gaps in performance exist, and identify opportunities for improvement. The overall rate (rate/population 3) can be utilized to compare performance to published versions of this measure prior to the 2018 performance year, when the measure had a single performance rate. For accountability reporting in the CMS MIPS program, the rate for population 2 is used for performance. The denominator of population criteria 2 is a subset of the resulting numerator for population criteria 1, as population criteria 2 is limited to assessing if patients identified as tobacco users received an appropriate tobacco cessation intervention. For all patients, population criteria 1 and 3 are applicable, but population criteria 2 will only be applicable for those patients who are identified as tobacco users. Therefore, data for every patient that meets the initial population criteria will only be submitted for population 1 and 3, whereas data submitted for population 2 will be for a subset of patients who meet the initial population criteria, as the denominator has been further limited to those who were identified as tobacco users. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS138v13. 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-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).</td>\n </tr>\n \n\n \n \n <tr>\n <th scope=\"row\"><b>Population Criteria: </b></th>\n <td style=\"padding-left: 4px;\">\n \n <table class=\"grid-dict\">\n \n <tr>\n <th><b>64e649752ad653247b573add</b></th>\n </tr>\n \n \n <tr>\n <td>Initial Population:</td>\n\n \n \n <td>All patients aged 12 years and older seen for at least two visits or at least one preventive visit during the measurement period</td>\n \n \n\n </tr>\n \n <tr>\n <td>Denominator:</td>\n\n \n \n <td>Population 1: Equals Initial Population.</td>\n \n \n\n </tr>\n \n <tr>\n <td>Denominator Exclusion:</td>\n\n \n \n <td>Exclude patients who are in hospice care for any part of the measurement period</td>\n \n \n\n </tr>\n \n <tr>\n <td>Numerator:</td>\n\n \n \n <td>Population 1: Patients who were screened for tobacco use at least once during the measurement period. </td>\n \n \n\n </tr>\n \n \n </table>\n \n <table class=\"grid-dict\">\n \n <tr>\n <th><b>64e649752ad653247b573ade</b></th>\n </tr>\n \n \n <tr>\n <td>Initial Population:</td>\n\n \n \n <td>All patients aged 12 years and older seen for at least two visits or at least one preventive visit during the measurement period</td>\n \n \n\n </tr>\n \n <tr>\n <td>Denominator:</td>\n\n \n \n <td>Population 2: Equals Initial Population who were screened for tobacco use during the measurement period and identified as a tobacco user.</td>\n \n \n\n </tr>\n \n <tr>\n <td>Denominator Exclusion:</td>\n\n \n \n <td>Exclude patients who are in hospice care for any part of the measurement period</td>\n \n \n\n </tr>\n \n <tr>\n <td>Numerator:</td>\n\n \n \n <td>Population 2: Patients who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period.</td>\n \n \n\n </tr>\n \n \n </table>\n \n <table class=\"grid-dict\">\n \n <tr>\n <th><b>64e649752ad653247b573adf</b></th>\n </tr>\n \n \n <tr>\n <td>Initial Population:</td>\n\n \n \n <td>All patients aged 12 years and older seen for at least two visits or at least one preventive visit during the measurement period</td>\n \n \n\n </tr>\n \n <tr>\n <td>Denominator:</td>\n\n \n \n <td>Population 3: Equals Initial Population.</td>\n \n \n\n </tr>\n \n <tr>\n <td>Denominator Exclusion:</td>\n\n \n \n <td>Exclude patients who are in hospice care for any part of the measurement period</td>\n \n \n\n </tr>\n \n <tr>\n <td>Numerator:</td>\n\n \n \n <td>Population 3: Patients who were screened for tobacco use at least once during the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period if identified as a tobacco user.</td>\n \n \n\n </tr>\n \n \n </table>\n \n </td>\n </tr>\n \n \n\n \n\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Libraries: </b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n \n <tr>\n <td><a href=\"Library-PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR.html\">PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR</a></td>\n </tr>\n \n </table>\n </td>\n </tr>\n \n\n \n\n \n \n <tr>\n <th scope=\"row\"><b>Terminology and Other Dependencies: </b></th>\n <td style=\"padding-left: 4px;\">\n \n <li><code>Library/Status|1.8.000</code></li>\n \n <li><code>Library/FHIRHelpers|4.4.000</code></li>\n \n <li><code>Library/QICoreCommon|2.1.000</code></li>\n \n <li><code>Library/CumulativeMedicationDuration|4.1.000</code></li>\n \n <li><code>Library/Hospice|6.12.000</code></li>\n \n <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-CPT.html\">Current Procedural Terminology (CPT®)</a></li>\n \n <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-observation-category.html\">Observation Category Codes</a></li>\n \n <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-icd10CM.html\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a></li>\n \n <li><a href=\"http://hl7.org/fhir/R4/codesystem-snomedct.html\">SNOMED CT (all versions)</a></li>\n \n <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html\">Logical Observation Identifiers, Names and Codes (LOINC)</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion\">Home Healthcare Services</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1011/expansion\">Occupational Therapy Evaluation</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion\">Office Visit</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1285/expansion\">Ophthalmological Services</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1022/expansion\">Physical Therapy Evaluation</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1492/expansion\">Psych Visit - Diagnostic Evaluation</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1496/expansion\">Psych Visit - Psychotherapy</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1141/expansion\">Psychoanalysis</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1530/expansion\">Speech and Hearing Evaluation</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion\">Telephone Visits</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1089/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion\">Annual Wellness Visit</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion\">Preventive Care Services - Established Office Visit, 18 and Up</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion\">Preventive Care Services-Initial Office Visit, 18 and Up</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1024/expansion\">Preventive Care, Established Office Visit, 0 to 17</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1022/expansion\">Preventive Care Services, Initial Office Visit, 0 to 17</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1027/expansion\">Preventive Care Services - Group Counseling</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1026/expansion\">Preventive Care Services-Individual Counseling</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1006/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1006</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1278/expansion\">Tobacco Use Screening</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1189/expansion\">Tobacco Non-User</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1170/expansion\">Tobacco User</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.509/expansion\">Tobacco Use Cessation Counseling</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1190/expansion\">Tobacco Use Cessation Pharmacotherapy</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion\">Hospice Care Ambulatory</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165</a></li>\n \n </td>\n </tr>\n <tr>\n <th scope=\"row\"><b>Parameters:</b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr>\n <th><b>name</b></th>\n <th><b>use</b></th>\n <th><b>min</b></th>\n <th><b>max</b></th>\n <th><b>type</b></th>\n </tr>\n \n <tr>\n <td>Measurement Period</td>\n <td>In</td>\n <td>0</td>\n <td>1</td>\n <td>Period</td>\n </tr>\n \n <tr>\n <td>ErrorLevel</td>\n <td>In</td>\n <td>0</td>\n <td>1</td>\n <td>string</td>\n </tr>\n \n <tr>\n <td>Denominator 3</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>boolean</td>\n </tr>\n \n <tr>\n <td>Numerator 3</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>boolean</td>\n </tr>\n \n <tr>\n <td>Denominator 2</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>boolean</td>\n </tr>\n \n <tr>\n <td>Numerator 1</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>boolean</td>\n </tr>\n \n <tr>\n <td>Numerator 2</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>boolean</td>\n </tr>\n \n <tr>\n <td>Initial Population</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>boolean</td>\n </tr>\n \n <tr>\n <td>Denominator Exclusion</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>boolean</td>\n </tr>\n \n <tr>\n <td>Denominator 1</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>boolean</td>\n </tr>\n \n </table>\n </td>\n </tr>\n\n <tr>\n <th scope=\"row\"><b>DataRequirements:</b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr>\n <th><b>Resource Type</b></th>\n <th><b>Resource Elements</b></th>\n <th><b>Valueset Name</b></th>\n <th><b>Valueset</b></th>\n </tr>\n \n <tr>\n <td>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n <td>\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Home Healthcare Services\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion\">Home Healthcare Services</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Occupational Therapy Evaluation\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1011/expansion\">Occupational Therapy Evaluation</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Office Visit\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion\">Office Visit</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Ophthalmological Services\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1285/expansion\">Ophthalmological Services</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Physical Therapy Evaluation\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1022/expansion\">Physical Therapy Evaluation</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Psych Visit Diagnostic Evaluation\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1492/expansion\">Psych Visit - Diagnostic Evaluation</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Psych Visit Psychotherapy\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1496/expansion\">Psych Visit - Psychotherapy</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Psychoanalysis\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1141/expansion\">Psychoanalysis</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Speech and Hearing Evaluation\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1530/expansion\">Speech and Hearing Evaluation</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Telephone Visits\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion\">Telephone Visits</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Virtual Encounter\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1089/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Annual Wellness Visit\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion\">Annual Wellness Visit</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Preventive Care Services Established Office Visit, 18 and Up\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion\">Preventive Care Services - Established Office Visit, 18 and Up</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Preventive Care Services Initial Office Visit, 18 and Up\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion\">Preventive Care Services-Initial Office Visit, 18 and Up</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Preventive Care, Established Office Visit, 0 to 17\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1024/expansion\">Preventive Care, Established Office Visit, 0 to 17</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Preventive Care Services, Initial Office Visit, 0 to 17\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1022/expansion\">Preventive Care Services, Initial Office Visit, 0 to 17</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Preventive Care Services Group Counseling\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1027/expansion\">Preventive Care Services - Group Counseling</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Preventive Care Services Individual Counseling\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1026/expansion\">Preventive Care Services-Individual Counseling</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Nutrition Services\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1006/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1006</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n hospitalization\n \n hospitalization.dischargeDisposition\n \n period\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Encounter Inpatient\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n period\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Hospice Encounter\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003</a></td>\n </tr>\n \n <tr>\n <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n <td>\n \n code\n \n effective\n \n value\n \n status\n \n status.value\n \n category\n \n </td>\n <td>\n \n \n Tobacco Use Screening\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1278/expansion\">Tobacco Use Screening</a></td>\n </tr>\n \n <tr>\n <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n <td>\n \n code\n \n effective\n \n status\n \n status.value\n \n category\n \n </td>\n <td>\n \n \n Tobacco Use Screening\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1278/expansion\">Tobacco Use Screening</a></td>\n </tr>\n \n <tr>\n <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n <td>\n \n code\n \n effective\n \n value\n \n status\n \n status.value\n \n category\n \n </td>\n <td>\n \n \n Tobacco Use Screening\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1278/expansion\">Tobacco Use Screening</a></td>\n </tr>\n \n <tr>\n <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n <td>\n \n code\n \n value\n \n effective\n \n status\n \n status.value\n \n category\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Procedure(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html\">QICoreProcedure</a>)</td>\n <td>\n \n code\n \n performed\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Tobacco Use Cessation Counseling\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.509/expansion\">Tobacco Use Cessation Counseling</a></td>\n </tr>\n \n <tr>\n <td>Procedure(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html\">QICoreProcedure</a>)</td>\n <td>\n \n code\n \n performed\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Hospice Care Ambulatory\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion\">Hospice Care Ambulatory</a></td>\n </tr>\n \n <tr>\n <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n <td>\n \n code\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n <td>\n \n code\n \n </td>\n <td>\n \n \n Hospice Diagnosis\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165</a></td>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication.reference\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n authoredOn\n \n authoredOn.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n authoredOn\n \n authoredOn.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Tobacco Use Cessation Pharmacotherapy\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1190/expansion\">Tobacco Use Cessation Pharmacotherapy</a></td>\n </tr>\n \n <tr>\n <td>ServiceRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html\">QICoreServiceRequest</a>)</td>\n <td>\n \n code\n \n authoredOn\n \n authoredOn.value\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n </td>\n <td>\n \n \n Hospice Care Ambulatory\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion\">Hospice Care Ambulatory</a></td>\n </tr>\n \n </table>\n </td>\n </tr>\n\n \n <tr>\n <th scope=\"row\"><b>Direct Reference Codes:</b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr>\n <th><b>display</b></th>\n <th><b>code</b></th>\n <th><b>system</b></th>\n </tr>\n \n <tr>\n <td>Health behavior intervention, individual, face-to-face; initial 30 minutes</td>\n <td>96158</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-CPT.html\">http://www.ama-assn.org/go/cpt</a></td>\n </tr>\n \n <tr>\n <td>Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)</td>\n <td>96156</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-CPT.html\">http://www.ama-assn.org/go/cpt</a></td>\n </tr>\n \n <tr>\n <td>Unlisted preventive medicine service</td>\n <td>99429</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-CPT.html\">http://www.ama-assn.org/go/cpt</a></td>\n </tr>\n \n <tr>\n <td>Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure</td>\n <td>99024</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-CPT.html\">http://www.ama-assn.org/go/cpt</a></td>\n </tr>\n \n <tr>\n <td>survey</td>\n <td>survey</td>\n <td><a href=\"http://hl7.org/fhir/R4/codesystem-observation-category.html\">http://terminology.hl7.org/CodeSystem/observation-category</a></td>\n </tr>\n \n <tr>\n <td>Tobacco abuse counseling</td>\n <td>Z71.6</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-icd10CM.html\">http://hl7.org/fhir/sid/icd-10-cm</a></td>\n </tr>\n \n <tr>\n <td>Discharge to home for hospice care (procedure)</td>\n <td>428361000124107</td>\n <td><a href=\"http://hl7.org/fhir/R4/codesystem-snomedct.html\">http://snomed.info/sct</a></td>\n </tr>\n \n <tr>\n <td>Discharge to healthcare facility for hospice care (procedure)</td>\n <td>428371000124100</td>\n <td><a href=\"http://hl7.org/fhir/R4/codesystem-snomedct.html\">http://snomed.info/sct</a></td>\n </tr>\n \n <tr>\n <td>Yes (qualifier value)</td>\n <td>373066001</td>\n <td><a href=\"http://hl7.org/fhir/R4/codesystem-snomedct.html\">http://snomed.info/sct</a></td>\n </tr>\n \n <tr>\n <td>Hospice care [Minimum Data Set]</td>\n <td>45755-6</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html\">http://loinc.org</a></td>\n </tr>\n \n </table>\n </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Logic Definitions:</b></th>\n <td style=\"padding-left: 4px;\">\n \n <table class=\"grid-dict\">\n <tr>\n <th><b>Group</b></th>\n <th><b>Scoring</b></th>\n <th><b>Population Criteria</b></th>\n <th><b>Expression</b></th>\n </tr>\n <tr>\n \n <td> 64e649752ad653247b573add </td>\n <td colspan=\"3\" style=\"padding-left: 4px;\">\n \n <b>Group scoring:</b>\n \n <span> proportion </span>\n \n \n\n \n\n \n\n \n\n \n <tr>\n \n <th scope=\"row\"><b>Type: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <span>Process </span>\n </p>\n \n \n \n </td>\n \n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Rate Aggregation: </b></th>\n <td colspan=\"3\" style=\"padding-left: 4px;\">None</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Improvement Notation: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n \n <p style=\"margin-bottom: 5px;\">\n <span>increase </span>\n </p>\n \n \n \n \n </td>\n </tr>\n \n\n \n\n </td>\n \n <tr>\n <td/>\n <td/>\n <td>Initial Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Initial Population":\n AgeInYearsAt(date from start of "Measurement Period") >= 12\n and ( Count("Qualifying Visit During Measurement Period") >= 2\n or exists "Preventive Visit During Measurement Period"\n )</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Denominator</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Denominator 1":\n "Initial Population"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Denominator Exclusion</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Denominator Exclusion":\n Hospice."Has Hospice Services"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Numerator</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Numerator 1":\n "Most Recent Tobacco Use Screening Indicates Tobacco Non User" is not null\n or "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null</code></pre>\n \n </td>\n </tr>\n \n \n \n <td> 64e649752ad653247b573ade </td>\n <td colspan=\"3\" style=\"padding-left: 4px;\">\n \n <b>Group scoring:</b>\n \n <span> proportion </span>\n \n \n\n \n\n \n\n \n\n \n <tr>\n \n <th scope=\"row\"><b>Type: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <span>Process </span>\n </p>\n \n \n \n </td>\n \n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Rate Aggregation: </b></th>\n <td colspan=\"3\" style=\"padding-left: 4px;\">None</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Improvement Notation: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n \n <p style=\"margin-bottom: 5px;\">\n <span>increase </span>\n </p>\n \n \n \n \n </td>\n </tr>\n \n\n \n\n </td>\n \n <tr>\n <td/>\n <td/>\n <td>Initial Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Initial Population":\n AgeInYearsAt(date from start of "Measurement Period") >= 12\n and ( Count("Qualifying Visit During Measurement Period") >= 2\n or exists "Preventive Visit During Measurement Period"\n )</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Denominator</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Denominator 2":\n "Initial Population"\n and "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Denominator Exclusion</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Denominator Exclusion":\n Hospice."Has Hospice Services"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Numerator</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Numerator 2":\n exists "Tobacco Cessation Counseling Given"\n or exists "Tobacco Cessation Pharmacotherapy Ordered"\n or exists "Active Pharmacotherapy for Tobacco Cessation"</code></pre>\n \n </td>\n </tr>\n \n \n \n <td> 64e649752ad653247b573adf </td>\n <td colspan=\"3\" style=\"padding-left: 4px;\">\n \n <b>Group scoring:</b>\n \n <span> proportion </span>\n \n \n\n \n\n \n\n \n\n \n <tr>\n \n <th scope=\"row\"><b>Type: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <span>Process </span>\n </p>\n \n \n \n </td>\n \n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Rate Aggregation: </b></th>\n <td colspan=\"3\" style=\"padding-left: 4px;\">None</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Improvement Notation: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n \n <p style=\"margin-bottom: 5px;\">\n <span>increase </span>\n </p>\n \n \n \n \n </td>\n </tr>\n \n\n \n\n </td>\n \n <tr>\n <td/>\n <td/>\n <td>Initial Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Initial Population":\n AgeInYearsAt(date from start of "Measurement Period") >= 12\n and ( Count("Qualifying Visit During Measurement Period") >= 2\n or exists "Preventive Visit During Measurement Period"\n )</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Denominator</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Denominator 3":\n "Initial Population"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Denominator Exclusion</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Denominator Exclusion":\n Hospice."Has Hospice Services"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Numerator</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Numerator 3":\n "Most Recent Tobacco Use Screening Indicates Tobacco Non User" is not null\n or ( "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null\n and ( exists "Tobacco Cessation Counseling Given"\n or exists "Tobacco Cessation Pharmacotherapy Ordered"\n or exists "Active Pharmacotherapy for Tobacco Cessation"\n )\n )</code></pre>\n \n </td>\n </tr>\n \n \n \n </tr>\n </table>\n \n\n <table class=\"grid-dict\">\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR</td>\n \n \n <td>Qualifying Visit During Measurement Period</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Qualifying Visit During Measurement Period":\n ( ( ( [Encounter] E\n where exists ( ( E.type ) T\n where T ~ "Health behavior intervention, individual, face-to-face; initial 30 minutes"\n )\n )\n union ( [Encounter] E\n where exists ( ( E.type ) T\n where T ~ "Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)"\n )\n )\n union [Encounter: "Home Healthcare Services"]\n union [Encounter: "Occupational Therapy Evaluation"]\n union [Encounter: "Office Visit"]\n union [Encounter: "Ophthalmological Services"]\n union [Encounter: "Physical Therapy Evaluation"]\n union [Encounter: "Psych Visit Diagnostic Evaluation"]\n union [Encounter: "Psych Visit Psychotherapy"]\n union [Encounter: "Psychoanalysis"]\n union [Encounter: "Speech and Hearing Evaluation"]\n union [Encounter: "Telephone Visits"]\n union [Encounter: "Virtual Encounter"]\n ).isEncounterPerformed ( ) ) OfficeBasedEncounter\n where OfficeBasedEncounter.period.toInterval ( ) during day of "Measurement Period"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR</td>\n \n \n <td>Preventive Visit During Measurement Period</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Preventive Visit During Measurement Period":\n ( ( [Encounter: "Annual Wellness Visit"]\n union [Encounter: "Preventive Care Services Established Office Visit, 18 and Up"]\n union [Encounter: "Preventive Care Services Initial Office Visit, 18 and Up"]\n union [Encounter: "Preventive Care, Established Office Visit, 0 to 17"]\n union [Encounter: "Preventive Care Services, Initial Office Visit, 0 to 17"]\n union [Encounter: "Preventive Care Services Group Counseling"]\n union [Encounter: "Preventive Care Services Individual Counseling"]\n union ( [Encounter] E\n where exists ( ( E.type ) T\n where T ~ "Unlisted preventive medicine service"\n )\n )\n union ( [Encounter] E\n where exists ( ( E.type ) T\n where T ~ "Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure"\n )\n )\n union [Encounter: "Nutrition Services"]\n ).isEncounterPerformed ( ) ) PreventiveEncounter\n where PreventiveEncounter.period.toInterval ( ) during day of "Measurement Period"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR</td>\n \n \n <td>Initial Population</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Initial Population":\n AgeInYearsAt(date from start of "Measurement Period") >= 12\n and ( Count("Qualifying Visit During Measurement Period") >= 2\n or exists "Preventive Visit During Measurement Period"\n )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR</td>\n \n \n <td>Denominator 3</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Denominator 3":\n "Initial Population"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR</td>\n \n \n <td>Most Recent Tobacco Use Screening Indicates Tobacco Non User</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Most Recent Tobacco Use Screening Indicates Tobacco Non User":\n ( Last((([Observation: "Tobacco Use Screening"]).isAssessmentPerformed()) TobaccoUseScreening\n where TobaccoUseScreening.effective.toInterval() during day of "Measurement Period"\n sort by start of effective.toInterval()\n ) ) MostRecentTobaccoUseScreening\n where MostRecentTobaccoUseScreening.value as Concept in "Tobacco Non User"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR</td>\n \n \n <td>Most Recent Tobacco Use Screening Indicates Tobacco User</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Most Recent Tobacco Use Screening Indicates Tobacco User":\n ( Last((([Observation: "Tobacco Use Screening"]).isAssessmentPerformed()) TobaccoUseScreening\n where TobaccoUseScreening.effective.toInterval() during day of "Measurement Period"\n sort by start of effective.toInterval()\n ) ) MostRecentTobaccoUseScreening\n where MostRecentTobaccoUseScreening.value as Concept in "Tobacco User"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR</td>\n \n \n <td>Tobacco Cessation Counseling Given</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Tobacco Cessation Counseling Given":\n ( ( ( [Procedure: "Tobacco Use Cessation Counseling"] ).isInterventionPerformed ( ) ) TobaccoCessationCounseling\n where TobaccoCessationCounseling.performed.toInterval ( ) during day of Interval[start of "Measurement Period" - 6 months, end of "Measurement Period"]\n )\n union ( ( [Condition: "Tobacco abuse counseling"] ) TobaccoCounseling\n where TobaccoCounseling.prevalenceInterval ( ) starts during day of Interval[start of "Measurement Period" - 6 months, end of "Measurement Period"]\n )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR</td>\n \n \n <td>Tobacco Cessation Pharmacotherapy Ordered</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Tobacco Cessation Pharmacotherapy Ordered":\n ( ( [MedicationRequest: "Tobacco Use Cessation Pharmacotherapy"] ).isMedicationOrder ( ) ) CessationPharmacotherapyOrdered\n where CessationPharmacotherapyOrdered.authoredOn during day of Interval[start of "Measurement Period" - 6 months, end of "Measurement Period"]</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR</td>\n \n \n <td>Active Pharmacotherapy for Tobacco Cessation</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Active Pharmacotherapy for Tobacco Cessation":\n ( ( [MedicationRequest: "Tobacco Use Cessation Pharmacotherapy"] ).isMedicationActive ( ) ) TakingCessationPharmacotherapy\n where TakingCessationPharmacotherapy.medicationRequestPeriod ( ) during day of Interval[start of "Measurement Period" - 6 months, end of "Measurement Period"]</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR</td>\n \n \n <td>Numerator 3</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Numerator 3":\n "Most Recent Tobacco Use Screening Indicates Tobacco Non User" is not null\n or ( "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null\n and ( exists "Tobacco Cessation Counseling Given"\n or exists "Tobacco Cessation Pharmacotherapy Ordered"\n or exists "Active Pharmacotherapy for Tobacco Cessation"\n )\n )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR</td>\n \n \n <td>Denominator 2</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Denominator 2":\n "Initial Population"\n and "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR</td>\n \n \n <td>Numerator 1</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Numerator 1":\n "Most Recent Tobacco Use Screening Indicates Tobacco Non User" is not null\n or "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR</td>\n \n \n <td>Numerator 2</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Numerator 2":\n exists "Tobacco Cessation Counseling Given"\n or exists "Tobacco Cessation Pharmacotherapy Ordered"\n or exists "Active Pharmacotherapy for Tobacco Cessation"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>Hospice</td>\n \n \n <td>Has Hospice Services</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Has Hospice Services":\n exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter\n where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"\n or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"\n )\n and InpatientEncounter.period.toInterval() ends during day of "Measurement Period"\n )\n or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter\n where HospiceEncounter.period.toInterval() overlaps day of "Measurement Period"\n )\n or exists ((([Observation: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment\n where HospiceAssessment.value ~ "Yes (qualifier value)"\n and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period"\n )\n or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder\n where HospiceOrder.authoredOn.toInterval() during day of "Measurement Period"\n // and HospiceOrder.doNotPerform is not true\n // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447\n )\n or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed\n where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period"\n )\n or exists (([Condition: "Hospice Diagnosis"]) HospiceCareDiagnosis\n where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"\n )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR</td>\n \n \n <td>Denominator Exclusion</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Denominator Exclusion":\n Hospice."Has Hospice Services"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR</td>\n \n \n <td>Denominator 1</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Denominator 1":\n "Initial Population"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>Status</td>\n \n \n <td>isEncounterPerformed</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">//Encounter, Performed\n//General usage unless required otherwise by measure intent (e.g., follow-up encounters)\ndefine fluent function isEncounterPerformed(Enc List<Encounter>):\n Enc E\n where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>FHIRHelpers</td>\n \n \n <td>ToConcept</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n if concept is null then\n null\n else\n System.Concept {\n codes: concept.coding C return ToCode(C),\n display: concept.text.value\n }</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>QICoreCommon</td>\n \n \n <td>toInterval</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in QICore, allowing this function to be used across any resource.\nThe input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.\nIf the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,\nand the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.\nIf the input is a DateTime Interval, the result is the input.\nIf the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result\nis a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending\nimmediately before one year later than the date the patient turned the age given as the end of the quantity interval.\nIf 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\n*/\ndefine fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):\n case\n\t when choice is DateTime then\n \tInterval[choice as DateTime, choice as DateTime]\n\t\twhen choice is Interval<DateTime> then\n \t\tchoice as Interval<DateTime>\n\t\twhen choice is Quantity then\n\t\t Interval[Patient.birthDate + (choice as Quantity),\n\t\t\t Patient.birthDate + (choice as Quantity) + 1 year)\n\t\twhen choice is Interval<Quantity> then\n\t\t Interval[Patient.birthDate + (choice.low as Quantity),\n\t\t\t Patient.birthDate + (choice.high as Quantity) + 1 year)\n\t\twhen choice is Timing then\n Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>\n\t\telse\n\t\t\tnull as Interval<DateTime>\n\tend</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>Status</td>\n \n \n <td>isAssessmentPerformed</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">//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.\n\n//Assessment, Performed\ndefine fluent function isAssessmentPerformed(Obs List<Observation>):\n Obs O\n where O.status in { 'final', 'amended', 'corrected' }\n and exists ( O.category ObservationCategory\n where ( ObservationCategory ) ~ "survey"\n )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>Status</td>\n \n \n <td>isInterventionPerformed</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">//Intervention, Performed\ndefine fluent function isInterventionPerformed(Proc List<Procedure>):\n Proc P\n where P.status ~ 'completed'</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>QICoreCommon</td>\n \n \n <td>prevalenceInterval</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition.\n@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting \ninterval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.\n*/\ndefine fluent function prevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ "active"\n or condition.clinicalStatus ~ "recurrence"\n or condition.clinicalStatus ~ "relapse" then\n Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n (end of condition.abatementInterval()) abatementDate\n return if abatementDate is null then\n Interval[start of condition.onset.toInterval(), abatementDate)\n else\n Interval[start of condition.onset.toInterval(), abatementDate]</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>Status</td>\n \n \n <td>isMedicationOrder</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">//Medication, Order: active and completed only\ndefine fluent function isMedicationOrder(MedicationRequest List<MedicationRequest>):\n MedicationRequest M\n where M.status in { 'active', 'completed' }\n and M.intent = 'order'</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>Status</td>\n \n \n <td>isMedicationActive</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">//Medication, Active\ndefine fluent function isMedicationActive(MedicationRequest List<MedicationRequest>):\n MedicationRequest M\n where M.status = 'active'\n and M.intent = 'order'</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CumulativeMedicationDuration</td>\n \n \n <td>medicationRequestPeriod</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define fluent function medicationRequestPeriod(Request "MedicationRequest"):\n Request R\n let\n dosage: singleton from R.dosageInstruction,\n doseAndRate: singleton from dosage.doseAndRate,\n timing: dosage.timing,\n frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),\n period: Quantity(timing.repeat.period, timing.repeat.periodUnit),\n doseRange: doseAndRate.dose,\n doseQuantity: doseAndRate.dose,\n dose: Coalesce(end of doseRange, doseQuantity),\n dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0),\n boundsPeriod: timing.repeat.bounds as Interval<DateTime>,\n daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).value,\n quantity: R.dispenseRequest.quantity,\n refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),\n startDate:\n Coalesce(\n date from start of boundsPeriod,\n date from R.authoredOn,\n date from start of R.dispenseRequest.validityPeriod\n ),\n totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills)\n return\n if startDate is not null and totalDaysSupplied is not null then\n Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ]\n else if startDate is not null and boundsPeriod."high" is not null then\n Interval[startDate, date from end of boundsPeriod]\n else\n null</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CumulativeMedicationDuration</td>\n \n \n <td>Quantity</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/**********************************************************************/\n/* Functions in this region are copied from opioid-mme-r4 */\n/**********************************************************************/\n\ndefine function Quantity(value Decimal, unit String):\n if value is not null then\n System.Quantity { value: value, unit: unit }\n else\n null</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CumulativeMedicationDuration</td>\n \n \n <td>ToDaily</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n Goal is to get to number of days\n Two broad approaches to the calculation:\n 1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered\n 2) Based on relevant period, determine a covered interval and calculate the length of that interval in days\nThis topic covers several use cases and illustrates how to calculate Cumulative\nMedication Duration for each type of medication resource using the supply and\nfrequency approach.\n*/\n\n/*\n For the first approach, we need to get from frequency to a frequency/day\n So we define ToDaily\n*/\n\n/*\n Calculates daily frequency given frequency within a period\n*/\ndefine function ToDaily(frequency System.Integer, period System.Quantity):\n case period.unit\n when 'h' then frequency * (24.0 / period.value)\n when 'min' then frequency * (24.0 / period.value) * 60\n when 's' then frequency * (24.0 / period.value) * 60 * 60\n when 'd' then frequency * (24.0 / period.value) / 24\n when 'wk' then frequency * (24.0 / period.value) / (24 * 7)\n when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n when 'hour' then frequency * (24.0 / period.value)\n when 'minute' then frequency * (24.0 / period.value) * 60\n when 'second' then frequency * (24.0 / period.value) * 60 * 60\n when 'day' then frequency * (24.0 / period.value) / 24\n when 'week' then frequency * (24.0 / period.value) / (24 * 7)\n when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n when 'hours' then frequency * (24.0 / period.value)\n when 'minutes' then frequency * (24.0 / period.value) * 60\n when 'seconds' then frequency * (24.0 / period.value) * 60 * 60\n when 'days' then frequency * (24.0 / period.value) / 24\n when 'weeks' then frequency * (24.0 / period.value) / (24 * 7)\n when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit)\n end</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>Status</td>\n \n \n <td>isInterventionOrder</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">//Intervention, Order: active and completed only \ndefine fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):\n ServiceRequest S\n where S.status in { 'active', 'completed' }\n and S.intent = 'order'</code></pre>\n </td>\n \n </tr>\n \n </table>\n </td>\n </tr>\n \n \n \n\n </table>\n</div>"
},
"contained" : [
{
"resourceType" : "Library",
"id" : "effective-data-requirements",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.ama-assn.org/go/cpt",
"code" : "96158",
"display" : "Health behavior intervention, individual, face-to-face; initial 30 minutes"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.ama-assn.org/go/cpt",
"code" : "96156",
"display" : "Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.ama-assn.org/go/cpt",
"code" : "99429",
"display" : "Unlisted preventive medicine service"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.ama-assn.org/go/cpt",
"code" : "99024",
"display" : "Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://terminology.hl7.org/CodeSystem/observation-category",
"code" : "survey",
"display" : "survey"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://hl7.org/fhir/sid/icd-10-cm",
"code" : "Z71.6",
"display" : "Tobacco abuse counseling"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "428361000124107",
"display" : "Discharge to home for hospice care (procedure)"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "428371000124100",
"display" : "Discharge to healthcare facility for hospice care (procedure)"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "373066001",
"display" : "Yes (qualifier value)"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "45755-6",
"display" : "Hospice care [Minimum Data Set]"
}
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR"
},
{
"url" : "name",
"valueString" : "Qualifying Visit During Measurement Period"
},
{
"url" : "statement",
"valueString" : "define \"Qualifying Visit During Measurement Period\":\n ( ( ( [Encounter] E\n where exists ( ( E.type ) T\n where T ~ \"Health behavior intervention, individual, face-to-face; initial 30 minutes\"\n )\n )\n union ( [Encounter] E\n where exists ( ( E.type ) T\n where T ~ \"Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)\"\n )\n )\n union [Encounter: \"Home Healthcare Services\"]\n union [Encounter: \"Occupational Therapy Evaluation\"]\n union [Encounter: \"Office Visit\"]\n union [Encounter: \"Ophthalmological Services\"]\n union [Encounter: \"Physical Therapy Evaluation\"]\n union [Encounter: \"Psych Visit Diagnostic Evaluation\"]\n union [Encounter: \"Psych Visit Psychotherapy\"]\n union [Encounter: \"Psychoanalysis\"]\n union [Encounter: \"Speech and Hearing Evaluation\"]\n union [Encounter: \"Telephone Visits\"]\n union [Encounter: \"Virtual Encounter\"]\n ).isEncounterPerformed ( ) ) OfficeBasedEncounter\n where OfficeBasedEncounter.period.toInterval ( ) during day of \"Measurement Period\""
},
{
"url" : "displaySequence",
"valueInteger" : 0
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR"
},
{
"url" : "name",
"valueString" : "Preventive Visit During Measurement Period"
},
{
"url" : "statement",
"valueString" : "define \"Preventive Visit During Measurement Period\":\n ( ( [Encounter: \"Annual Wellness Visit\"]\n union [Encounter: \"Preventive Care Services Established Office Visit, 18 and Up\"]\n union [Encounter: \"Preventive Care Services Initial Office Visit, 18 and Up\"]\n union [Encounter: \"Preventive Care, Established Office Visit, 0 to 17\"]\n union [Encounter: \"Preventive Care Services, Initial Office Visit, 0 to 17\"]\n union [Encounter: \"Preventive Care Services Group Counseling\"]\n union [Encounter: \"Preventive Care Services Individual Counseling\"]\n union ( [Encounter] E\n where exists ( ( E.type ) T\n where T ~ \"Unlisted preventive medicine service\"\n )\n )\n union ( [Encounter] E\n where exists ( ( E.type ) T\n where T ~ \"Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure\"\n )\n )\n union [Encounter: \"Nutrition Services\"]\n ).isEncounterPerformed ( ) ) PreventiveEncounter\n where PreventiveEncounter.period.toInterval ( ) during day of \"Measurement Period\""
},
{
"url" : "displaySequence",
"valueInteger" : 1
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR"
},
{
"url" : "name",
"valueString" : "Initial Population"
},
{
"url" : "statement",
"valueString" : "define \"Initial Population\":\n AgeInYearsAt(date from start of \"Measurement Period\") >= 12\n and ( Count(\"Qualifying Visit During Measurement Period\") >= 2\n or exists \"Preventive Visit During Measurement Period\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 2
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR"
},
{
"url" : "name",
"valueString" : "Denominator 3"
},
{
"url" : "statement",
"valueString" : "define \"Denominator 3\":\n \"Initial Population\""
},
{
"url" : "displaySequence",
"valueInteger" : 3
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR"
},
{
"url" : "name",
"valueString" : "Most Recent Tobacco Use Screening Indicates Tobacco Non User"
},
{
"url" : "statement",
"valueString" : "define \"Most Recent Tobacco Use Screening Indicates Tobacco Non User\":\n ( Last((([Observation: \"Tobacco Use Screening\"]).isAssessmentPerformed()) TobaccoUseScreening\n where TobaccoUseScreening.effective.toInterval() during day of \"Measurement Period\"\n sort by start of effective.toInterval()\n ) ) MostRecentTobaccoUseScreening\n where MostRecentTobaccoUseScreening.value as Concept in \"Tobacco Non User\""
},
{
"url" : "displaySequence",
"valueInteger" : 4
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR"
},
{
"url" : "name",
"valueString" : "Most Recent Tobacco Use Screening Indicates Tobacco User"
},
{
"url" : "statement",
"valueString" : "define \"Most Recent Tobacco Use Screening Indicates Tobacco User\":\n ( Last((([Observation: \"Tobacco Use Screening\"]).isAssessmentPerformed()) TobaccoUseScreening\n where TobaccoUseScreening.effective.toInterval() during day of \"Measurement Period\"\n sort by start of effective.toInterval()\n ) ) MostRecentTobaccoUseScreening\n where MostRecentTobaccoUseScreening.value as Concept in \"Tobacco User\""
},
{
"url" : "displaySequence",
"valueInteger" : 5
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR"
},
{
"url" : "name",
"valueString" : "Tobacco Cessation Counseling Given"
},
{
"url" : "statement",
"valueString" : "define \"Tobacco Cessation Counseling Given\":\n ( ( ( [Procedure: \"Tobacco Use Cessation Counseling\"] ).isInterventionPerformed ( ) ) TobaccoCessationCounseling\n where TobaccoCessationCounseling.performed.toInterval ( ) during day of Interval[start of \"Measurement Period\" - 6 months, end of \"Measurement Period\"]\n )\n union ( ( [Condition: \"Tobacco abuse counseling\"] ) TobaccoCounseling\n where TobaccoCounseling.prevalenceInterval ( ) starts during day of Interval[start of \"Measurement Period\" - 6 months, end of \"Measurement Period\"]\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 6
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR"
},
{
"url" : "name",
"valueString" : "Tobacco Cessation Pharmacotherapy Ordered"
},
{
"url" : "statement",
"valueString" : "define \"Tobacco Cessation Pharmacotherapy Ordered\":\n ( ( [MedicationRequest: \"Tobacco Use Cessation Pharmacotherapy\"] ).isMedicationOrder ( ) ) CessationPharmacotherapyOrdered\n where CessationPharmacotherapyOrdered.authoredOn during day of Interval[start of \"Measurement Period\" - 6 months, end of \"Measurement Period\"]"
},
{
"url" : "displaySequence",
"valueInteger" : 7
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR"
},
{
"url" : "name",
"valueString" : "Active Pharmacotherapy for Tobacco Cessation"
},
{
"url" : "statement",
"valueString" : "define \"Active Pharmacotherapy for Tobacco Cessation\":\n ( ( [MedicationRequest: \"Tobacco Use Cessation Pharmacotherapy\"] ).isMedicationActive ( ) ) TakingCessationPharmacotherapy\n where TakingCessationPharmacotherapy.medicationRequestPeriod ( ) during day of Interval[start of \"Measurement Period\" - 6 months, end of \"Measurement Period\"]"
},
{
"url" : "displaySequence",
"valueInteger" : 8
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR"
},
{
"url" : "name",
"valueString" : "Numerator 3"
},
{
"url" : "statement",
"valueString" : "define \"Numerator 3\":\n \"Most Recent Tobacco Use Screening Indicates Tobacco Non User\" is not null\n or ( \"Most Recent Tobacco Use Screening Indicates Tobacco User\" is not null\n and ( exists \"Tobacco Cessation Counseling Given\"\n or exists \"Tobacco Cessation Pharmacotherapy Ordered\"\n or exists \"Active Pharmacotherapy for Tobacco Cessation\"\n )\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 9
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR"
},
{
"url" : "name",
"valueString" : "Denominator 2"
},
{
"url" : "statement",
"valueString" : "define \"Denominator 2\":\n \"Initial Population\"\n and \"Most Recent Tobacco Use Screening Indicates Tobacco User\" is not null"
},
{
"url" : "displaySequence",
"valueInteger" : 10
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR"
},
{
"url" : "name",
"valueString" : "Numerator 1"
},
{
"url" : "statement",
"valueString" : "define \"Numerator 1\":\n \"Most Recent Tobacco Use Screening Indicates Tobacco Non User\" is not null\n or \"Most Recent Tobacco Use Screening Indicates Tobacco User\" is not null"
},
{
"url" : "displaySequence",
"valueInteger" : 11
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR"
},
{
"url" : "name",
"valueString" : "Numerator 2"
},
{
"url" : "statement",
"valueString" : "define \"Numerator 2\":\n exists \"Tobacco Cessation Counseling Given\"\n or exists \"Tobacco Cessation Pharmacotherapy Ordered\"\n or exists \"Active Pharmacotherapy for Tobacco Cessation\""
},
{
"url" : "displaySequence",
"valueInteger" : 12
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "Hospice"
},
{
"url" : "name",
"valueString" : "Has Hospice Services"
},
{
"url" : "statement",
"valueString" : "define \"Has Hospice Services\":\n exists ((([Encounter: \"Encounter Inpatient\"]).isEncounterPerformed()) InpatientEncounter\n where (InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n or InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\"\n )\n and InpatientEncounter.period.toInterval() ends during day of \"Measurement Period\"\n )\n or exists ((([Encounter: \"Hospice Encounter\"]).isEncounterPerformed()) HospiceEncounter\n where HospiceEncounter.period.toInterval() overlaps day of \"Measurement Period\"\n )\n or exists ((([Observation: \"Hospice care [Minimum Data Set]\"]).isAssessmentPerformed()) HospiceAssessment\n where HospiceAssessment.value ~ \"Yes (qualifier value)\"\n and HospiceAssessment.effective.toInterval() overlaps day of \"Measurement Period\"\n )\n or exists ((([ServiceRequest: \"Hospice Care Ambulatory\"]).isInterventionOrder()) HospiceOrder\n where HospiceOrder.authoredOn.toInterval() during day of \"Measurement Period\"\n // and HospiceOrder.doNotPerform is not true\n // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447\n )\n or exists ((([Procedure: \"Hospice Care Ambulatory\"]).isInterventionPerformed()) HospicePerformed\n where HospicePerformed.performed.toInterval() overlaps day of \"Measurement Period\"\n )\n or exists (([Condition: \"Hospice Diagnosis\"]) HospiceCareDiagnosis\n where HospiceCareDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 13
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR"
},
{
"url" : "name",
"valueString" : "Denominator Exclusion"
},
{
"url" : "statement",
"valueString" : "define \"Denominator Exclusion\":\n Hospice.\"Has Hospice Services\""
},
{
"url" : "displaySequence",
"valueInteger" : 14
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR"
},
{
"url" : "name",
"valueString" : "Denominator 1"
},
{
"url" : "statement",
"valueString" : "define \"Denominator 1\":\n \"Initial Population\""
},
{
"url" : "displaySequence",
"valueInteger" : 15
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "Status"
},
{
"url" : "name",
"valueString" : "isEncounterPerformed"
},
{
"url" : "statement",
"valueString" : "//Encounter, Performed\n//General usage unless required otherwise by measure intent (e.g., follow-up encounters)\ndefine fluent function isEncounterPerformed(Enc List<Encounter>):\n Enc E\n where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}"
},
{
"url" : "displaySequence",
"valueInteger" : 16
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "FHIRHelpers"
},
{
"url" : "name",
"valueString" : "ToConcept"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n if concept is null then\n null\n else\n System.Concept {\n codes: concept.coding C return ToCode(C),\n display: concept.text.value\n }"
},
{
"url" : "displaySequence",
"valueInteger" : 17
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "QICoreCommon"
},
{
"url" : "name",
"valueString" : "toInterval"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in QICore, allowing this function to be used across any resource.\nThe input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.\nIf the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,\nand the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.\nIf the input is a DateTime Interval, the result is the input.\nIf the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result\nis a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending\nimmediately before one year later than the date the patient turned the age given as the end of the quantity interval.\nIf 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\n*/\ndefine fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):\n case\n\t when choice is DateTime then\n \tInterval[choice as DateTime, choice as DateTime]\n\t\twhen choice is Interval<DateTime> then\n \t\tchoice as Interval<DateTime>\n\t\twhen choice is Quantity then\n\t\t Interval[Patient.birthDate + (choice as Quantity),\n\t\t\t Patient.birthDate + (choice as Quantity) + 1 year)\n\t\twhen choice is Interval<Quantity> then\n\t\t Interval[Patient.birthDate + (choice.low as Quantity),\n\t\t\t Patient.birthDate + (choice.high as Quantity) + 1 year)\n\t\twhen choice is Timing then\n Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>\n\t\telse\n\t\t\tnull as Interval<DateTime>\n\tend"
},
{
"url" : "displaySequence",
"valueInteger" : 18
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "Status"
},
{
"url" : "name",
"valueString" : "isAssessmentPerformed"
},
{
"url" : "statement",
"valueString" : "//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.\n\n//Assessment, Performed\ndefine fluent function isAssessmentPerformed(Obs List<Observation>):\n Obs O\n where O.status in { 'final', 'amended', 'corrected' }\n and exists ( O.category ObservationCategory\n where ( ObservationCategory ) ~ \"survey\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 19
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "Status"
},
{
"url" : "name",
"valueString" : "isInterventionPerformed"
},
{
"url" : "statement",
"valueString" : "//Intervention, Performed\ndefine fluent function isInterventionPerformed(Proc List<Procedure>):\n Proc P\n where P.status ~ 'completed'"
},
{
"url" : "displaySequence",
"valueInteger" : 20
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "QICoreCommon"
},
{
"url" : "name",
"valueString" : "prevalenceInterval"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition.\n@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting \ninterval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.\n*/\ndefine fluent function prevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ \"active\"\n or condition.clinicalStatus ~ \"recurrence\"\n or condition.clinicalStatus ~ \"relapse\" then\n Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n (end of condition.abatementInterval()) abatementDate\n return if abatementDate is null then\n Interval[start of condition.onset.toInterval(), abatementDate)\n else\n Interval[start of condition.onset.toInterval(), abatementDate]"
},
{
"url" : "displaySequence",
"valueInteger" : 21
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "Status"
},
{
"url" : "name",
"valueString" : "isMedicationOrder"
},
{
"url" : "statement",
"valueString" : "//Medication, Order: active and completed only\ndefine fluent function isMedicationOrder(MedicationRequest List<MedicationRequest>):\n MedicationRequest M\n where M.status in { 'active', 'completed' }\n and M.intent = 'order'"
},
{
"url" : "displaySequence",
"valueInteger" : 22
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "Status"
},
{
"url" : "name",
"valueString" : "isMedicationActive"
},
{
"url" : "statement",
"valueString" : "//Medication, Active\ndefine fluent function isMedicationActive(MedicationRequest List<MedicationRequest>):\n MedicationRequest M\n where M.status = 'active'\n and M.intent = 'order'"
},
{
"url" : "displaySequence",
"valueInteger" : 23
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CumulativeMedicationDuration"
},
{
"url" : "name",
"valueString" : "medicationRequestPeriod"
},
{
"url" : "statement",
"valueString" : "define fluent function medicationRequestPeriod(Request \"MedicationRequest\"):\n Request R\n let\n dosage: singleton from R.dosageInstruction,\n doseAndRate: singleton from dosage.doseAndRate,\n timing: dosage.timing,\n frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),\n period: Quantity(timing.repeat.period, timing.repeat.periodUnit),\n doseRange: doseAndRate.dose,\n doseQuantity: doseAndRate.dose,\n dose: Coalesce(end of doseRange, doseQuantity),\n dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0),\n boundsPeriod: timing.repeat.bounds as Interval<DateTime>,\n daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).value,\n quantity: R.dispenseRequest.quantity,\n refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),\n startDate:\n Coalesce(\n date from start of boundsPeriod,\n date from R.authoredOn,\n date from start of R.dispenseRequest.validityPeriod\n ),\n totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills)\n return\n if startDate is not null and totalDaysSupplied is not null then\n Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ]\n else if startDate is not null and boundsPeriod.\"high\" is not null then\n Interval[startDate, date from end of boundsPeriod]\n else\n null"
},
{
"url" : "displaySequence",
"valueInteger" : 24
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CumulativeMedicationDuration"
},
{
"url" : "name",
"valueString" : "Quantity"
},
{
"url" : "statement",
"valueString" : "/**********************************************************************/\n/* Functions in this region are copied from opioid-mme-r4 */\n/**********************************************************************/\n\ndefine function Quantity(value Decimal, unit String):\n if value is not null then\n System.Quantity { value: value, unit: unit }\n else\n null"
},
{
"url" : "displaySequence",
"valueInteger" : 25
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CumulativeMedicationDuration"
},
{
"url" : "name",
"valueString" : "ToDaily"
},
{
"url" : "statement",
"valueString" : "/*\n Goal is to get to number of days\n Two broad approaches to the calculation:\n 1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered\n 2) Based on relevant period, determine a covered interval and calculate the length of that interval in days\nThis topic covers several use cases and illustrates how to calculate Cumulative\nMedication Duration for each type of medication resource using the supply and\nfrequency approach.\n*/\n\n/*\n For the first approach, we need to get from frequency to a frequency/day\n So we define ToDaily\n*/\n\n/*\n Calculates daily frequency given frequency within a period\n*/\ndefine function ToDaily(frequency System.Integer, period System.Quantity):\n case period.unit\n when 'h' then frequency * (24.0 / period.value)\n when 'min' then frequency * (24.0 / period.value) * 60\n when 's' then frequency * (24.0 / period.value) * 60 * 60\n when 'd' then frequency * (24.0 / period.value) / 24\n when 'wk' then frequency * (24.0 / period.value) / (24 * 7)\n when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n when 'hour' then frequency * (24.0 / period.value)\n when 'minute' then frequency * (24.0 / period.value) * 60\n when 'second' then frequency * (24.0 / period.value) * 60 * 60\n when 'day' then frequency * (24.0 / period.value) / 24\n when 'week' then frequency * (24.0 / period.value) / (24 * 7)\n when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n when 'hours' then frequency * (24.0 / period.value)\n when 'minutes' then frequency * (24.0 / period.value) * 60\n when 'seconds' then frequency * (24.0 / period.value) * 60 * 60\n when 'days' then frequency * (24.0 / period.value) / 24\n when 'weeks' then frequency * (24.0 / period.value) / (24 * 7)\n when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit)\n end"
},
{
"url" : "displaySequence",
"valueInteger" : 26
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "Status"
},
{
"url" : "name",
"valueString" : "isInterventionOrder"
},
{
"url" : "statement",
"valueString" : "//Intervention, Order: active and completed only \ndefine fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):\n ServiceRequest S\n where S.status in { 'active', 'completed' }\n and S.intent = 'order'"
},
{
"url" : "displaySequence",
"valueInteger" : 27
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
}
],
"name" : "EffectiveDataRequirements",
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/library-type",
"code" : "module-definition"
}
]
},
"relatedArtifact" : [
{
"type" : "depends-on",
"display" : "Library Status",
"resource" : "Library/Status|1.8.000"
},
{
"type" : "depends-on",
"display" : "Library FHIRHelpers",
"resource" : "Library/FHIRHelpers|4.4.000"
},
{
"type" : "depends-on",
"display" : "Library QICoreCommon",
"resource" : "Library/QICoreCommon|2.1.000"
},
{
"type" : "depends-on",
"display" : "Library CMD",
"resource" : "Library/CumulativeMedicationDuration|4.1.000"
},
{
"type" : "depends-on",
"display" : "Library Hospice",
"resource" : "Library/Hospice|6.12.000"
},
{
"type" : "depends-on",
"display" : "Code system CPT",
"resource" : "http://www.ama-assn.org/go/cpt"
},
{
"type" : "depends-on",
"display" : "Code system ObservationCategoryCodes",
"resource" : "http://terminology.hl7.org/CodeSystem/observation-category"
},
{
"type" : "depends-on",
"display" : "Code system ICD10CM",
"resource" : "http://hl7.org/fhir/sid/icd-10-cm"
},
{
"type" : "depends-on",
"display" : "Code system SNOMEDCT",
"resource" : "http://snomed.info/sct"
},
{
"type" : "depends-on",
"display" : "Code system LOINC",
"resource" : "http://loinc.org"
},
{
"type" : "depends-on",
"display" : "Value set Home Healthcare Services",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"
},
{
"type" : "depends-on",
"display" : "Value set Occupational Therapy Evaluation",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1011"
},
{
"type" : "depends-on",
"display" : "Value set Office Visit",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
},
{
"type" : "depends-on",
"display" : "Value set Ophthalmological Services",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1285"
},
{
"type" : "depends-on",
"display" : "Value set Physical Therapy Evaluation",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1022"
},
{
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"name" : "PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR",
"title" : "Preventive Care and Screening: Tobacco Use: Screening and Cessation InterventionFHIR",
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"date" : "2024-07-09T14:53:56+00:00",
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"description" : "Percentage of patients aged 12 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period if identified as a tobacco user. Three rates are reported: a. Percentage of patients aged 12 years and older who were screened for tobacco use one or more times during the measurement period b. Percentage of patients aged 12 years and older who were identified as a tobacco user during the measurement period who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period c. Percentage of patients aged 12 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period if identified as a tobacco user",
"purpose" : "UNKNOWN",
"usage" : "The requirement of two or more visits is to establish that the eligible clinician has an existing relationship with the patient for certain types of encounters. To satisfy the intent of this measure, a patient must have at least one tobacco use screening during the measurement period. If a patient has multiple tobacco use screenings during the measurement period, only the most recent screening, which has a documented status of tobacco user or tobacco non-user, will be used to satisfy the measure requirements. If a patient uses any type of tobacco (i.e., smokes or uses smokeless tobacco), the expectation is that they should receive tobacco cessation intervention: either counseling and/or pharmacotherapy. As noted above in the 2021 USPSTF recommendation statement, the current evidence is insufficient to recommend electronic cigarettes (e-cigarettes) for tobacco cessation. However, as noted above in the Definition section, the 2021 USPSTF recommendation also references the US Food and Drug Administration definition of tobacco, which includes e-cigarettes, hookah pens and other electronic nicotine delivery systems. Therefore, the measure does consider the use of e-cigarettes and other electronic nicotine delivery systems to be tobacco use. If a patient's tobacco use status is unknown, the patient does not meet the screening requirement and does not meet the numerator for populations 1 or 3. Instances where tobacco use status of \"unknown\" include: 1) the patient was not screened; or 2) the patient was screened and the patient (or caregiver) was unable to provide a definitive answer. In order to promote a team-based approach to patient care, the tobacco cessation intervention can be performed by another healthcare provider; therefore, the tobacco use screening and tobacco cessation intervention do not need to be performed by the same provider or clinician. This measure contains three reporting rates which aim to identify patients who were screened for tobacco use (rate/population 1), patients who were identified as tobacco users and who received a tobacco cessation intervention (rate/population 2), and a comprehensive look at the overall performance on tobacco screening and cessation intervention (rate/population 3). By separating this measure into various reporting rates, the eligible clinician will be able to better ascertain where gaps in performance exist, and identify opportunities for improvement. The overall rate (rate/population 3) can be utilized to compare performance to published versions of this measure prior to the 2018 performance year, when the measure had a single performance rate. For accountability reporting in the CMS MIPS program, the rate for population 2 is used for performance. The denominator of population criteria 2 is a subset of the resulting numerator for population criteria 1, as population criteria 2 is limited to assessing if patients identified as tobacco users received an appropriate tobacco cessation intervention. For all patients, population criteria 1 and 3 are applicable, but population criteria 2 will only be applicable for those patients who are identified as tobacco users. Therefore, data for every patient that meets the initial population criteria will only be submitted for population 1 and 3, whereas data submitted for population 2 will be for a subset of patients who meet the initial population criteria, as the denominator has been further limited to those who were identified as tobacco users. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS138v13. 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-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).",
"copyright" : "This Physician Performance Measure (Measure) and related data specifications are owned by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. The Physician Consortium for Performance Improvement’s (PCPI) and American Medical Association’s (AMA) significant past efforts and contributions to the development and updating of the measure are acknowledged. (C) 2012-2024 National Committee for Quality Assurance. All Rights Reserved. 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. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications. CPT(R) codes, descriptions and other data are copyright 2024. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Some measure specifications contain coding from LOINC(R) (http://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2024 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at http://loinc.org/terms-of-use. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2024 World Health Organization. All Rights Reserved. Some measures use RxNorm, a standardized nomenclature and coding for clinical drugs and drug delivery devices, which is made publicly available courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services. NLM is not responsible for the measures and does not endorse or recommend this or any other product. “HL7” is the registered trademark of Health Level Seven International.",
"effectivePeriod" : {
"start" : "2025-01-01",
"end" : "2025-12-31"
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🔗 "https://madie.cms.gov/Library/PreventiveCareAndTobaccoUseScreeningAndCessationInterventionFHIR"
],
"disclaimer" : "The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE 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].",
"rationale" : "This measure is intended to promote adult tobacco screening and tobacco cessation interventions for those who use tobacco products. There is good evidence that tobacco screening and brief cessation intervention (including counseling and/or pharmacotherapy) is successful in helping tobacco users quit. Tobacco users who are able to stop using tobacco lower their risk for heart disease, lung disease, and stroke.",
"clinicalRecommendationStatement" : "The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and U.S. Food and Drug Administration (FDA)-approved pharmacotherapy for cessation to nonpregnant adults who use tobacco (Grade A Recommendation) (U.S. Preventive Services Task Force, 2021). The USPSTF recommends that clinicians ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant persons who use tobacco (Grade A Recommendation) (U.S. Preventive Services Task Force, 2021). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of pharmacotherapy interventions for tobacco cessation in pregnant women (Grade I Statement) (U.S. Preventive Services Task Force, 2021). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of electronic cigarettes (e-cigarettes) for tobacco cessation in adults, including pregnant persons. The USPSTF recommends that clinicians direct patients who use tobacco to other tobacco cessation interventions with proven effectiveness and established safety (Grade I Statement) (U.S. Preventive Services Task Force, 2021). The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents (Grade B Statement) (U.S. Preventive Services Task Force, 2020). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care--feasible interventions for the cessation of tobacco use among school-aged children and adolescents (Grade I Statement) (U.S. Preventive Services Task Force, 2020). All patients should be asked if they use tobacco and should have their tobacco use status documented on a regular basis. Evidence has shown that clinic screening systems, such as expanding the vital signs to include tobacco use status or the use of other reminder systems such as chart stickers or computer prompts, significantly increase rates of clinician intervention. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008). All physicians should strongly advise every patient who smokes to quit because evidence shows that physician advice to quit smoking increases abstinence rates. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008). Minimal interventions lasting less than 3 minutes increase overall tobacco abstinence rates. Every tobacco user should be offered at least a minimal intervention, whether or not he or she is referred to an intensive intervention. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008). The combination of counseling and medication is more effective for smoking cessation than either medication or counseling alone. Therefore, whenever feasible and appropriate, both counseling and medication should be provided to patients trying to quit smoking. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008).",
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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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