Proportion

Process

increase

define "Initial Population":
  exists "Prostate Cancer Diagnosis"

define "Denominator":
  "Initial Population"
    and "First Prostate Cancer Treatment during day of Measurement Period" is not null
    and "Most Recent Prostate Cancer Staging Tumor Size T1a to T2a" is not null
    and "Most Recent PSA Test Result is Low"
    and "Most Recent Gleason Score is Low"

define "Numerator":
  not exists "Bone Scan Study Performed"

define "Denominator Exceptions":
  "Has Diagnosis of Pain related to Prostate Cancer"
    or "Has Salvage Therapy Performed after Prostate Cancer Diagnosis"
    or "Has Bone Scan Study Performed with Documented Reason"

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

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

define "Prostate Cancer Diagnosis":
  [Condition: "Prostate Cancer"] ProstateCancer
    where ProstateCancer.prevalenceInterval ( ) overlaps day of "Measurement Period"
      and ( ProstateCancer.isProblemListItem ( )
          or ProstateCancer.isHealthConcern ( )
      )

define "Bone Scan Study Performed":
  [Observation: "Bone Scan"] BoneScan
    with "Prostate Cancer Diagnosis" ActiveProstateCancer
      such that BoneScan.effective.toInterval ( ) starts after start of ActiveProstateCancer.prevalenceInterval ( )
    where BoneScan.effective.toInterval ( ) ends during day of "Measurement Period"

define "Numerator":
  not exists "Bone Scan Study Performed"

define "Initial Population":
  exists "Prostate Cancer Diagnosis"

define "First Prostate Cancer Treatment during day of Measurement Period":
  First([Procedure: "Prostate Cancer Treatment"] ProstateCancerTreatment
      where ProstateCancerTreatment.performed.toInterval() ends during day of "Measurement Period"
        and ProstateCancerTreatment.status = 'completed'
      sort by start of performed.toInterval()
  )

define "Most Recent Prostate Cancer Staging Tumor Size T1a to T2a":
  ( Last([Observation: "Tumor staging (tumor staging)"] ProstateCancerStaging
      with "First Prostate Cancer Treatment during day of Measurement Period" FirstProstateCancerTreatment
        such that ProstateCancerStaging.effective.toInterval() starts before start of FirstProstateCancerTreatment.performed.toInterval()
          and ProstateCancerStaging.status in { 'final', 'amended', 'corrected' }
      sort by start of effective.toInterval()
  ) ) LastProstateCancerStaging
    where ( LastProstateCancerStaging.value ~ "T1a: Prostate tumor incidental histologic finding in 5 percent or less of tissue resected (finding)"
        or LastProstateCancerStaging.value ~ "T1b: Prostate tumor incidental histologic finding in greater than 5 percent of tissue resected (finding)"
        or LastProstateCancerStaging.value ~ "Neoplasm of prostate primary tumor staging category T1c: Tumor identified by needle biopsy (finding)"
        or LastProstateCancerStaging.value ~ "Neoplasm of prostate primary tumor staging category T2a: Involves one-half of one lobe or less (finding)"
    )

define "Most Recent PSA Test Result is Low":
  ( Last([Observation: "Prostate Specific Antigen Test"] PSATest
      with "Most Recent Prostate Cancer Staging Tumor Size T1a to T2a" MostRecentProstateCancerStaging
        such that PSATest.effective.toInterval() starts before MostRecentProstateCancerStaging.effective.toInterval()
          and PSATest.status in { 'final', 'amended', 'corrected' }
      sort by start of effective.toInterval()
  ) ) LastPSATest
    return LastPSATest.value as Quantity < 10 'ng/mL'

define "Most Recent Gleason Score is Low":
  ( Last([Observation: "Gleason score in Specimen Qualitative"] GleasonScore
      with "First Prostate Cancer Treatment during day of Measurement Period" FirstProstateCancerTreatment
        such that GleasonScore.effective.toInterval() starts before start of FirstProstateCancerTreatment.performed.toInterval()
          and GleasonScore.status in { 'final', 'amended', 'corrected' }
      sort by start of effective.toInterval()
  ) ) LastGleasonScore
    return LastGleasonScore.value as Integer <= 6

define "Denominator":
  "Initial Population"
    and "First Prostate Cancer Treatment during day of Measurement Period" is not null
    and "Most Recent Prostate Cancer Staging Tumor Size T1a to T2a" is not null
    and "Most Recent PSA Test Result is Low"
    and "Most Recent Gleason Score is Low"

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

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

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

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

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

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

define "Has Diagnosis of Pain related to Prostate Cancer":
  exists ( [Condition: "Pain Warranting Further Investigation for Prostate Cancer"] ProstateCancerPain
      with "Prostate Cancer Diagnosis" ActiveProstateCancer
        such that ProstateCancerPain.prevalenceInterval ( ) starts after start of ActiveProstateCancer.prevalenceInterval ( )
          and ( ProstateCancerPain.isProblemListItem ( )
              or ProstateCancerPain.isHealthConcern ( )
          )
  )

define "Has Salvage Therapy Performed after Prostate Cancer Diagnosis":
  exists ( [Procedure: "Salvage Therapy"] SalvageTherapy
      with "Prostate Cancer Diagnosis" ActiveProstateCancer
        such that SalvageTherapy.performed.toInterval ( ) starts after start of ActiveProstateCancer.prevalenceInterval ( )
          and SalvageTherapy.status = 'completed'
  )

define "Has Bone Scan Study Performed with Documented Reason":
  exists "Bone Scan Study Performed" BoneScanAfterDiagnosis
    where BoneScanAfterDiagnosis.value ~ "Procedure reason record (record artifact)"

define "Denominator Exceptions":
  "Has Diagnosis of Pain related to Prostate Cancer"
    or "Has Salvage Therapy Performed after Prostate Cancer Diagnosis"
    or "Has Bone Scan Study Performed with Documented Reason"

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

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

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

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

define function ToString(value uri): value.value

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