Process

increase

define "Initial Population":
  "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge"

define "Denominator":
  "Initial Population"

define "Denominator Exclusion":
  /*Excludes encounters of patients with cancer or who are receiving palliative or hospice care at the time of the encounter or who are discharged to another inpatient care facility or expire during the inpatient stay*/
  
  ( "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter
      where exists ( [Condition: "Cancer Related Pain"] CancerPain
          where ( CancerPain.isProblemListItem ( )
              or CancerPain.isHealthConcern ( )
          )
            and CancerPain.prevalenceInterval ( ) overlaps day of InpatientEncounter.period
      )
        or exists ( ( InpatientEncounter.encounterDiagnosis ( ) ) InpatientEncounterDiagnosis
            where InpatientEncounterDiagnosis.code in "Cancer Related Pain"
        )
        or exists ( [Condition: "Sickle Cell Disease with and without Crisis"] SickleCellDisease
            where SickleCellDisease.prevalenceInterval ( ) overlaps day of InpatientEncounter.period
        )
        or exists ( [Condition: "Opioid Use Disorder"] OUD
            where start of OUD.prevalenceInterval ( ) before day of end of InpatientEncounter.period
        )
        or exists ( "Treatment for Opioid Use Disorders" OUDTreatment
            where OUDTreatment.authoredOn during day of InpatientEncounter.period
        )
        or exists ( "Intervention Palliative or Hospice Care" PalliativeOrHospiceCare
            where Coalesce(start of PalliativeOrHospiceCare.performed.toInterval(), PalliativeOrHospiceCare.authoredOn) during day of InpatientEncounter."hospitalizationWithObservation" ( )
        )
        or ( InpatientEncounter.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"
            or InpatientEncounter.hospitalization.dischargeDisposition in "Hospice Care Referral or Admission"
            or InpatientEncounter.hospitalization.dischargeDisposition in "Patient Expired"
            or InpatientEncounter.hospitalization.dischargeDisposition in "Left Against Medical Advice"
        )
  )

define "Numerator":
  /*Encounters of patients prescribed two or more opioids or an opioid and benzodiazepine at discharge.*/
  
  ( ( "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter
        where ( Count("Opioid at Discharge" OpioidMedications
              where OpioidMedications.authoredOn during day of InpatientEncounter.period
              return distinct OpioidMedications.medication
          ) >= 2
        )
          or exists ( "Opioid at Discharge" OpioidDischargeMedications
              where OpioidDischargeMedications.authoredOn during day of InpatientEncounter.period
                and exists "Benzodiazepine at Discharge" BenzodiazepineDischargeMedication
                  where BenzodiazepineDischargeMedication.authoredOn during day of InpatientEncounter.period
          )
    )
  )

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 "Inpatient Encounter":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
		where EncounterInpatient.status = 'finished'
		and EncounterInpatient.period ends during day of "Measurement Period"

define "Inpatient Encounter with Age Greater than or Equal to 18":
  CQMCommon."Inpatient Encounter" InpatientHospitalEncounter
    where AgeInYearsAt(date from start of InpatientHospitalEncounter.period) >= 18

define "Opioid at Discharge":
  ( [MedicationRequest: "Schedule II, III and IV Opioid Medications"] OpioidMedications
    where ( OpioidMedications.isCommunity ( )
        or OpioidMedications.isDischarge ( )
    ) ) OpioidDischargeMedication
    where OpioidDischargeMedication.status in { 'active', 'completed' }
      and OpioidDischargeMedication.intent = 'order'

define "Benzodiazepine at Discharge":
  ( [MedicationRequest: medication in "Schedule IV Benzodiazepines"] BenzoMedications
    where ( BenzoMedications.isCommunity ( )
        or BenzoMedications.isDischarge ( )
    ) ) BenzodiazepineDischargeMedication
    where BenzodiazepineDischargeMedication.status in { 'active', 'completed' }
      and BenzodiazepineDischargeMedication.intent = 'order'

define "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge":
  "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter
    with ( "Opioid at Discharge"
      union "Benzodiazepine at Discharge" ) OpioidOrBenzodiazepineAtDischarge
      such that OpioidOrBenzodiazepineAtDischarge.authoredOn during day of InpatientEncounter.period

define "Numerator":
  /*Encounters of patients prescribed two or more opioids or an opioid and benzodiazepine at discharge.*/
  
  ( ( "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter
        where ( Count("Opioid at Discharge" OpioidMedications
              where OpioidMedications.authoredOn during day of InpatientEncounter.period
              return distinct OpioidMedications.medication
          ) >= 2
        )
          or exists ( "Opioid at Discharge" OpioidDischargeMedications
              where OpioidDischargeMedications.authoredOn during day of InpatientEncounter.period
                and exists "Benzodiazepine at Discharge" BenzodiazepineDischargeMedication
                  where BenzodiazepineDischargeMedication.authoredOn during day of InpatientEncounter.period
          )
    )
  )

define "Initial Population":
  "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge"

define "Denominator":
  "Initial Population"

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

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

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

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

define "Treatment for Opioid Use Disorders":
  [MedicationRequest: "Medications for Opioid Use Disorder (MOUD)"] MedicationTreatment
    with [Procedure: "Opioid Medication Assisted Treatment (MAT)"] MAT
      such that MedicationTreatment.authoredOn during day of MAT.performed.toInterval ( )
        and MedicationTreatment.authoredOn during day of "Measurement Period"

define "Intervention Palliative or Hospice Care":
  [ServiceRequest: "Palliative or Hospice Care"]
    union [Procedure: "Palliative or Hospice Care"]

define "Denominator Exclusion":
  /*Excludes encounters of patients with cancer or who are receiving palliative or hospice care at the time of the encounter or who are discharged to another inpatient care facility or expire during the inpatient stay*/
  
  ( "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter
      where exists ( [Condition: "Cancer Related Pain"] CancerPain
          where ( CancerPain.isProblemListItem ( )
              or CancerPain.isHealthConcern ( )
          )
            and CancerPain.prevalenceInterval ( ) overlaps day of InpatientEncounter.period
      )
        or exists ( ( InpatientEncounter.encounterDiagnosis ( ) ) InpatientEncounterDiagnosis
            where InpatientEncounterDiagnosis.code in "Cancer Related Pain"
        )
        or exists ( [Condition: "Sickle Cell Disease with and without Crisis"] SickleCellDisease
            where SickleCellDisease.prevalenceInterval ( ) overlaps day of InpatientEncounter.period
        )
        or exists ( [Condition: "Opioid Use Disorder"] OUD
            where start of OUD.prevalenceInterval ( ) before day of end of InpatientEncounter.period
        )
        or exists ( "Treatment for Opioid Use Disorders" OUDTreatment
            where OUDTreatment.authoredOn during day of InpatientEncounter.period
        )
        or exists ( "Intervention Palliative or Hospice Care" PalliativeOrHospiceCare
            where Coalesce(start of PalliativeOrHospiceCare.performed.toInterval(), PalliativeOrHospiceCare.authoredOn) during day of InpatientEncounter."hospitalizationWithObservation" ( )
        )
        or ( InpatientEncounter.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"
            or InpatientEncounter.hospitalization.dischargeDisposition in "Hospice Care Referral or Admission"
            or InpatientEncounter.hospitalization.dischargeDisposition in "Patient Expired"
            or InpatientEncounter.hospitalization.dischargeDisposition in "Left Against Medical Advice"
        )
  )

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

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

/*
@description: Returns true if the given MedicationRequest has a category of Community
*/
define fluent function isCommunity(medicationRequest MedicationRequest):
  exists (medicationRequest.category C
    where C ~ Community
  )

/*
@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 MedicationRequest has a category of Discharge
*/
define fluent function isDischarge(medicationRequest MedicationRequest):
  exists (medicationRequest.category C
    where C ~ Discharge
  )

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
        }

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

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

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

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

/*
@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).
@comment: This function can be used to determine the logical id of a given resource. It can be used in
a single-server environment to trace references. However, this function does not attempt to resolve
or distinguish the base of the given url, and so cannot be used safely in multi-server environments.
*/
define fluent function getId(uri String):
  Last(Split(uri, '/'))

/*
@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter
*/
define fluent function hospitalizationWithObservation(TheEncounter Encounter ):
  TheEncounter Visit
  		let ObsVisit: Last([Encounter: "Observation Services"] LastObs
  				where LastObs.status = 'finished'
            and LastObs.period ends 1 hour or less on or before start of Visit.period
  				sort by end of period
  			),
  			VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
  			EDVisit: Last([Encounter: "Emergency Department Visit"] LastED
  				where LastED.status = 'finished'
            and LastED.period ends 1 hour or less on or before VisitStart
  				sort by end of period
  			)
  		return Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]