Proportion

Outcome

Decreased score indicates improvement

define "Initial Population":
  PCMaternal."Delivery Encounter with Age Range"

define "Denominator":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation"

define "Denominator Exclusion":
  "Delivery Encounters with COVID and Respiratory Condition or Procedure"

define "Delivery Encounters with Severe Obstetric Complications":
  "Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion"
    union "Delivery Encounters with Expiration"
    union "Delivery Encounters with Blood Transfusion"

define "SOC with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC":
  ( "Delivery Encounters with Severe Obstetric Complications" SOCEncounter
      where exists ( ( SOCEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
          where EncounterDiagnosis.code in "Placenta Increta or Percreta"
      )
        and ( exists "Delivery Encounters with Blood Transfusion"
            or exists "Delivery Encounters with Hysterectomy"
        )
  )
	//The following logic keeps encounter in the numerator if there is an additional SOC besides Blood Transfusion or Hysterectomy
    
    except ( ( "Delivery Encounters with Severe Obstetric Complications" SOCEncounter
          where ( SOCEncounter.pOAIsNoOrUTD ( ) in "Severe Maternal Morbidity Diagnoses" )
      )
        union "Delivery Encounters with Cardiac Conversion, Tracheostomy or Ventilation Procedures"
        union "Delivery Encounters with Expiration"
    )

Proportion

Outcome

define "Initial Population":
  PCMaternal."Delivery Encounter with Age Range"

define "Denominator":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation"

define "Denominator Exclusion":
  "Delivery Encounters with COVID and Respiratory Condition or Procedure"

define "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only":
  "Delivery Encounters with Severe Obstetric Complications"
    intersect "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions"

define "SOC Excluding Blood Transfusions Only with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC":
  ( "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only" SOCExcludingTransfusion
      where exists ( ( SOCExcludingTransfusion.encounterDiagnosis ( ) ) EncounterDiagnoses
          where EncounterDiagnoses.code in "Placenta Increta or Percreta"
      )
        and ( exists "Delivery Encounters with Blood Transfusion"
            or exists "Delivery Encounters with Hysterectomy"
        )
  )
	
	//The following logic keeps encounter in the numerator if there is an additional SOC besides Blood Transfusion or Hysterectomy
    
    except ( ( "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only" SOCExcludingTransfusion
          where SOCExcludingTransfusion.pOAIsNoOrUTD ( ) in "Severe Maternal Morbidity Diagnoses"
      )
        union "Delivery Encounters with Cardiac Conversion, Tracheostomy or Ventilation Procedures"
        union "Delivery Encounters with Expiration"
    )

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

define "Encounter with Age Range":
 CQMCommon."Inpatient Encounter" InpatientEncounter
                      where AgeInYearsAt(date from start of InpatientEncounter.period) in Interval[ 8, 65 )

define "Delivery Encounter with Age Range":
  "Encounter with Age Range" EncounterWithAge
                with ["Procedure": "Delivery Procedures"] DeliveryProcedure
                such that DeliveryProcedure.status = 'completed'
                and DeliveryProcedure.performed.toInterval  ( ) starts during EncounterWithAge.hospitalizationWithEDOBTriageObservation ()

define "Delivery Encounters with Calculated Gestational Age Greater than or Equal to 20 Weeks":
  PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
    where DeliveryEncounter.calculatedGestationalAge ( ) >= 20

define "Delivery Encounters with Estimated Gestational Age Assessment Greater than or Equal to 20 Weeks":
  PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
    where DeliveryEncounter.calculatedGestationalAge ( ) is null
      and ( DeliveryEncounter.lastEstimatedGestationalAge ( ) >= 20 weeks )

define "Delivery Encounters with Gestational Age Greater than or Equal to 20 Weeks Based on Coding":
  PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
    let CGA: DeliveryEncounter.calculatedGestationalAge ( ),
    EGA: DeliveryEncounter.lastEstimatedGestationalAge ( )
    where CGA is null
      and EGA is null
      and exists ( ( DeliveryEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
          where EncounterDiagnosis.code in "20 to 42 Plus Weeks Gestation"
      )

define "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation":
  "Delivery Encounters with Calculated Gestational Age Greater than or Equal to 20 Weeks"
    union "Delivery Encounters with Estimated Gestational Age Assessment Greater than or Equal to 20 Weeks"
    union "Delivery Encounters with Gestational Age Greater than or Equal to 20 Weeks Based on Coding"

define "Risk Variable Asthma":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Acute or Persistent Asthma"

define "Risk Variable Placental Accreta Spectrum":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Placenta Accreta"
      or TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Placenta Increta or Percreta"

define "Risk Variable Neuromuscular":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Neuromuscular Disease"

define "Risk Variable Hypertension":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Hypertension"

define "Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsNoOrUTD ( ) in "Severe Maternal Morbidity Diagnoses"
      or exists ( ["Procedure": "Severe Maternal Morbidity Procedures"] SMMProcedures
          where SMMProcedures.status = 'completed'
            and SMMProcedures.performed.toInterval ( ) starts during day of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )
      )

define "Delivery Encounters with Expiration":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.hospitalization.dischargeDisposition in "Patient Expired"

define "Delivery Encounters with Blood Transfusion":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    with ["Procedure": "Blood Transfusion"] BloodTransfusion
      such that BloodTransfusion.status = 'completed'
        and BloodTransfusion.performed.toInterval ( ) starts during day of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )

define "Delivery Encounters with Severe Obstetric Complications":
  "Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion"
    union "Delivery Encounters with Expiration"
    union "Delivery Encounters with Blood Transfusion"

define "Delivery Encounters with Hysterectomy":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    with ["Procedure": "Hysterectomy"] Hysterectomy
      such that Hysterectomy.status = 'completed'
        and Hysterectomy.performed.toInterval ( ) starts during day of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )

define "Cardiac Conversion, Tracheostomy or Ventilation Procedures":
  ["Procedure": "Conversion of Cardiac Rhythm"]
    union ["Procedure": "Tracheostomy"]
    union ["Procedure": "Ventilation"]

define "Delivery Encounters with Cardiac Conversion, Tracheostomy or Ventilation Procedures":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    with "Cardiac Conversion, Tracheostomy or Ventilation Procedures" ConvTrachVentProcedures
      such that ConvTrachVentProcedures.status = 'completed'
        and ConvTrachVentProcedures.performed.toInterval ( ) starts during day of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )

define "SOC with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC":
  ( "Delivery Encounters with Severe Obstetric Complications" SOCEncounter
      where exists ( ( SOCEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
          where EncounterDiagnosis.code in "Placenta Increta or Percreta"
      )
        and ( exists "Delivery Encounters with Blood Transfusion"
            or exists "Delivery Encounters with Hysterectomy"
        )
  )
	//The following logic keeps encounter in the numerator if there is an additional SOC besides Blood Transfusion or Hysterectomy
    
    except ( ( "Delivery Encounters with Severe Obstetric Complications" SOCEncounter
          where ( SOCEncounter.pOAIsNoOrUTD ( ) in "Severe Maternal Morbidity Diagnoses" )
      )
        union "Delivery Encounters with Cardiac Conversion, Tracheostomy or Ventilation Procedures"
        union "Delivery Encounters with Expiration"
    )

define "Risk Variable Preterm Birth":
/*  CGA = Calculated Gestational Age.  EGA = Estimated Gestational Age. */
  
  ( PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
      let CGA: DeliveryEncounter.calculatedGestationalAge ( ),
      EGA: DeliveryEncounter.lastEstimatedGestationalAge ( )
      where CGA in Interval[20, 36]
        or ( CGA is null
            and ( EGA >= 20 weeks
                and EGA <= 36 weeks
            )
        )
  )
    union ( PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
        let CGA: DeliveryEncounter.calculatedGestationalAge ( ),
        EGA: DeliveryEncounter.lastEstimatedGestationalAge ( )
        where CGA is null
          and EGA is null
          and DeliveryEncounter.pOAIsYesOrExempt ( ) in "Preterm Birth"
    )

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

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

define "Risk Variable Placental Abruption":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Placental Abruption"

define "Delivery Encounters with COVID and Respiratory Condition or Procedure":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where exists ( ( TwentyWeeksPlusEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
        where EncounterDiagnosis.code in "COVID 19 Confirmed"
    )
      and ( exists ( ( TwentyWeeksPlusEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
            where EncounterDiagnosis.code in "Respiratory Conditions Related to COVID 19"
        )
          or exists ( ["Procedure": "Respiratory Support Procedures Related to COVID 19"] COVIDRespiratoryProcedure
              where COVIDRespiratoryProcedure.status = 'completed'
                and COVIDRespiratoryProcedure.performed.toInterval ( ) starts during day of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )
          )
      )

define "Denominator Exclusion":
  "Delivery Encounters with COVID and Respiratory Condition or Procedure"

define "Risk Variable Morbid Obesity":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Morbid or Severe Obesity"

define "Risk Variable Preexisting Diabetes":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Preexisting Diabetes"

define "Risk Variable Bariatric Surgery":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Bariatric Surgery"

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

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

define "Risk Variable Placenta Previa":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Placenta Previa"

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 "Risk Variable Bleeding Disorder":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Bleeding Disorder"

//First resulted value 24 hours prior to start of encounter and before time of delivery
 //Report white blood cell count as 10*3/uL



define "Risk Variable First White Blood Cell Count Lab Test":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    let FirstWBC: First(["USCoreLaboratoryResultObservationProfile": "White blood cells count lab test"] WBC
        where WBC.issued during Interval[start of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, TwentyWeeksPlusEncounter.lastTimeOfDelivery())
          and WBC.status in { 'final', 'amended', 'corrected' }
          and WBC.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: TwentyWeeksPlusEncounter.id,
      FirstWBCResult: FirstWBC.value as Quantity,
      Timing: FirstWBC.issued
    }

//First resulted value 24 hours prior to start of encounter and before time of delivery
 //Report hematocrit as %



define "Risk Variable First Hematocrit Lab Test":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    let FirstHematocrit: First(["USCoreLaboratoryResultObservationProfile": "Hematocrit lab test"] Hematocrit
        where Hematocrit.issued during Interval[start of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, TwentyWeeksPlusEncounter.lastTimeOfDelivery())
          and Hematocrit.status in { 'final', 'amended', 'corrected' }
          and Hematocrit.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: TwentyWeeksPlusEncounter.id,
      FirstHematocritResult: FirstHematocrit.value as Quantity,
      Timing: FirstHematocrit.issued
    }

define "Risk Variable Severe Preeclampsia":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Severe Preeclampsia"

define "Risk Variable Anemia":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Anemia"

define "Risk Variable Cardiac Disease":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Cardiac Disease"

define "Risk Variable Long Term Anticoagulant Use":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Long Term Anticoagulant Use"

//First resulted value 24 hours prior to start of encounter and before time of delivery
//Report systolic blood pressure as mm[Hg]
//Systolic blood pressure value cannot be null per QICore profile requirement.




define "Risk Variable Systolic Blood Pressure":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    let FirstSystolicBP: First(["observation-bp"] BP
        where BP.effective.earliest() during Interval[start of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, TwentyWeeksPlusEncounter.lastTimeOfDelivery())
          and BP.status in { 'final', 'amended', 'corrected' }
          and BP.component.value is not null
        sort by effective.earliest()
    )
    return {
      EncounterId: TwentyWeeksPlusEncounter.id,
      FirstSBPResult: FirstSystolicBP.component C
        where C.code ~ "Systolic blood pressure"
        return C.value as Quantity,
      Timing: FirstSystolicBP.effective.earliest ( )
    }

define "Risk Variable Substance Abuse":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Substance Abuse"

define "Risk Variable Renal Disease":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Renal Disease"

define "Variable Calculated Gestational Age":
 // This definition establishes a variable of CGA (Calculated Gestational Age).  CGA is a supplemental data element to store the calculated gestational age result from the "CalculatedGestationalAge" function.  The data element enables the capturing and saving of the CGA for data analysis post data receipt. Hospitals do not need to submit any additional data to comply with this definition
  "Delivery Encounter with Age Range" DeliveryEncounter
    let CGA: DeliveryEncounter.calculatedGestationalAge()
  //  return { QualifyingEncounter, CGA }
    return {
      EncounterID: DeliveryEncounter.id,
      CalculatedCGA: CGA
    }

define "SDE Variable Calculated Gestational Age":
  //This definition establishes a variable of CGA (Calculated Gestational Age).  CGA is a supplemental data element to store the calculated gestational age result from the "CalculatedGestationalAge" function.  The data element enables the capturing and saving of the CGA for data analysis post data receipt. Hospitals do not need to submit any additional data to comply with this definition. 
  
  PCMaternal."Variable Calculated Gestational Age"

define "Risk Variable Gastrointestinal Disease":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Gastrointestinal Disease"

define "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions":
  "Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion"
    union "Delivery Encounters with Expiration"

define "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only":
  "Delivery Encounters with Severe Obstetric Complications"
    intersect "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions"

define "Risk Variable Pulmonary Hypertension":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Pulmonary Hypertension"

define "Risk Variable Thyrotoxicosis":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Thyrotoxicosis"

define "Risk Variable Other Preeclampsia":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Mild or Moderate Preeclampsia"

define "Initial Population":
  PCMaternal."Delivery Encounter with Age Range"

define "Risk Variable Economic Housing Instability":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Economic Housing Instability"

define "Risk Variable HIV":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "HIV in Pregnancy Childbirth and Puerperium"

define "SOC Excluding Blood Transfusions Only with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC":
  ( "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only" SOCExcludingTransfusion
      where exists ( ( SOCExcludingTransfusion.encounterDiagnosis ( ) ) EncounterDiagnoses
          where EncounterDiagnoses.code in "Placenta Increta or Percreta"
      )
        and ( exists "Delivery Encounters with Blood Transfusion"
            or exists "Delivery Encounters with Hysterectomy"
        )
  )
	
	//The following logic keeps encounter in the numerator if there is an additional SOC besides Blood Transfusion or Hysterectomy
    
    except ( ( "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only" SOCExcludingTransfusion
          where SOCExcludingTransfusion.pOAIsNoOrUTD ( ) in "Severe Maternal Morbidity Diagnoses"
      )
        union "Delivery Encounters with Cardiac Conversion, Tracheostomy or Ventilation Procedures"
        union "Delivery Encounters with Expiration"
    )

//First resulted value 24 hours prior to start of encounter and before time of delivery
 //Report heart rate as beats/min
 //Heart rate value cannot be null per QICore profile requirement.




define "Risk Variable Heart Rate":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    let FirstHeartRate: First(["observation-heartrate"] HeartRate
        where HeartRate.effective.earliest() during Interval[start of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, TwentyWeeksPlusEncounter.lastTimeOfDelivery())
          and HeartRate.status in { 'final', 'amended', 'corrected' }
        sort by effective.earliest()
    )
    return {
      EncounterId: TwentyWeeksPlusEncounter.id,
      FirstHRResult: FirstHeartRate.value as Quantity,
      Timing: FirstHeartRate.effective.earliest ( )
    }

define "Risk Variable Maternal Age":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    let MaternalAge: AgeInYearsAt(date from start of TwentyWeeksPlusEncounter.period)
    return { TwentyWeeksPlusEncounter, MaternalAge }

define "Risk Variable Mental Health Disorder":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Mental Health Disorder"

define "Risk Variable Obstetrical VTE":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Venous Thromboembolism in Pregnancy"

define "Risk Variable Autoimmune Disease":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Autoimmune Disease"

define "Risk Variable Previous Cesarean":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Previous Cesarean"

define "Risk Variable Gestational Diabetes":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Gestational Diabetes"

define "Risk Variable Multiple Pregnancy":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.pOAIsYesOrExempt ( ) in "Multiple Pregnancy"

define "Denominator":
  "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation"

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

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

/*define function "HospitalizationWithEDOBTriageObservation"(Encounter Encounter ):
  HospitalizationWithEDOBTriageObservation returns the total interval from the start of any immediately prior emergency department visit or OB Triage visit through the observation visit to the discharge of the given encounter
  Encounter Visit
    let ObsVisit: Last(["Encounter": "Observation Services"] LastObs
        where LastObs.period ends 1 hour or less on or before start of Visit.period
          and LastObs.status = 'finished'
        sort by 
        end of period
    ),
    VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
    EDOBTriageVisit: Last(["Encounter": "ED Visit and OB Triage"] LastEDOBTriage
        where LastEDOBTriage.period ends 1 hour or less on or before VisitStart
          and LastEDOBTriage.status = 'finished'
        sort by 
        end of period
    )
    return Interval[Coalesce(start of EDOBTriageVisit.period, VisitStart), 
    end of Visit.period]*/
    
    
define fluent function hospitalizationWithEDOBTriageObservation (TheEncounter Encounter ):
  /*hospitalizationWithEDOBTriageObservation returns the total interval from the start of any immediately prior emergency department visit or OB Triage visit through the observation visit to the discharge of the given encounter*/
  TheEncounter Visit
    let ObsVisit: Last(["Encounter": "Observation Services"] LastObs
        where LastObs.period ends 1 hour or less on or before start of Visit.period
          and LastObs.status = 'finished'
        sort by 
        end of period
    ),
    VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
    EDOBTriageVisit: Last(["Encounter": "ED Visit and OB Triage"] LastEDOBTriage
        where LastEDOBTriage.period ends 1 hour or less on or before VisitStart
          and LastEDOBTriage.status = 'finished'
        sort by 
        end of period
    )
    return Interval[Coalesce(start of EDOBTriageVisit.period, VisitStart), 
    end of Visit.period]

define fluent function calculatedGestationalAge (TheEncounter Encounter ):
  //Gestational Age = (280-(Estimated Delivery Date minus Reference Date/Delivery Date))/7
 ( 280 - ( difference in days between TheEncounter.lastTimeOfDelivery () and TheEncounter.lastEstimatedDeliveryDate( )) ) div 7

define fluent function lastTimeOfDelivery (TheEncounter Encounter ):
  Last(["Observation": "Date and time of obstetric delivery"] TimeOfDelivery
      where TimeOfDelivery.value as DateTime is not null
        and TimeOfDelivery.status in { 'final', 'amended', 'corrected' }
        and TimeOfDelivery.effective.earliest () during TheEncounter.hospitalizationWithEDOBTriageObservation ()
        and TimeOfDelivery.value as DateTime during TheEncounter.hospitalizationWithEDOBTriageObservation()
      sort by effective.earliest()
  ).value as DateTime

/*
@description: Given an interval, return the starting point if the interval has a starting boundary specified,
otherwise, return the ending point
*/
define fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
  (choice.toInterval()) period
    return
      if (period."hasStart"()) then start of period
      else end of period

/*===============================================================*/
  /*  03/14/2022 from MATGlobalCommonFunctionsv7.000 - latest QDM  */
  /*     even though this PCMaternalFHIR was derived from          */
  /*     PCMaternal=2.1.000 cql, to make next update easier.       */
  /*     Will need to re-insert "Global". in front of these        */
  /*     function names later (whereever they are directly used.*/

define fluent function lastEstimatedDeliveryDate (TheEncounter Encounter ):
  /*This function identifies the last time the EDD was assessed 42 weeks or less prior to or on delivery and stores the result of that assessment.*/
  Last(["Observation": "Delivery date Estimated"] EstimatedDateOfDelivery
      where EstimatedDateOfDelivery.value as DateTime is not null
        and EstimatedDateOfDelivery.status in { 'final', 'amended', 'corrected' }
        and EstimatedDateOfDelivery.effective.earliest ( ) 42 weeks or less before or on TheEncounter.lastTimeOfDelivery ()
      sort by effective.earliest ( )
  ).value as DateTime

/*define fluent function lastEstimatedGestationalAge (TheEncounter Encounter ):
  Last(["Observation": "Estimated Gestational Age at Delivery"] EstimatedGestationalAge
      where EstimatedGestationalAge.value is not null
        and EstimatedGestationalAge.status in { 'final', 'amended', 'corrected' }
        and EstimatedGestationalAge.effective.earliest() 24 hours or less before or on TheEncounter.lastTimeOfDelivery ()
      sort by effective.earliest ()
  ).value as Quantity*/
  
  define fluent function lastEstimatedGestationalAge (TheEncounter Encounter ):
  Last(["Observation": "Estimated Gestational Age at Delivery"] EstimatedGestationalAge
  let EGATiming:  EstimatedGestationalAge.effective.earliest() where 
  (EGATiming 24 hours or less before or on TheEncounter.lastTimeOfDelivery () 
  and EstimatedGestationalAge.value is not null 
  and EstimatedGestationalAge.status in { 'final', 'amended', 'corrected' }) or 
      (EGATiming same day as TheEncounter.lastTimeOfDelivery () 
      and EGATiming during TheEncounter.hospitalizationWithEDOBTriageObservation() 
      and EstimatedGestationalAge.value is not null)
 sort by effective.earliest ())
         .value as Quantity

/*
@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, '/'))

define fluent function pOAIsYesOrExempt(TheEncounter Encounter):
  TheEncounter.diagnosis EncounterDiagnoses
    where EncounterDiagnoses.diagnosisPresentOnAdmission in "Present On Admission is Yes or Exempt"
    return EncounterDiagnoses.condition.getCondition ( ).code

define function ToString(value uri): value.value

/*
@description: Returns the Condition resource for the given reference
*/
define fluent function getCondition(reference Reference):
  singleton from ([Condition] C where C.id = reference.reference.getId())

/*define function "FirstLabTestWithEncounterId"(LabList List<Observation>, CCDE String ):
     "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  let FirstLab: First(LabList Lab
  //(first resulted value 24 hours prior to start of encounter and before time of delivery)
      where Lab.issued.earliest() during Interval[start of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation()- 1440 minutes, TwentyWeeksPlusEncounter.lastTimeOfDelivery()) 
      and Lab.status in {'final', 'amended', 'corrected'}
      and Lab.value is not null
      sort by issued.earliest())
    return {
    EncounterId: TwentyWeeksPlusEncounter.id,
    FirstResult: FirstLab.value as Quantity,
    Timing: FirstLab.issued
  }

define function "FirstPhysicalExamWithEncounterId"(ExamList List<Observation>, CCDE String):
     "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  let FirstExam: First(ExamList Exam
    where Exam.effective.earliest() during Interval[start of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation()- 1440 minutes, TwentyWeeksPlusEncounter.lastTimeOfDelivery()) 
    and Exam.status in {'final', 'amended', 'corrected'}
    and Exam.value is not null
    sort by effective.earliest() )
       return {
    EncounterId: TwentyWeeksPlusEncounter.id,
    FirstResult: FirstExam.value as Quantity,
    Timing: FirstExam.effective.earliest()
  }
  
define "Risk Variable Lab and Physical Exam Results":
  flatten{
     // First physical exams (vital signs):  Report heart rate as {beats}/min, systolic blood pressure as mm[Hg]
          "FirstPhysicalExamWithEncounterId"([Observation: "Heart rate"], 'FirstHeartRate'),
          "FirstPhysicalExamWithEncounterId"([Observation: "Systolic blood pressure"], 'FirstSystolicBP'),
     //First lab tests:  Report hematocrit as %, white blood cell count as 10*3/uL
          "FirstLabTestWithEncounterId"([Observation: "Hematocrit lab test"], 'FirstHematocrit'),
          "FirstLabTestWithEncounterId"([Observation: "White blood cells count lab test"], 'FirstWhiteBloodCell') 
    }*/


define fluent function pOAIsNoOrUTD(TheEncounter Encounter):
  TheEncounter.diagnosis EncounterDiagnoses
    where EncounterDiagnoses.diagnosisPresentOnAdmission in "Present on Admission is No or Unable To Determine"
    return EncounterDiagnoses.condition.getCondition ( ).code

/*
@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
        }