Proportion

Process

increase

define "Initial Population":
  AgeInYearsAt(date from 
    end of "Measurement Period"
  ) in Interval[3, 17]
    and exists ( "Qualifying Encounters" )

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  Hospice."Has Hospice Services"
    or exists ( "Pregnancy Diagnosis Which Overlaps Measurement Period" )

define "Numerator 1":
  exists ( "BMI Percentile in Measurement Period" )
    and exists ( "Height in Measurement Period" )
    and exists ( "Weight in Measurement Period" )

Proportion

Process

increase

define "Initial Population":
  AgeInYearsAt(date from 
    end of "Measurement Period"
  ) in Interval[3, 17]
    and exists ( "Qualifying Encounters" )

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  Hospice."Has Hospice Services"
    or exists ( "Pregnancy Diagnosis Which Overlaps Measurement Period" )

define "Numerator 2":
  exists ( ( [Procedure: "Counseling for Nutrition"] ).isInterventionPerformed ( ) ) NutritionCounseling
    where NutritionCounseling.performed.toInterval ( ) during day of "Measurement Period"

Proportion

Process

increase

define "Initial Population":
  AgeInYearsAt(date from 
    end of "Measurement Period"
  ) in Interval[3, 17]
    and exists ( "Qualifying Encounters" )

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  Hospice."Has Hospice Services"
    or exists ( "Pregnancy Diagnosis Which Overlaps Measurement Period" )

define "Numerator 3":
  exists ( ( [Procedure: "Counseling for Physical Activity"] ).isInterventionPerformed ( ) ) ActivityCounseling
    where ActivityCounseling.performed.toInterval ( ) during day of "Measurement Period"

define "Stratifaction 1":
  AgeInYearsAt(date from 
    end of "Measurement Period"
  ) in Interval[3, 11]

define "Numerator 3":
  exists ( ( [Procedure: "Counseling for Physical Activity"] ).isInterventionPerformed ( ) ) ActivityCounseling
    where ActivityCounseling.performed.toInterval ( ) during day of "Measurement Period"

define "Stratifaction 2":
  AgeInYearsAt(date from 
    end of "Measurement Period"
  ) in Interval[12, 17]

define "Qualifying Encounters":
  ( ( [Encounter: "Office Visit"]
      union [Encounter: "Preventive Care Services Individual Counseling"]
      union [Encounter: "Preventive Care, Established Office Visit, 0 to 17"]
      union [Encounter: "Preventive Care Services, Initial Office Visit, 0 to 17"]
      union [Encounter: "Preventive Care Services Group Counseling"]
      union [Encounter: "Home Healthcare Services"]
      union [Encounter: "Telephone Visits"]
  ).isEncounterPerformed ( ) ) ValidEncounters
    where ValidEncounters.period.toInterval ( ) during day of "Measurement Period"

define "Initial Population":
  AgeInYearsAt(date from 
    end of "Measurement Period"
  ) in Interval[3, 17]
    and exists ( "Qualifying Encounters" )

define "Denominator":
  "Initial Population"

define "BMI Percentile in Measurement Period":
  ( ( ["observation-bmi"] ).isObservationBMI ( ) ) BMIPercentile
    where BMIPercentile.effective.toInterval ( ) during day of "Measurement Period"
      and BMIPercentile.value is not null

define "Height in Measurement Period":
  ( ( ["observation-bodyheight"] ).isObservationBodyHeight ( ) ) Height
    where Height.effective.toInterval ( ) during day of "Measurement Period"
      and Height.value is not null

define "Weight in Measurement Period":
  ( ( ["observation-bodyweight"] ).isObservationBodyWeight ( ) ) Weight
    where Weight.effective.toInterval ( ) during day of "Measurement Period"
      and Weight.value is not null

define "Numerator 1":
  exists ( "BMI Percentile in Measurement Period" )
    and exists ( "Height in Measurement Period" )
    and exists ( "Weight in Measurement Period" )

define "Numerator 2":
  exists ( ( [Procedure: "Counseling for Nutrition"] ).isInterventionPerformed ( ) ) NutritionCounseling
    where NutritionCounseling.performed.toInterval ( ) during day of "Measurement Period"

define "Has Hospice Services":
  exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter
      where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
          or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
      )
        and InpatientEncounter.period.toInterval() ends during day of "Measurement Period"
  )
    or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter
        where HospiceEncounter.period.toInterval() overlaps day of "Measurement Period"
    )
    or exists ((([Observation: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment
        where HospiceAssessment.value ~ "Yes (qualifier value)"
          and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period"
    )
    or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder
        where HospiceOrder.authoredOn.toInterval() during day of "Measurement Period"
        // and HospiceOrder.doNotPerform is not true
        // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447
    )
    or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed
        where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period"
    )
    or exists (([Condition: "Hospice Diagnosis"]) HospiceCareDiagnosis
        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
    )

define "Pregnancy Diagnosis Which Overlaps Measurement Period":
  ( [Condition: "Pregnancy"] ) Pregnancy
    where Pregnancy.prevalenceInterval ( ) overlaps "Measurement Period"

define "Denominator Exclusions":
  Hospice."Has Hospice Services"
    or exists ( "Pregnancy Diagnosis Which Overlaps Measurement Period" )

//Intervention, Performed
define fluent function isInterventionPerformed(Proc List<Procedure>):
  Proc P
    where P.status ~ 'completed'

//Encounter, Performed
//General usage unless required otherwise by measure intent (e.g., follow-up encounters)
define fluent function isEncounterPerformed(Enc List<Encounter>):
  Enc E
    where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}

/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If 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
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
  case
	  when choice is DateTime then
    	Interval[choice as DateTime, choice as DateTime]
		when choice is Interval<DateTime> then
  		choice as Interval<DateTime>
		when choice is Quantity then
		  Interval[Patient.birthDate + (choice as Quantity),
			  Patient.birthDate + (choice as Quantity) + 1 year)
		when choice is Interval<Quantity> then
		  Interval[Patient.birthDate + (choice.low as Quantity),
			  Patient.birthDate + (choice.high as Quantity) + 1 year)
		when choice is Timing then
      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
		else
			null as Interval<DateTime>
	end

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

define fluent function isObservationBMI(Obs List<"QICore.observation-bmi">):
  Obs O
    where O.status in { 'final', 'amended', 'corrected' }

define fluent function isObservationBodyHeight(Obs List<"QICore.observation-bodyheight">):
  Obs O
    where O.status in { 'final', 'amended', 'corrected' }

define fluent function isObservationBodyWeight(Obs List<"QICore.observation-bodyweight">):
  Obs O
    where O.status in { 'final', 'amended', 'corrected' }

//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.

//Assessment, Performed
define fluent function isAssessmentPerformed(Obs List<Observation>):
  Obs O
    where O.status in { 'final', 'amended', 'corrected' }
          and exists ( O.category ObservationCategory
          where ( ObservationCategory ) ~ "survey"
      )

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

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

//Intervention, Order: active and completed only    
define fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):
  ServiceRequest S
    where S.status in { 'active', 'completed' }
      and S.intent = 'order'

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

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