http://cms.gov/fhir/mct/Measure/DischargedonAntithromboticTherapyQICore4
type: Measure
node role: treeRoot
meta:
  version id:
    v: 24
  last updated:
    v: 2021-08-24T13:12:30.000-06:00
  source:
    v: #q1Mp1RX4PUIGipJl
    l: q1Mp1RX4PUIGipJl
  profile:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm
    l: proportion-measure-cqfm
  profile:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm
    l: computable-measure-cqfm
language:
  v: en
text:
  status:
    v: extensions
  div:
    v: Id: DischargedonAntithromboticTherapyQICore4 Url: Discharged on Antithrombotic Therapy QICore Version: 0.1.0 Identifier: value: 755216b2-5fa4-474d-bb29-ae8eaa209460 Identifier: value: 1095FHIR Name: DischargedonAntithromboticTherapyQICore4 Title: Discharged on Antithrombotic Therapy QICore Status: draft Experimental: false Scoring: system: http://terminology.hl7.org/CodeSystem/measure-scoring code: proportion display: Proportion Improvement Notation: system: http://terminology.hl7.org/CodeSystem/measure-improvement-notation code: increase Type: system: http://terminology.hl7.org/CodeSystem/measure-type code: process Date: 2022-07-05 20:34:35-0600 Publisher: HL7 International - [Some] Work Group Description: Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge Populations: Group Population Description Initial Population Inpatient hospitalizations for patients age 18 and older, discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less than or equal to 120 days that ends during the measurement period Denominator Inpatient hospitalizations for patients with a principal diagnosis of Ischemic stroke Denominator Exclusion Inpatient hospitalizations for patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations. Inpatient hospitalizations for patients discharged to another hospital Inpatient hospitalizations for patients who left against medical advice Inpatient hospitalizations for patients who expired Inpatient hospitalizations for patients discharged to home for hospice care Inpatient hospitalizations for patients discharged to a health care facility for hospice care Inpatient hospitalizations for patients with comfort measures documented Denominator Exception Inpatient hospitalizations for patients with a documented reason for not prescribing antithrombotic t…
contained: Library
  id:
    v: effective-data-requirements
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/medicationrequest-category
        l: medicationrequest-category
      code:
        v: community
      display:
        v: Community
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/medicationrequest-category
        l: medicationrequest-category
      code:
        v: discharge
      display:
        v: Discharge
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: TJCOverallFHIR
    extension:
      url:
        v: name
        l: name
      value: String
        v: Non Elective Inpatient Encounter
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: // Translator issue with 1.4.9-SNAPSHOT: https://github.com/cqframework/clinical_quality_language/issues/511 define "Non Elective Inpatient Encounter": ["Encounter": "Non-Elective Inpatient Encounter"] NonElectiveEncounter where Global."LengthInDays"(NonElectiveEncounter.period) <= 120 and NonElectiveEncounter.period ends during day of "Measurement Period"
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 0
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: TJCOverallFHIR
    extension:
      url:
        v: name
        l: name
      value: String
        v: All Stroke Encounter
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "All Stroke Encounter": "Non Elective Inpatient Encounter" NonElectiveEncounter where Global.PrincipalDiagnosis(NonElectiveEncounter).code in "Hemorrhagic Stroke" or Global.PrincipalDiagnosis(NonElectiveEncounter).code in "Ischemic Stroke"
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 1
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: TJCOverallFHIR
    extension:
      url:
        v: name
        l: name
      value: String
        v: Encounter with Principal Diagnosis and Age
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "Encounter with Principal Diagnosis and Age": "All Stroke Encounter" AllStrokeEncounter with ["Patient"] BirthDate such that AgeInYearsAt(start of AllStrokeEncounter.period) >= 18
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 2
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: TJCOverallFHIR
    extension:
      url:
        v: name
        l: name
      value: String
        v: Ischemic Stroke Encounter
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "Ischemic Stroke Encounter": "Encounter with Principal Diagnosis and Age" EncounterWithAge where Global.PrincipalDiagnosis(EncounterWithAge).code in "Ischemic Stroke"
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 3
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
    extension:
      url:
        v: name
        l: name
      value: String
        v: Antithrombotic Therapy at Discharge
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "Antithrombotic Therapy at Discharge": ["MedicationRequest": medication in "Antithrombotic Therapy"] Antithrombotic where Antithrombotic.doNotPerform is not true and exists ( Antithrombotic.category C where FHIRHelpers.ToConcept ( C ) ~ Global."Community" or FHIRHelpers.ToConcept ( C ) ~ Global."Discharge" ) and Antithrombotic.status in { 'active', 'completed' } and Antithrombotic.intent = 'order'
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 4
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
    extension:
      url:
        v: name
        l: name
      value: String
        v: Numerator
    extension:
      url:
        v: statement
        l: statement
      value: String

String
v: define "Numerator": TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter with "Antithrombotic Therapy at Discharge" DischargeAntithrombotic such that DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period

url:
  v: displaySequence
  l: displaySequence
value: Integer
  v: 5

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
extension:
  url:
    v: name
    l: name
  value: String
    v: Denominator
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Denominator": TJC."Ischemic Stroke Encounter"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 6
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
extension:
  url:
    v: name
    l: name
  value: String
    v: Initial Population
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Initial Population": TJC."Encounter with Principal Diagnosis and Age"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 7
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: TJCOverallFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Ischemic Stroke Encounters with Discharge Disposition
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Ischemic Stroke Encounters with Discharge Disposition": "Ischemic Stroke Encounter" IschemicStrokeEncounter where IschemicStrokeEncounter.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility" or IschemicStrokeEncounter.hospitalization.dischargeDisposition in "Left Against Medical Advice" or IschemicStrokeEncounter.hospitalization.dischargeDisposition in "Patient Expired" or IschemicStrokeEncounter.hospitalization.dischargeDisposition in "Discharged to Home for Hospice Care" or IschemicStrokeEncounter.hospitalization.dischargeDisposition in "Discharged to Health Care Facility for Hospice Care"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 8
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: TJCOverallFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Intervention Comfort Measures
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Intervention Comfort Measures": ( ["ServiceRequest": "Comfort Measures"] P where P.intent = 'order' ) union ( ["Procedure": "Comfort Measures"] InterventionPerformed where InterventionPerformed.status in { 'completed', 'in-progress' } )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 9
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: TJCOverallFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounter with Comfort Measures during Hospitalization
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Encounter with Comfort Measures during Hospitalization": "Ischemic Stroke Encounter" IschemicStrokeEncounter with "Intervention Comfort Measures" ComfortMeasure such that Coalesce((start of Global."Normalize Interval"(ComfortMeasure.performed)), ComfortMeasure.authoredOn)during Global."HospitalizationWithObservation" ( IschemicStrokeEncounter )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 10
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
extension:
  url:
    v: name
    l: name
  value: String
    v: Denominator Exclusions
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Denominator Exclusions": TJC."Ischemic Stroke Encounters with Discharge Disposition" union TJC."Encounter with Comfort Measures during Hospitalization"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 11
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
extension:
  url:
    v: name
    l: name
  value: String
    v: Antithrombotic Not Given at Discharge
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Antithrombotic Not Given at Discharge": ["MedicationRequest": medication in "Antithrombotic Therapy"] NoAntithromboticDischarge where NoAntithromboticDischarge.doNotPerform is true and ( NoAntithromboticDischarge.reasonCode in "Medical Reason" or NoAntithromboticDischarge.reasonCode in "Patient Refusal" ) and exists ( NoAntithromboticDischarge.category C where FHIRHelpers.ToConcept ( C ) ~ Global."Community" or FHIRHelpers.ToConcept ( C ) ~ Global."Discharge" ) and NoAntithromboticDischarge.status in { 'completed', 'cancelled' } and NoAntithromboticDischarge.intent = 'order'
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 12
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounter With No Antithrombotic At Discharge
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Encounter With No Antithrombotic At Discharge": TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter with "Antithrombotic Not Given at Discharge" NoDischargeAntithrombotic such that NoDischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 13
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
extension:
  url:
    v: name
    l: name
  value: String
    v: Pharmacological Contraindications for Antithrombotic Therapy at Discharge
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Pharmacological Contraindications for Antithrombotic Therapy at Discharge": ["MedicationRequest": medication in "Pharmacological Contraindications For Antithrombotic Therapy"] Pharmacological where Pharmacological.doNotPerform is not true and exists ( Pharmacological.category C where FHIRHelpers.ToConcept ( C ) ~ Global."Community" or FHIRHelpers.ToConcept ( C ) ~ Global."Discharge" ) and Pharmacological.status in { 'active', 'completed' } and Pharmacological.intent = 'order'
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 14
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounter With Pharmacological Contraindications for Antithrombotic Therapy at Discharge
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Encounter With Pharmacological Contraindications for Antithrombotic Therapy at Discharge": TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter with "Pharmacological Contraindications for Antithrombotic Therapy at Discharge" DischargePharmacological such that DischargePharmacological.authoredOn during IschemicStrokeEncounter.period
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 15
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
extension:
  url:
    v: name
    l: name
  value: String
    v: Denominator Exceptions
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Denominator Exceptions": "Encounter With No Antithrombotic At Discharge" union "Encounter With Pharmacological Contraindications for Antithrombotic Therapy at Discharge"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 16
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

v: active

coding:
  system:
    v: http://terminology.hl7.org/CodeSystem/library-type
    l: library-type
  code:
    v: module-definition

type:
  v: depends-on
display:
  v: Library TJC
resource:
  v: http://ecqi.healthit.gov/ecqms/Library/TJCOverallFHIR|1.8.000
  l: http://ecqi.healthit.gov/ecqms/Library/TJCOverallFHIR

type:
  v: depends-on
display:
  v: Library Global
resource:
  v: http://ecqi.healthit.gov/ecqms/Library/MATGlobalCommonFunctionsFHIR4|6.1.000
  l: http://ecqi.healthit.gov/ecqms/Library/MATGlobalCommonFunctionsFHIR4

type:
  v: depends-on
display:
  v: Library FHIRHelpers
resource:
  v: http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers|4.0.001
  l: http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers

type:
  v: depends-on
display:
  v: Code system MedicationRequestCategory
resource:
  v: http://terminology.hl7.org/CodeSystem/medicationrequest-category
  l: medicationrequest-category

type:
  v: depends-on
display:
  v: Value set Non-Elective Inpatient Encounter
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424

type:
  v: depends-on
display:
  v: Value set Hemorrhagic Stroke
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.212
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.212

type:
  v: depends-on
display:
  v: Value set Ischemic Stroke
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247

type:
  v: depends-on
display:
  v: Value set Antithrombotic Therapy
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.201
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.201

type:
  v: depends-on
display:
  v: Value set Discharge To Acute Care Facility
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87

type:
  v: depends-on
display:
  v: Value set Left Against Medical Advice
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.308
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.308

type:
  v: depends-on
display:
  v: Value set Patient Expired
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309

type:
  v: depends-on
display:
  v: Value set Discharged to Home for Hospice Care
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.209
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.209

type:
  v: depends-on
display:
  v: Value set Discharged to Health Care Facility for Hospice Care
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.207
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.207

type:
  v: depends-on
display:
  v: Value set Comfort Measures
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45
  l: http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45

type:
  v: depends-on
display:
  v: Value set Observation Services
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143

type:
  v: depends-on
display:
  v: Value set Emergency Department Visit
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292

type:
  v: depends-on
display:
  v: Value set Medical Reason
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.473
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.473

type:
  v: depends-on
display:
  v: Value set Patient Refusal
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93

type:
  v: depends-on
display:
  v: Value set Pharmacological Contraindications For Antithrombotic Therapy
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52

name:
  v: Measurement Period
use:
  v: in
min:
  v: 0
max:
  v: 1
type:
  v: Period

name:
  v: Numerator
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Encounter

name:
  v: Denominator
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Encounter

name:
  v: Initial Population
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Encounter

name:
  v: Denominator Exclusions
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Encounter

name:
  v: Denominator Exceptions
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Encounter

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/StructureDefinition/Encounter
  l: Encounter
must support:
  v: type
must support:
  v: period
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/StructureDefinition/Encounter
  l: Encounter
must support:
  v: type
must support:
  v: period
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/StructureDefinition/Encounter
  l: Encounter
must support:
  v: type
must support:
  v: period
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/StructureDefinition/Condition
  l: Condition
must support:
  v: id

type:
  v: Patient
profile:
  v: http://hl7.org/fhir/StructureDefinition/Patient
  l: Patient

type:
  v: MedicationRequest
profile:
  v: http://hl7.org/fhir/StructureDefinition/MedicationRequest
  l: MedicationRequest
must support:
  v: medication
must support:
  v: doNotPerform
must support:
  v: category
must support:
  v: status
must support:
  v: intent
must support:
  v: authoredOn
must support:
  v: reasonCode
code filter:
  path:
    v: medication
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.201
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.201

type:
  v: MedicationRequest
profile:
  v: http://hl7.org/fhir/StructureDefinition/MedicationRequest
  l: MedicationRequest
must support:
  v: medication
must support:
  v: doNotPerform
must support:
  v: category
must support:
  v: status
must support:
  v: intent
must support:
  v: authoredOn
code filter:
  path:
    v: medication
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52

type:
  v: ServiceRequest
profile:
  v: http://hl7.org/fhir/StructureDefinition/ServiceRequest
  l: ServiceRequest
must support:
  v: code
must support:
  v: intent
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45
    l: http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45

type:
  v: Procedure
profile:
  v: http://hl7.org/fhir/StructureDefinition/Procedure
  l: Procedure
must support:
  v: code
must support:
  v: status
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45
    l: http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45

url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis
  l: cqfm-populationBasis
value: Code
  v: Encounter

url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem
  l: cqfm-softwaresystem
value: Reference
  l: cqf-tooling
  reference:
    v: Device/cqf-tooling

id:
  v: effective-data-requirements
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements
  l: cqfm-effectiveDataRequirements
value: Reference
  l: effective-data-requirements
  reference:
    v: #effective-data-requirements

use:
  v: official
system:
  v: http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/guid
  l: guid

use:
  v: official
system:
  v: http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/cms
  l: cms
value:
  v: 1095FHIR

v: 0.1.0

v: Discharged on Antithrombotic Therapy QICore

v: draft

v: false

v: 2022-07-05T20:34:35-06:00

v: HL7 International - [Some] Work Group

telecom:
  system:
    v: url
  value:
    v: http://hl7.org/Special/committees/[something]

v: Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge

coding:
  system:
    v: urn:iso:std:iso:3166
    l: 3166
  code:
    v: US

v: The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist. For patients with a stroke due to a cardioembolic source (e.g. atrial fibrillation, mechanical heart valve), warfarin is recommended unless contraindicated. In recent years, novel oral anticoagulant agents (NOACs) have been developed and approved by the U.S. Food and Drug Administration (FDA) for stroke prevention, and may be considered as an alternative to warfarin for select patients. Anticoagulation therapy is not generally recommended for secondary stroke prevention in patients presumed to have a non-cardioembolic stroke. Anticoagulants at doses to prevent venous thromboembolism are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA.

v: Measure specifications are in the Public Domain LOINC(R) copyright 2004-2020 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2020 International Health Terminology Standards Development Organisation. All Rights Reserved.

start:
  v: 2022-01-01
end:
  v: 2022-12-31

v: These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.

coding:
  system:
    v: http://terminology.hl7.org/CodeSystem/measure-scoring
    l: measure-scoring
  code:
    v: proportion
  display:
    v: Proportion

coding:
  system:
    v: http://terminology.hl7.org/CodeSystem/measure-type
    l: measure-type
  code:
    v: process

v: The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist. For patients with a stroke due to a cardioembolic source (e.g. atrial fibrillation, mechanical heart valve), warfarin is recommended unless contraindicated. In recent years, novel oral anticoagulant agents (NOACs) have been developed and approved by the U.S. Food and Drug Administration (FDA) for stroke prevention, and may be considered as an alternative to warfarin for select patients. Anticoagulation therapy is not generally recommended for secondary stroke prevention in patients presumed to have a non-cardioembolic stroke. Anticoagulants at doses to prevent venous thromboembolism are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA.

v: Clinical trial results suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist

coding:
  system:
    v: http://terminology.hl7.org/CodeSystem/measure-improvement-notation
    l: measure-improvement-notation
  code:
    v: increase

v: The "Non-elective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions. The "Medication, Discharge" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS104v10

description:
  v: Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: initial-population
      display:
        v: Initial Population
  description:
    v: Inpatient hospitalizations for patients age 18 and older, discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less than or equal to 120 days that ends during the measurement period
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Initial Population
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: denominator
      display:
        v: Denominator
  description:
    v: Inpatient hospitalizations for patients with a principal diagnosis of Ischemic stroke
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Denominator
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: denominator-exclusion
      display:
        v: Denominator Exclusion
  description:
    v: Inpatient hospitalizations for patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations. Inpatient hospitalizations for patients discharged to another hospital Inpatient hospitalizations for patients who left against medical advice Inpatient hospitalizations for patients who expired Inpatient hospitalizations for patients discharged to home for hospice care Inpatient hospitalizations for patients discharged to a health care facility for hospice care Inpatient hospitalizations for patients with comfort measures documented
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Denominator Exclusions
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: denominator-exception
      display:
        v: Denominator Exception
  description:
    v: Inpatient hospitalizations for patients with a documented reason for not prescribing antithrombotic therapy at discharge. Inpatient hospitalizations for patients who receive Ticagrelor or Prasugrel as an antithrombotic therapy at discharge.
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Denominator Exceptions
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: numerator
      display:
        v: Numerator
  description:
    v: Inpatient hospitalizations for patients prescribed or continuing to take antithrombotic therapy at hospital discharge
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Numerator

code:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-supplemental-data-example
      l: measure-supplemental-data-example
    code:
      v: gender
    display:
      v: Gender
usage:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-data-usage
      l: measure-data-usage
    code:
      v: supplemental-data
    display:
      v: Supplemental Data
criteria:
  language:
    v: text/cql-identifier
  expression:
    v: SDE Sex

code:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-supplemental-data-example
      l: measure-supplemental-data-example
    code:
      v: ethnicity
    display:
      v: Ethnicity
usage:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-data-usage
      l: measure-data-usage
    code:
      v: supplemental-data
    display:
      v: Supplemental Data
criteria:
  language:
    v: text/cql-identifier
  expression:
    v: SDE Ethnicity

code:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-supplemental-data-example
      l: measure-supplemental-data-example
    code:
      v: payer
    display:
      v: Payer
usage:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-data-usage
      l: measure-data-usage
    code:
      v: supplemental-data
    display:
      v: Supplemental Data
criteria:
  language:
    v: text/cql-identifier
  expression:
    v: SDE Payer