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 therapy at discharge. Inpatient hospitalizations for patients who receive Ticagrelor or Prasugrel as an antithrombotic therapy at discharge. Numerator Inpatient hospitalizations for patients prescribed or continuing to take antithrombotic therapy at hospital discharge Supplemental Data: expression system SDE Sex http://terminology.hl7.org/CodeSystem/measure-data-usage SDE Ethnicity http://terminology.hl7.org/CodeSystem/measure-data-usage SDE Payer http://terminology.hl7.org/CodeSystem/measure-data-usage Jurisdiction: US Purpose: 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. Copyright: 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. Disclaimer: 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. Effective Period: 2022-01-01..2022-12-31 Logic Definitions: Group Scoring Population Criteria Expression Measure scoring: proportion Initial Population Initial Population Denominator Denominator Denominator Exclusion Denominator Exclusions Denominator Exception Denominator Exceptions Numerator Numerator
// 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"
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"
Encounter with Principal Diagnosis and Age
define "Encounter with Principal Diagnosis and Age": "All Stroke Encounter" AllStrokeEncounter with ["Patient"] BirthDate such that AgeInYearsAt(start of AllStrokeEncounter.period) >= 18
define "Ischemic Stroke Encounter": "Encounter with Principal Diagnosis and Age" EncounterWithAge where Global.PrincipalDiagnosis(EncounterWithAge).code in "Ischemic Stroke"
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'
define "Numerator": TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter with "Antithrombotic Therapy at Discharge" DischargeAntithrombotic such that DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period
define "Denominator": TJC."Ischemic Stroke Encounter"
define "Initial Population": TJC."Encounter with Principal Diagnosis and Age"
Ischemic Stroke Encounters with Discharge Disposition
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"
define "Intervention Comfort Measures": ( ["ServiceRequest": "Comfort Measures"] P where P.intent = 'order' ) union ( ["Procedure": "Comfort Measures"] InterventionPerformed where InterventionPerformed.status in { 'completed', 'in-progress' } )
Encounter with Comfort Measures during Hospitalization
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 )
define "Denominator Exclusions": TJC."Ischemic Stroke Encounters with Discharge Disposition" union TJC."Encounter with Comfort Measures during Hospitalization"
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'
Encounter With No Antithrombotic At Discharge
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
Pharmacological Contraindications for Antithrombotic Therapy at Discharge
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'
Encounter With Pharmacological Contraindications for Antithrombotic Therapy at Discharge
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
define "Denominator Exceptions": "Encounter With No Antithrombotic At Discharge" union "Encounter With Pharmacological Contraindications for Antithrombotic Therapy at Discharge"
Value set Non-Elective Inpatient Encounter
Value set Discharge To Acute Care Facility
Value set Discharged to Home for Hospice Care
Value set Discharged to Health Care Facility for Hospice Care
Value set Pharmacological Contraindications For Antithrombotic Therapy
Discharged on Antithrombotic Therapy QICore
Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge
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.
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.
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.
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
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
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
Inpatient hospitalizations for patients with a principal diagnosis of Ischemic stroke
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
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.
Inpatient hospitalizations for patients prescribed or continuing to take antithrombotic therapy at hospital discharge