SMART DAK Cervical Cancer Screening
0.0.1 - ci-build

SMART DAK Cervical Cancer Screening, published by Dan Heslinga (independent contributor). This guide is not an authorized publication; it is the continuous build for version 0.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/dhes/smart-dak-cxca/ and changes regularly. See the Directory of published versions

Measure: CXCA.IND.02 — Cervical Cancer Screening Cascade Completion (NotDone-aware)

Official URL: http://smart.who.int/cxca/Measure/CXCAIND02 Version: 0.0.1
Draft as of 2026-05-14 Computable Name: CXCAIND02

Proportion of HPV-positive women in the measurement period whose follow-up cascade reached resolution — either through completed cytology or through explicit documented non-occurrence using the CXCAServiceNotRequested profile. Patients with neither (absent records) are excluded from the numerator, surfacing visibility gaps rather than conflating them with documented LTFU. See input/cql/CXCAIND02CascadeCompletionLogic.cql for the methodology rationale and the Mongolia April 2026 Khan-Uul pilot numbers that motivate this measure (371 HPV+ women, 184 cytology, 187 LTFU).

Knowledge Artifact Metadata
Name (machine-readable) CXCAIND02
Title (human-readable) CXCA.IND.02 — Cervical Cancer Screening Cascade Completion (NotDone-aware)
Status Draft
Experimental false
Description

Proportion of HPV-positive women in the measurement period whose follow-up cascade reached resolution — either through completed cytology or through explicit documented non-occurrence using the CXCAServiceNotRequested profile. Patients with neither (absent records) are excluded from the numerator, surfacing visibility gaps rather than conflating them with documented LTFU. See input/cql/CXCAIND02CascadeCompletionLogic.cql for the methodology rationale and the Mongolia April 2026 Khan-Uul pilot numbers that motivate this measure (371 HPV+ women, 184 cytology, 187 LTFU).
Measure Steward Dan Heslinga (independent contributor)
Steward Contact Details Dan Heslinga (independent contributor): https://github.com/dhes
Measure Metadata
Version Number 0.0.1
Measure Scoring Proportion
Measure Population Criteria
Initial Population Description: No description provided Logic Definition: Initial Population
Denominator Description: No description provided Logic Definition: Denominator
Numerator Description: No description provided Logic Definition: Numerator
Numerator Exclusion Description: No description provided Logic Definition: Numerator Exclusion
Measure Logic
Primary Library CXCAIND02CascadeCompletionLogic
Dependency Description: FHIR model information
Resource: http://fhir.org/guides/cqf/common/Library/FHIR-ModelInfo|4.0.1
Canonical URL: http://fhir.org/guides/cqf/common/Library/FHIR-ModelInfo|4.0.1
Parameter Name: PatientHasHPVPositiveInPeriod
Use: In
Min Cardinality: 0
Max Cardinality: 1
Type: boolean
Parameter Name: PatientHasCytologyCompletedInPeriod
Use: In
Min Cardinality: 0
Max Cardinality: 1
Type: boolean
Parameter Name: PatientHasCytologyNotDoneRecordedInPeriod
Use: In
Min Cardinality: 0
Max Cardinality: 1
Type: boolean
Parameter Name: Numerator
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: boolean
Parameter Name: Denominator
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: boolean
Parameter Name: Initial Population
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: boolean
Parameter Name: Numerator Exclusion
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: boolean
Measure Logic Definitions
Logic Definition Library Name: CXCAIND02CascadeCompletionLogic 
/*
 * @numerator: HPV+ patients who reached cascade *resolution* — either by
 *   completing cytology OR by having a documented non-occurrence record.
 */
define "Numerator":
  "PatientHasHPVPositiveInPeriod"
    and ("PatientHasCytologyCompletedInPeriod"
      or "PatientHasCytologyNotDoneRecordedInPeriod")
Logic Definition Library Name: CXCAIND02CascadeCompletionLogic 
/*
 * @denominator: Patients with an HPV+ result during the measurement period.
 *   These are the patients whose cascade we want to track.
 */
define "Denominator":
  "PatientHasHPVPositiveInPeriod"
Logic Definition Library Name: CXCAIND02CascadeCompletionLogic 
/*
 * @initialPopulation: as defined by Member State (placeholder — true)
 *   Real implementation: women in target age range alive at start of period
 *   in the jurisdiction.
 */
define "Initial Population":
  true
Logic Definition Library Name: CXCAIND02CascadeCompletionLogic 
/*
 * @numeratorExclusion: HPV+ patients whose resolution was via documented
 *   non-occurrence (LTFU) rather than actual cytology completion.
 *
 *   FHIR Measure semantics: numerator-exclusion is subtracted from the
 *   numerator when computing the proportion. This lets a single Measure
 *   resource expose three computable views:
 *     - Cascade resolution rate: Numerator / Denominator
 *     - True follow-up rate:     (Numerator − NumeratorExclusion) / Denominator
 *     - Documented LTFU rate:    NumeratorExclusion / Denominator
 *   Together with (Denominator − Numerator) = the absent / unknown count,
 *   this gives programme managers a four-way partition of the HPV+ cohort.
 */
define "Numerator Exclusion":
  "PatientHasHPVPositiveInPeriod"
    and "PatientHasCytologyNotDoneRecordedInPeriod"
    and not "PatientHasCytologyCompletedInPeriod"
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