{ "calculate_sdes": null, "calculation_method": "EPISODE_OF_CARE", "cms_id": "CMS105v7", "component": false, "component_hqmf_set_ids": [ ], "composite": false, "composite_hqmf_set_id": null, "cql_libraries": [ { "cql": "library DischargedonStatinMedication version '7.1.000'\r\n\r\nusing QDM version '5.3'\r\n\r\ninclude MATGlobalCommonFunctions version '2.0.000' called Global\r\ninclude TJC_Overall version '1.4.000' called TJC\r\n\r\nvalueset \"ONC Administrative Sex\": 'urn:oid:2.16.840.1.113762.1.4.1'\r\nvalueset \"Race\": 'urn:oid:2.16.840.1.114222.4.11.836'\r\nvalueset \"Ethnicity\": 'urn:oid:2.16.840.1.114222.4.11.837'\r\nvalueset \"Payer\": 'urn:oid:2.16.840.1.114222.4.11.3591'\r\nvalueset \"LDL-c\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.215'\r\nvalueset \"Medical Reason\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.473'\r\nvalueset \"Patient Refusal\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.93'\r\nvalueset \"Statin Allergen\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.423'\r\nvalueset \"Statin Grouper\": 'urn:oid:2.16.840.1.113762.1.4.1110.19'\r\n\r\ncontext Patient\r\n\r\ndefine \"SDE Ethnicity\":\r\n\t[\"Patient Characteristic Ethnicity\": \"Ethnicity\"]\r\n\r\ndefine \"SDE Payer\":\r\n\t[\"Patient Characteristic Payer\": \"Payer\"]\r\n\r\ndefine \"SDE Race\":\r\n\t[\"Patient Characteristic Race\": \"Race\"]\r\n\r\ndefine \"SDE Sex\":\r\n\t[\"Patient Characteristic Sex\": \"ONC Administrative Sex\"]\r\n\r\ndefine \"Statin Allergy\":\r\n\t[\"Allergy/Intolerance\": \"Statin Allergen\"]\r\n\r\ndefine \"Statin at Discharge\":\r\n\t[\"Medication, Discharge\": \"Statin Grouper\"]\r\n\r\ndefine \"Statin Not Given at Discharge\":\r\n\t[\"Medication, Not Discharged\": \"Statin Grouper\"] NoStatinDischarge\r\n\t\twhere NoStatinDischarge.negationRationale in \"Medical Reason\"\r\n\t\t\tor NoStatinDischarge.negationRationale in \"Patient Refusal\"\r\n\r\ndefine \"Denominator\":\r\n\tTJC.\"Ischemic Stroke Encounter\"\r\n\r\ndefine \"Initial Population\":\r\n\tTJC.\"Encounter with Principal Diagnosis and Age\"\r\n\r\ndefine \"Numerator\":\r\n\tTJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\r\n\t\twith \"Statin at Discharge\" DischargeStatin\r\n\t\t\tsuch that DischargeStatin.authorDatetime during IschemicStrokeEncounter.relevantPeriod\r\n\r\ndefine \"Encounter with Max LDL less than 70 mg per dL\":\r\n\tTJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\r\n\t\twhere Max([\"Laboratory Test, Performed\": \"LDL-c\"] Ldl\r\n\t\t\t\twhere Ldl.resultDatetime during Interval[Global.\"ToDate\"(start of IschemicStrokeEncounter.relevantPeriod - 30 days), end of IschemicStrokeEncounter.relevantPeriod]\r\n\t\t\t\treturn Ldl.result as Quantity\r\n\t\t)< 70 'mg/dL'\r\n\r\ndefine \"Denominator Exclusions\":\r\n\tTJC.\"Ischemic Stroke Encounters with Discharge Status\"\r\n\t\tunion TJC.\"Comfort Measures during Hospitalization\"\r\n\r\ndefine \"Denominator Exceptions\":\r\n\t( TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\r\n\t\t\twith \"Statin Not Given at Discharge\" NoDischargeStatin\r\n\t\t\t\tsuch that NoDischargeStatin.authorDatetime during IschemicStrokeEncounter.relevantPeriod\r\n\t)\r\n\t\tunion ( TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\r\n\t\t\t\twith \"Statin Allergy\" StatinAllergy\r\n\t\t\t\t\tsuch that StatinAllergy.prevalencePeriod starts on or before end of IschemicStrokeEncounter.relevantPeriod\r\n\t\t)\r\n\t\tunion \"Encounter with Max LDL less than 70 mg per dL\"\r\n", "elm": { "library": { "identifier": { "id": "DischargedonStatinMedication", "version": "7.1.000" }, "schemaIdentifier": { "id": "urn:hl7-org:elm", "version": "r1" }, "usings": { "def": [ { "localIdentifier": "System", "uri": "urn:hl7-org:elm-types:r1" }, { "localId": "1", "locator": "3:1-3:23", "localIdentifier": "QDM", "uri": "urn:healthit-gov:qdm:v5_3", "version": "5.3" } ] }, "includes": { "def": [ { "localId": "2", "locator": "5:1-5:64", "localIdentifier": "Global", "path": "MATGlobalCommonFunctions", "version": "2.0.000" }, { "localId": "3", "locator": "7:1-7:48", "localIdentifier": "TJC", "path": "TJC_Overall", "version": "1.4.000" } ] }, "valueSets": { "def": [ { "localId": "4", "locator": "10:1-10:68", "name": "ONC Administrative Sex", "id": "2.16.840.1.113762.1.4.1", "accessLevel": "Public" }, { "localId": "5", "locator": "11:1-11:53", "name": "Race", "id": "2.16.840.1.114222.4.11.836", "accessLevel": "Public" }, { "localId": "6", "locator": "12:1-12:58", "name": "Ethnicity", "id": "2.16.840.1.114222.4.11.837", "accessLevel": "Public" }, { "localId": "7", "locator": "13:1-13:55", "name": "Payer", "id": "2.16.840.1.114222.4.11.3591", "accessLevel": "Public" }, { "localId": "8", "locator": "14:1-14:61", "name": "LDL-c", "id": "2.16.840.1.113883.3.117.1.7.1.215", "accessLevel": "Public" }, { "localId": "9", "locator": "15:1-15:70", "name": "Medical Reason", "id": "2.16.840.1.113883.3.117.1.7.1.473", "accessLevel": "Public" }, { "localId": "10", "locator": "16:1-16:70", "name": "Patient Refusal", "id": "2.16.840.1.113883.3.117.1.7.1.93", "accessLevel": "Public" }, { "localId": "11", "locator": "17:1-17:71", "name": "Statin Allergen", "id": "2.16.840.1.113883.3.117.1.7.1.423", "accessLevel": "Public" }, { "localId": "12", "locator": "18:1-18:66", "name": "Statin Grouper", "id": "2.16.840.1.113762.1.4.1110.19", "accessLevel": "Public" } ] }, "statements": { "def": [ { "locator": "22:1-22:15", "name": "Patient", "context": "Patient", "expression": { "type": "SingletonFrom", "operand": { "locator": "22:1-22:15", "dataType": "{urn:healthit-gov:qdm:v5_3}Patient", "templateId": "Patient", "type": "Retrieve" } } }, { "localId": "14", "locator": "24:1-25:50", "name": "SDE Ethnicity", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "14", "s": [ { "value": [ "define ", "\"SDE Ethnicity\"", ":\n\t" ] }, { "r": "13", "s": [ { "value": [ "[", "\"Patient Characteristic Ethnicity\"", ": " ] }, { "s": [ { "value": [ "\"Ethnicity\"" ] } ] }, { "value": [ "]" ] } ] } ] } } ], "expression": { "localId": "13", "locator": "25:2-25:50", "dataType": "{urn:healthit-gov:qdm:v5_3}PatientCharacteristicEthnicity", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Ethnicity", "type": "ValueSetRef" } } }, { "localId": "16", "locator": "27:1-28:42", "name": "SDE Payer", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "16", "s": [ { "value": [ "define ", "\"SDE Payer\"", ":\n\t" ] }, { "r": "15", "s": [ { "value": [ "[", "\"Patient Characteristic Payer\"", ": " ] }, { "s": [ { "value": [ "\"Payer\"" ] } ] }, { "value": [ "]" ] } ] } ] } } ], "expression": { "localId": "15", "locator": "28:2-28:42", "dataType": "{urn:healthit-gov:qdm:v5_3}PatientCharacteristicPayer", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Payer", "type": "ValueSetRef" } } }, { "localId": "18", "locator": "30:1-31:40", "name": "SDE Race", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "18", "s": [ { "value": [ "define ", "\"SDE Race\"", ":\n\t" ] }, { "r": "17", "s": [ { "value": [ "[", "\"Patient Characteristic Race\"", ": " ] }, { "s": [ { "value": [ "\"Race\"" ] } ] }, { "value": [ "]" ] } ] } ] } } ], "expression": { "localId": "17", "locator": "31:2-31:40", "dataType": "{urn:healthit-gov:qdm:v5_3}PatientCharacteristicRace", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Race", "type": "ValueSetRef" } } }, { "localId": "20", "locator": "33:1-34:57", "name": "SDE Sex", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "20", "s": [ { "value": [ "define ", "\"SDE Sex\"", ":\n\t" ] }, { "r": "19", "s": [ { "value": [ "[", "\"Patient Characteristic Sex\"", ": " ] }, { "s": [ { "value": [ "\"ONC Administrative Sex\"" ] } ] }, { "value": [ "]" ] } ] } ] } } ], "expression": { "localId": "19", "locator": "34:2-34:57", "dataType": "{urn:healthit-gov:qdm:v5_3}PatientCharacteristicSex", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "ONC Administrative Sex", "type": "ValueSetRef" } } }, { "localId": "22", "locator": "36:1-37:43", "name": "Statin Allergy", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "22", "s": [ { "value": [ "define ", "\"Statin Allergy\"", ":\n\t" ] }, { "r": "21", "s": [ { "value": [ "[", "\"Allergy/Intolerance\"", ": " ] }, { "s": [ { "value": [ "\"Statin Allergen\"" ] } ] }, { "value": [ "]" ] } ] } ] } } ], "expression": { "localId": "21", "locator": "37:2-37:43", "dataType": "{urn:healthit-gov:qdm:v5_3}AllergyIntolerance", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Statin Allergen", "type": "ValueSetRef" } } }, { "localId": "24", "locator": "39:1-40:44", "name": "Statin at Discharge", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "24", "s": [ { "value": [ "define ", "\"Statin at Discharge\"", ":\n\t" ] }, { "r": "23", "s": [ { "value": [ "[", "\"Medication, Discharge\"", ": " ] }, { "s": [ { "value": [ "\"Statin Grouper\"" ] } ] }, { "value": [ "]" ] } ] } ] } } ], "expression": { "localId": "23", "locator": "40:2-40:44", "dataType": "{urn:healthit-gov:qdm:v5_3}PositiveMedicationDischarge", "templateId": "PositiveMedicationDischarge", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Statin Grouper", "type": "ValueSetRef" } } }, { "localId": "37", "locator": "42:1-45:62", "name": "Statin Not Given at Discharge", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "37", "s": [ { "value": [ "define ", "\"Statin Not Given at Discharge\"", ":\n\t" ] }, { "r": "36", "s": [ { "s": [ { "r": "26", "s": [ { "r": "25", "s": [ { "r": "25", "s": [ { "value": [ "[", "\"Medication, Not Discharged\"", ": " ] }, { "s": [ { "value": [ "\"Statin Grouper\"" ] } ] }, { "value": [ "]" ] } ] } ] }, { "value": [ " ", "NoStatinDischarge" ] } ] } ] }, { "value": [ "\n\t\t" ] }, { "r": "35", "s": [ { "value": [ "where " ] }, { "r": "35", "s": [ { "r": "30", "s": [ { "r": "28", "s": [ { "r": "27", "s": [ { "value": [ "NoStatinDischarge" ] } ] }, { "value": [ "." ] }, { "r": "28", "s": [ { "value": [ "negationRationale" ] } ] } ] }, { "value": [ " in " ] }, { "r": "29", "s": [ { "value": [ "\"Medical Reason\"" ] } ] } ] }, { "value": [ "\n\t\t\tor " ] }, { "r": "34", "s": [ { "r": "32", "s": [ { "r": "31", "s": [ { "value": [ "NoStatinDischarge" ] } ] }, { "value": [ "." ] }, { "r": "32", "s": [ { "value": [ "negationRationale" ] } ] } ] }, { "value": [ " in " ] }, { "r": "33", "s": [ { "value": [ "\"Patient Refusal\"" ] } ] } ] } ] } ] } ] } ] } } ], "expression": { "localId": "36", "locator": "43:2-45:62", "type": "Query", "source": [ { "localId": "26", "locator": "43:2-43:67", "alias": "NoStatinDischarge", "expression": { "localId": "25", "locator": "43:2-43:49", "dataType": "{urn:healthit-gov:qdm:v5_3}NegativeMedicationDischarge", "templateId": "NegativeMedicationDischarge", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Statin Grouper", "type": "ValueSetRef" } } } ], "relationship": [ ], "where": { "localId": "35", "locator": "44:3-45:62", "type": "Or", "operand": [ { "localId": "30", "locator": "44:9-44:63", "type": "InValueSet", "code": { "localId": "28", "locator": "44:9-44:43", "path": "negationRationale", "scope": "NoStatinDischarge", "type": "Property" }, "valueset": { "localId": "29", "locator": "44:48-44:63", "name": "Medical Reason" } }, { "localId": "34", "locator": "45:7-45:62", "type": "InValueSet", "code": { "localId": "32", "locator": "45:7-45:41", "path": "negationRationale", "scope": "NoStatinDischarge", "type": "Property" }, "valueset": { "localId": "33", "locator": "45:46-45:62", "name": "Patient Refusal" } } ] } } }, { "localId": "40", "locator": "47:1-48:32", "name": "Denominator", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "40", "s": [ { "value": [ "define ", "\"Denominator\"", ":\n\t" ] }, { "r": "39", "s": [ { "r": "38", "s": [ { "value": [ "TJC" ] } ] }, { "value": [ "." ] }, { "r": "39", "s": [ { "value": [ "\"Ischemic Stroke Encounter\"" ] } ] } ] } ] } } ], "expression": { "localId": "39", "locator": "48:2-48:32", "name": "Ischemic Stroke Encounter", "libraryName": "TJC", "type": "ExpressionRef" } }, { "localId": "43", "locator": "50:1-51:49", "name": "Initial Population", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "43", "s": [ { "value": [ "define ", "\"Initial Population\"", ":\n\t" ] }, { "r": "42", "s": [ { "r": "41", "s": [ { "value": [ "TJC" ] } ] }, { "value": [ "." ] }, { "r": "42", "s": [ { "value": [ "\"Encounter with Principal Diagnosis and Age\"" ] } ] } ] } ] } } ], "expression": { "localId": "42", "locator": "51:2-51:49", "name": "Encounter with Principal Diagnosis and Age", "libraryName": "TJC", "type": "ExpressionRef" } }, { "localId": "55", "locator": "53:1-56:89", "name": "Numerator", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "55", "s": [ { "value": [ "define ", "\"Numerator\"", ":\n\t" ] }, { "r": "54", "s": [ { "s": [ { "r": "45", "s": [ { "r": "44", "s": [ { "s": [ { "value": [ "TJC", ".", "\"Ischemic Stroke Encounter\"" ] } ] } ] }, { "value": [ " ", "IschemicStrokeEncounter" ] } ] } ] }, { "value": [ "\n\t\t" ] }, { "r": "53", "s": [ { "value": [ "with " ] }, { "r": "47", "s": [ { "r": "46", "s": [ { "s": [ { "value": [ "\"Statin at Discharge\"" ] } ] } ] }, { "value": [ " ", "DischargeStatin" ] } ] }, { "value": [ "\n\t\t\tsuch that " ] }, { "r": "52", "s": [ { "r": "49", "s": [ { "r": "48", "s": [ { "value": [ "DischargeStatin" ] } ] }, { "value": [ "." ] }, { "r": "49", "s": [ { "value": [ "authorDatetime" ] } ] } ] }, { "value": [ " ", "during", " " ] }, { "r": "51", "s": [ { "r": "50", "s": [ { "value": [ "IschemicStrokeEncounter" ] } ] }, { "value": [ "." ] }, { "r": "51", "s": [ { "value": [ "relevantPeriod" ] } ] } ] } ] } ] } ] } ] } } ], "expression": { "localId": "54", "locator": "54:2-56:89", "type": "Query", "source": [ { "localId": "45", "locator": "54:2-54:56", "alias": "IschemicStrokeEncounter", "expression": { "localId": "44", "locator": "54:2-54:32", "name": "Ischemic Stroke Encounter", "libraryName": "TJC", "type": "ExpressionRef" } } ], "relationship": [ { "localId": "53", "locator": "55:3-56:89", "alias": "DischargeStatin", "type": "With", "expression": { "localId": "46", "locator": "55:8-55:28", "name": "Statin at Discharge", "type": "ExpressionRef" }, "suchThat": { "localId": "52", "locator": "56:14-56:89", "type": "In", "operand": [ { "localId": "49", "locator": "56:14-56:43", "path": "authorDatetime", "scope": "DischargeStatin", "type": "Property" }, { "localId": "51", "locator": "56:52-56:89", "path": 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{ "value": [ "\n\t\t\t\t" ] }, { "r": "73", "s": [ { "value": [ "where " ] }, { "r": "73", "s": [ { "r": "61", "s": [ { "r": "60", "s": [ { "value": [ "Ldl" ] } ] }, { "value": [ "." ] }, { "r": "61", "s": [ { "value": [ "resultDatetime" ] } ] } ] }, { "value": [ " ", "during", " " ] }, { "r": "72", "s": [ { "value": [ "Interval[" ] }, { "r": "68", "s": [ { "r": "62", "s": [ { "value": [ "Global" ] } ] }, { "value": [ "." ] }, { "r": "68", "s": [ { "value": [ "\"ToDate\"", "(" ] }, { "r": "67", "s": [ { "r": "65", "s": [ { "value": [ "start of " ] }, { "r": "64", "s": [ { "r": "63", "s": [ { "value": [ "IschemicStrokeEncounter" ] } ] }, { "value": [ "." ] }, { "r": "64", "s": [ { "value": [ "relevantPeriod" ] } ] } ] } ] }, { "value": [ " - " ] }, { "r": "66", "s": [ { "value": [ "30 ", "days" ] } ] } ] }, { "value": [ ")" ] } ] } ] }, { "value": [ ", " ] }, { "r": "71", "s": [ { "value": [ "end of " ] }, { "r": "70", "s": [ { "r": "69", "s": [ { "value": [ "IschemicStrokeEncounter" ] 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], "node_type": "Query", "ref_id": "101" }, { "children": [ { "text": "\n union " } ] }, { "children": [ { "children": [ { "text": "( " } ] }, { "children": [ { "children": [ { "children": [ { "children": [ { "children": [ { "children": [ { "text": "TJC.\"Ischemic Stroke Encounter\"" } ] } ] } ], "node_type": "ExpressionRef", "ref_id": "102" }, { "children": [ { "text": " IschemicStrokeEncounter" } ] } ], "ref_id": "103" } ] }, { "children": [ { "text": "\n " } ] }, { "children": [ { "children": [ { "text": "with " } ] }, { "children": [ { "children": [ { "children": [ { "children": [ { "text": "\"Statin Allergy\"" } ] } ] } ], "node_type": "ExpressionRef", "ref_id": "104" }, { "children": [ { "text": " StatinAllergy" } ] } ], "ref_id": "105" }, { "children": [ { "text": "\n such that " } ] }, { "children": [ { "children": [ { "children": [ { "children": [ { "text": "StatinAllergy" } ] } ], "ref_id": "106" }, { "children": [ { "text": "." } ] }, { "children": [ { "children": [ { "text": "prevalencePeriod" } ] } ], "node_type": "Property", "ref_id": "107" } ], "node_type": "Property", "ref_id": "107" }, { "children": [ { "text": " starts on or before " } ] }, { "children": [ { "children": [ { "text": "end of " } ] }, { "children": [ { "children": [ { "children": [ { "text": "IschemicStrokeEncounter" } ] } ], "ref_id": "108" }, { "children": [ { "text": "." } ] }, { "children": [ { "children": [ { "text": "relevantPeriod" } ] } ], "node_type": "Property", "ref_id": "109" } ], "node_type": "Property", "ref_id": "109" } ], "node_type": "End", "ref_id": "110" } ], "node_type": "SameOrBefore", "ref_id": "111" } ], "ref_id": "112" } ], "node_type": "Query", "ref_id": "113" }, { "children": [ { "text": "\n )" } ] } ], "node_type": "Query", "ref_id": "113" } ], "node_type": "Union", "ref_id": "114" }, { "children": [ { "text": "\n union " } ] }, { "children": [ { "children": [ { "text": "\"Encounter with Max LDL less than 70 mg per dL\"" } ] } ], "node_type": "ExpressionRef", "ref_id": "115" } ], "node_type": "Union", "ref_id": "116" } ], "ref_id": "117" } ], "define_name": "Denominator Exceptions" } ], "identifier": { "id": "DischargedonStatinMedication", "version": "7.1.000" } }, "is_main_library": true, "is_top_level": true, "library_name": "DischargedonStatinMedication", "library_version": "7.1.000", "statement_dependencies": [ { "statement_name": "Patient" }, { "statement_name": "SDE Ethnicity" }, { "statement_name": "SDE Payer" }, { "statement_name": "SDE Race" }, { "statement_name": "SDE Sex" }, { "statement_name": "Statin Allergy" }, { "statement_name": "Statin at Discharge" }, { "statement_name": "Statin Not Given at Discharge" }, { "statement_name": "Denominator", "statement_references": [ { "hqmf_id": null, "library_name": "TJC_Overall", "statement_name": "Ischemic Stroke Encounter" } ] }, { "statement_name": "Initial Population", "statement_references": [ { "hqmf_id": null, "library_name": "TJC_Overall", "statement_name": "Encounter with Principal Diagnosis and Age" } ] }, { "statement_name": "Numerator", "statement_references": [ { "hqmf_id": null, "library_name": "TJC_Overall", "statement_name": "Ischemic Stroke Encounter" }, { "hqmf_id": null, "library_name": "DischargedonStatinMedication", "statement_name": "Statin at Discharge" } ] }, { "statement_name": "Encounter with Max LDL less than 70 mg per dL", "statement_references": [ { "hqmf_id": null, "library_name": "TJC_Overall", "statement_name": "Ischemic Stroke Encounter" }, { "hqmf_id": null, "library_name": "MATGlobalCommonFunctions", "statement_name": "ToDate" } ] }, { "statement_name": "Denominator Exclusions", "statement_references": [ { "hqmf_id": null, "library_name": "TJC_Overall", "statement_name": "Ischemic Stroke Encounters with Discharge Status" }, { "hqmf_id": null, "library_name": "TJC_Overall", "statement_name": "Comfort Measures during Hospitalization" } ] }, { "statement_name": "Denominator Exceptions", "statement_references": [ { "hqmf_id": null, "library_name": "TJC_Overall", "statement_name": "Ischemic Stroke Encounter" }, { "hqmf_id": null, "library_name": "DischargedonStatinMedication", "statement_name": "Statin Not Given at Discharge" }, { "hqmf_id": null, "library_name": "TJC_Overall", "statement_name": "Ischemic Stroke Encounter" }, { "hqmf_id": null, "library_name": "DischargedonStatinMedication", "statement_name": "Statin Allergy" }, { "hqmf_id": null, "library_name": "DischargedonStatinMedication", "statement_name": "Encounter with Max LDL less than 70 mg per dL" } ] } ] }, { "cql": "library TJC_Overall version '1.4.000'\r\n\r\nusing QDM version '5.3'\r\n\r\ninclude MATGlobalCommonFunctions version '2.0.000' called Global\r\n\r\ncodesystem \"LOINC:2.46\": 'urn:oid:2.16.840.1.113883.6.1' version 'urn:hl7:version:2.46'\r\ncodesystem \"SNOMEDCT:2016-03\": 'urn:oid:2.16.840.1.113883.6.96' version 'urn:hl7:version:2016-03'\r\n\r\nvalueset \"Encounter Inpatient\": 'urn:oid:2.16.840.1.113883.3.666.5.307'\r\nvalueset \"Non-Elective Inpatient Encounter\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.424'\r\nvalueset \"Ischemic Stroke\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.247'\r\nvalueset \"Hemorrhagic Stroke\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.212'\r\nvalueset \"Comfort Measures\": 'urn:oid:1.3.6.1.4.1.33895.1.3.0.45'\r\nvalueset \"Emergency Department Visit\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.292'\r\nvalueset \"Left Against Medical Advice\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.308'\r\nvalueset \"Discharged to Health Care Facility for Hospice Care\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.207'\r\nvalueset \"Patient Expired\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.309'\r\nvalueset \"Discharge To Acute Care Facility\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.87'\r\nvalueset \"Discharged to Home for Hospice Care\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.209'\r\n\r\ncode \"Birthdate\": '21112-8' from \"LOINC:2.46\" display 'Birth date'\r\ncode \"Dead\": '419099009' from \"SNOMEDCT:2016-03\" display 'Dead'\r\n\r\nparameter \"Measurement Period\" Interval\r\n\r\ncontext Patient\r\n\r\ndefine \"Intervention Comfort Measures\":\r\n\t[\"Intervention, Order\": \"Comfort Measures\"]\r\n\t\tunion [\"Intervention, Performed\": \"Comfort Measures\"]\r\n\r\ndefine \"All Stroke Encounter\":\r\n\t\"Non Elective Inpatient Encounter\" NonElectiveEncounter\r\n\t\twhere NonElectiveEncounter.principalDiagnosis in \"Hemorrhagic Stroke\"\r\n\t\t\tor NonElectiveEncounter.principalDiagnosis in \"Ischemic Stroke\"\r\n\r\ndefine \"Ischemic Stroke Encounter\":\r\n\t\"Encounter with Principal Diagnosis and Age\" EncounterWithAge\r\n\t\twhere EncounterWithAge.principalDiagnosis in \"Ischemic Stroke\"\r\n\r\ndefine \"Ischemic Stroke Encounters with Discharge Status\":\r\n\t( ( \"Ischemic Stroke Encounter\" IschemicStrokeEncounter\r\n\t\t\t\twhere IschemicStrokeEncounter.dischargeDisposition in \"Discharge To Acute Care Facility\"\r\n\t\t\t\t\tor IschemicStrokeEncounter.dischargeDisposition in \"Left Against Medical Advice\"\r\n\t\t\t\t\tor IschemicStrokeEncounter.dischargeDisposition in \"Patient Expired\"\r\n\t\t\t\t\tor IschemicStrokeEncounter.dischargeDisposition in \"Discharged to Home for Hospice Care\"\r\n\t\t\t\t\tor IschemicStrokeEncounter.dischargeDisposition in \"Discharged to Health Care Facility for Hospice Care\"\r\n\t\t)\r\n\t)\r\n\r\ndefine \"Comfort Measures during Hospitalization\":\r\n\t\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\r\n\t\twith \"Intervention Comfort Measures\" ComfortMeasure\r\n\t\t\tsuch that Coalesce(start of ComfortMeasure.relevantPeriod, ComfortMeasure.authorDatetime)during Global.\"Hospitalization\"(IschemicStrokeEncounter)\r\n\r\ndefine \"Encounter with Principal Diagnosis and Age\":\r\n\t\"All Stroke Encounter\" AllStrokeEncounter\r\n\t\twith [\"Patient Characteristic Birthdate\"] BirthDate\r\n\t\t\tsuch that Global.\"CalendarAgeInYearsAt\"(BirthDate.birthDatetime, start of AllStrokeEncounter.relevantPeriod)>= 18\r\n\r\ndefine \"Non Elective Inpatient Encounter\":\r\n\t[\"Encounter, Performed\": \"Non-Elective Inpatient Encounter\"] NonElectiveEncounter\r\n\t\twhere Global.\"LengthInDays\"(NonElectiveEncounter.relevantPeriod)<= 120\r\n\t\t\tand NonElectiveEncounter.relevantPeriod ends during \"Measurement Period\"\r\n", "elm": { "library": { "identifier": { "id": "TJC_Overall", "version": "1.4.000" }, "schemaIdentifier": { "id": "urn:hl7-org:elm", "version": "r1" }, "usings": { "def": [ { "localIdentifier": "System", "uri": "urn:hl7-org:elm-types:r1" }, { "localId": "1", "locator": "3:1-3:23", "localIdentifier": "QDM", "uri": "urn:healthit-gov:qdm:v5_3", "version": "5.3" } ] }, "includes": { "def": [ { "localId": "2", "locator": "5:1-5:64", "localIdentifier": "Global", "path": "MATGlobalCommonFunctions", "version": "2.0.000" } ] }, "parameters": { "def": [ { "localId": "22", "locator": "25:1-25:49", "name": "Measurement Period", "accessLevel": "Public", "parameterTypeSpecifier": { "localId": "21", "locator": "25:32-25:49", "type": "IntervalTypeSpecifier", "pointType": { "localId": "20", "locator": "25:41-25:48", "name": "{urn:hl7-org:elm-types:r1}DateTime", "type": "NamedTypeSpecifier" } } } ] }, "codeSystems": { "def": [ { "localId": "3", "locator": "7:1-7:87", "name": "LOINC:2.46", "id": "2.16.840.1.113883.6.1", "version": "urn:hl7:version:2.46", "accessLevel": "Public" }, { "localId": "4", "locator": "8:1-8:97", "name": "SNOMEDCT:2016-03", "id": "2.16.840.1.113883.6.96", "version": "urn:hl7:version:2016-03", "accessLevel": "Public" } ] }, "valueSets": { "def": [ { "localId": "5", "locator": "10:1-10:71", "name": "Encounter Inpatient", "id": "2.16.840.1.113883.3.666.5.307", "accessLevel": "Public" }, { "localId": "6", "locator": "11:1-11:88", "name": "Non-Elective Inpatient Encounter", "id": "2.16.840.1.113883.3.117.1.7.1.424", "accessLevel": "Public" }, { "localId": "7", "locator": "12:1-12:71", "name": "Ischemic Stroke", "id": "2.16.840.1.113883.3.117.1.7.1.247", "accessLevel": "Public" }, { "localId": "8", "locator": "13:1-13:74", "name": "Hemorrhagic Stroke", "id": "2.16.840.1.113883.3.117.1.7.1.212", "accessLevel": "Public" }, { "localId": "9", "locator": "14:1-14:65", "name": "Comfort Measures", "id": "1.3.6.1.4.1.33895.1.3.0.45", "accessLevel": "Public" }, { "localId": "10", "locator": "15:1-15:82", "name": "Emergency Department Visit", "id": "2.16.840.1.113883.3.117.1.7.1.292", "accessLevel": "Public" }, { "localId": "11", "locator": "16:1-16:83", "name": "Left Against Medical Advice", "id": "2.16.840.1.113883.3.117.1.7.1.308", "accessLevel": "Public" }, { "localId": "12", "locator": "17:1-17:107", "name": "Discharged to Health Care Facility for Hospice Care", "id": "2.16.840.1.113883.3.117.1.7.1.207", "accessLevel": "Public" }, { "localId": "13", "locator": "18:1-18:71", "name": "Patient Expired", "id": "2.16.840.1.113883.3.117.1.7.1.309", "accessLevel": "Public" }, { "localId": "14", "locator": "19:1-19:87", "name": "Discharge To Acute Care Facility", "id": "2.16.840.1.113883.3.117.1.7.1.87", "accessLevel": "Public" }, { "localId": "15", "locator": "20:1-20:91", "name": "Discharged to Home for Hospice Care", "id": "2.16.840.1.113883.3.117.1.7.1.209", "accessLevel": "Public" } ] }, "codes": { "def": [ { "localId": "17", "locator": "22:1-22:66", "name": "Birthdate", "id": "21112-8", "display": "Birth date", "accessLevel": "Public", "codeSystem": { "localId": "16", "locator": "22:34-22:45", "name": "LOINC:2.46" } }, { "localId": "19", "locator": "23:1-23:63", "name": "Dead", "id": "419099009", "display": "Dead", "accessLevel": "Public", "codeSystem": { "localId": "18", "locator": "23:31-23:48", "name": "SNOMEDCT:2016-03" } } ] }, "statements": { "def": [ { "locator": "27:1-27:15", "name": "Patient", "context": "Patient", "expression": { "type": "SingletonFrom", "operand": { "locator": "27:1-27:15", "dataType": "{urn:healthit-gov:qdm:v5_3}Patient", "templateId": "Patient", "type": "Retrieve" } } }, { "localId": "26", "locator": "29:1-31:55", "name": "Intervention Comfort Measures", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "26", "s": [ { "value": [ "define ", "\"Intervention Comfort Measures\"", ":\n\t" ] }, { "r": "25", "s": [ { "r": "23", "s": [ { "value": [ "[", "\"Intervention, Order\"", ": " ] }, { "s": [ { "value": [ "\"Comfort Measures\"" ] } ] }, { "value": [ "]" ] } ] }, { "value": [ "\n\t\tunion " ] }, { "r": "24", "s": [ { "value": [ "[", "\"Intervention, Performed\"", ": " ] }, { "s": [ { "value": [ "\"Comfort Measures\"" ] } ] }, { "value": [ "]" ] } ] } ] } ] } } ], "expression": { "localId": "25", "locator": "30:2-31:55", "type": "Union", "operand": [ { "locator": "30:2-30:44", "type": "As", "operand": { "localId": "23", "locator": "30:2-30:44", "dataType": 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"value": [ "NonElectiveEncounter" ] } ] }, { "value": [ "." ] }, { "r": "31", "s": [ { "value": [ "relevantPeriod" ] } ] } ] }, { "value": [ ")" ] } ] } ] }, { "value": [ "<=", " ", "120" ] } ] }, { "value": [ "\n\t\t\tand " ] }, { "r": "38", "s": [ { "r": "36", "s": [ { "r": "35", "s": [ { "value": [ "NonElectiveEncounter" ] } ] }, { "value": [ "." ] }, { "r": "36", "s": [ { "value": [ "relevantPeriod" ] } ] } ] }, { "value": [ " ", "ends during", " " ] }, { "r": "37", "s": [ { "value": [ "\"Measurement Period\"" ] } ] } ] } ] } ] } ] } ] } } ], "expression": { "localId": "40", "locator": "63:2-65:75", "type": "Query", "source": [ { "localId": "28", "locator": "63:2-63:82", "alias": "NonElectiveEncounter", "expression": { "localId": "27", "locator": "63:2-63:61", "dataType": "{urn:healthit-gov:qdm:v5_3}PositiveEncounterPerformed", "templateId": "PositiveEncounterPerformed", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Non-Elective Inpatient Encounter", "type": 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")" } ] } ], "node_type": "Coalesce", "ref_id": "116" }, { "children": [ { "text": "during " } ], "node_type": "In", "ref_id": "120" }, { "children": [ { "children": [ { "children": [ { "text": "Global" } ] } ], "ref_id": "117" }, { "children": [ { "text": "." } ] }, { "children": [ { "children": [ { "text": "\"Hospitalization\"(" } ] }, { "children": [ { "children": [ { "text": "IschemicStrokeEncounter" } ] } ], "node_type": "AliasRef", "ref_id": "118" }, { "children": [ { "text": ")" } ] } ], "node_type": "FunctionRef", "ref_id": "119" } ], "node_type": "FunctionRef", "ref_id": "119" } ], "node_type": "In", "ref_id": "120" } ], "ref_id": "121" } ], "node_type": "Query", "ref_id": "122" } ], "ref_id": "123" } ], "define_name": "Comfort Measures during Hospitalization" } ], "identifier": { "id": "TJC_Overall", "version": "1.4.000" } }, "is_main_library": false, "is_top_level": true, "library_name": "TJC_Overall", "library_version": "1.4.000", "statement_dependencies": [ { "statement_name": "Ischemic Stroke Encounter", "statement_references": [ { "hqmf_id": null, "library_name": "TJC_Overall", "statement_name": "Encounter with Principal Diagnosis and Age" } ] }, { "statement_name": "Encounter with Principal Diagnosis and Age", "statement_references": [ { "hqmf_id": null, "library_name": "TJC_Overall", "statement_name": "All Stroke Encounter" }, { "hqmf_id": null, "library_name": "MATGlobalCommonFunctions", "statement_name": "CalendarAgeInYearsAt" } ] }, { "statement_name": "All Stroke Encounter", "statement_references": [ { "hqmf_id": null, "library_name": "TJC_Overall", "statement_name": "Non Elective Inpatient Encounter" } ] }, { "statement_name": "Non Elective Inpatient Encounter", "statement_references": [ { "hqmf_id": null, "library_name": "MATGlobalCommonFunctions", "statement_name": "LengthInDays" } ] }, { "statement_name": "Ischemic Stroke Encounters with Discharge Status", "statement_references": [ { "hqmf_id": null, "library_name": "TJC_Overall", "statement_name": "Ischemic Stroke Encounter" } ] }, { "statement_name": "Comfort Measures during Hospitalization", "statement_references": [ { "hqmf_id": null, "library_name": "TJC_Overall", "statement_name": "Ischemic Stroke Encounter" }, { "hqmf_id": null, "library_name": "TJC_Overall", "statement_name": "Intervention Comfort Measures" }, { "hqmf_id": null, "library_name": "MATGlobalCommonFunctions", "statement_name": "Hospitalization" } ] }, { "statement_name": "Intervention Comfort Measures" } ] }, { "cql": "library MATGlobalCommonFunctions version '2.0.000'\r\n\r\nusing QDM version '5.3'\r\n\r\ncodesystem \"LOINC:2.46\": 'urn:oid:2.16.840.1.113883.6.1' version 'urn:hl7:version:2.46'\r\ncodesystem \"SNOMEDCT:2016-03\": 'urn:oid:2.16.840.1.113883.6.96' version 'urn:hl7:version:2016-03'\r\n\r\nvalueset \"Emergency Department Visit\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.292'\r\nvalueset \"Encounter Inpatient\": 'urn:oid:2.16.840.1.113883.3.666.5.307'\r\nvalueset \"Intensive Care Unit\": 'urn:oid:2.16.840.1.113762.1.4.1110.23'\r\n\r\ncode \"Birthdate\": '21112-8' from \"LOINC:2.46\" display 'Birth date'\r\ncode \"Dead\": '419099009' from \"SNOMEDCT:2016-03\" display 'Dead'\r\n\r\nparameter \"Measurement Period\" Interval\r\n\r\ncontext Patient\r\n\r\ndefine \"Encounter\":\r\n\t[\"Encounter, Performed\": \"Emergency Department Visit\"]\r\n\r\ndefine \"Inpatient Encounter\":\r\n\t[\"Encounter, Performed\": \"Encounter Inpatient\"] EncounterInpatient\r\n\t\twhere \"LengthInDays\"(EncounterInpatient.relevantPeriod)<= 120\r\n\t\t\tand EncounterInpatient.relevantPeriod ends during \"Measurement Period\"\n\n/*ToDate takes a given DateTime value and returns a DateTime with the time components \"zeroed\", and the timezone of the input value, for example, given the DateTime @2012-01-01T06:30:00.0Z, this function will return @2012-01-01T00:00:00.0Z.*/\r\n\r\ndefine function \"ToDate\"(Value DateTime):\r\n\tDateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezone from Value)\n\n/*CalendarAgeInDaysAt calculates the calendar age (meaning the age without considering time components) in days.*/\r\n\r\ndefine function \"CalendarAgeInDaysAt\"(BirthDateTime DateTime, AsOf DateTime):\r\n\tdays between ToDate(BirthDateTime)and ToDate(AsOf)\n\n/*CalendarAgeInDays calculates the calendar age (meaning the age without considering time components) in days as of today*/\r\n\r\ndefine function \"CalendarAgeInDays\"(BirthDateTime DateTime):\r\n\tCalendarAgeInDaysAt(BirthDateTime, Today())\n\n/*CalendarAgeInMonthsAt calculates the calendar age (meaning the age without considering time components) in months.*/\r\n\r\ndefine function \"CalendarAgeInMonthsAt\"(BirthDateTime DateTime, AsOf DateTime):\r\n\tmonths between ToDate(BirthDateTime)and ToDate(AsOf)\n\n/*CalendarAgeInMonths calculates the calendar age (meaning the age without considering time components) in months as of today.*/\r\n\r\ndefine function \"CalendarAgeInMonths\"(BirthDateTime DateTime):\r\n\tCalendarAgeInMonthsAt(BirthDateTime, Today())\n\n/*CalendarAgeInYearsAt calculates the calendar age (meaning the age without considering time components) in years.*/\r\n\r\ndefine function \"CalendarAgeInYearsAt\"(BirthDateTime DateTime, AsOf DateTime):\r\n\tyears between ToDate(BirthDateTime)and ToDate(AsOf)\n\n/*CalendarAgeInYears calculates the calendar age (meaning the age without considering time components) in years as of today.*/\r\n\r\ndefine function \"CalendarAgeInYears\"(BirthDateTime DateTime):\r\n\tCalendarAgeInYearsAt(BirthDateTime, Today())\n\n/*Hospitalization returns the total interval for admission to discharge for the given encounter, or for the admission of any immediately prior emergency department visit to the discharge of the given encounter.*/\r\n\r\ndefine function \"Hospitalization\"(Encounter \"Encounter, Performed\"):\r\n\t( singleton from ( [\"Encounter, Performed\": \"Emergency Department Visit\"] EDVisit\r\n\t\t\twhere EDVisit.relevantPeriod ends 1 hour or less on or before start of Encounter.relevantPeriod\r\n\t) ) X\r\n\t\treturn if X is null then Encounter.relevantPeriod else Interval[start of X.relevantPeriod, end of Encounter.relevantPeriod]\n\n/*calculates the difference in calendar days between the start and end of the given interval.*/\r\n\r\ndefine function \"LengthInDays\"(Value Interval):\r\n\tdifference in days between start of Value and end of Value\n\n/* returns list of all locations within an encounter, including locations for immediately prior ED visit. If data contains many encounters within 1 hour before the start of encounter error will occur indicating the hospitalization cannot be determined*/\r\n\r\ndefine function \"Hospitalization Locations\"(Encounter \"Encounter, Performed\"):\r\n\t( singleton from ( [\"Encounter, Performed\": \"Emergency Department Visit\"] EDVisit\r\n\t\t\twhere EDVisit.relevantPeriod ends 1 hour or less on or before start of Encounter.relevantPeriod\r\n\t) ) EDEncounter\r\n\t\treturn if EDEncounter is null then Encounter.facilityLocations else flatten { EDEncounter.facilityLocations, Encounter.facilityLocations }\n\n/*Returns the length of stay in days (i.e. the number of days between admission and discharge) for the given encounter, or from the admission of any immediately prior emergency department visit to the discharge of the encounter*/\r\n\r\ndefine function \"Hospitalization Length of Stay\"(Encounter \"Encounter, Performed\"):\r\n\tLengthInDays(\"Hospitalization\"(Encounter))\n\n/*Returns admission time for an encounter or for immediately prior emergency department visit. If the data contain many encounters within 1 hour before the start of the encounter an error indicating hospitalization cannot be determined\n*/\r\n\r\ndefine function \"Hospital Admission Time\"(Encounter \"Encounter, Performed\"):\r\n\tstart of \"Hospitalization\"(Encounter)\n\n/*Hospital Discharge Time returns the discharge time for an encounter*/\r\n\r\ndefine function \"Hospital Discharge Time\"(Encounter \"Encounter, Performed\"):\r\n\tend of Encounter.relevantPeriod\n\n/*Returns earliest arrival time for an encounter including any prior ED visit. If the data contain multiple encounters within 1 hour before the start of the encounter, an error will occur indicating it cannot be unambiguously determined\n*/\r\n\r\ndefine function \"Hospital Arrival Time\"(Encounter \"Encounter, Performed\"):\r\n\tstart of First((\"Hospitalization Locations\"(Encounter))HospitalLocation\r\n\t\t\tsort by start of locationPeriod\r\n\t).locationPeriod\n\n/*Returns the latest departure time for encounter including any prior ED visit. If the data contain multiple encounters within 1 hour before the start of the encounter, an error will occur indicating it cannot be unambiguously determined*/\r\n\r\ndefine function \"Hospital Departure Time\"(Encounter \"Encounter, Performed\"):\r\n\tend of Last((\"Hospitalization Locations\"(Encounter))HospitalLocation\r\n\t\t\tsort by start of locationPeriod\r\n\t).locationPeriod\n\n/*Returns the arrival time in the ED for the encounter. If the data contain multiple encounters within 1 hour before the start of the encounter or multiple ED locations an error will occur indicating it cannot be determined\n*/\r\n\r\ndefine function \"Emergency Department Arrival Time\"(Encounter \"Encounter, Performed\"):\r\n\tstart of ( singleton from ( ( \"Hospitalization Locations\"(Encounter)) HospitalLocation\r\n\t\t\t\twhere HospitalLocation.code in \"Emergency Department Visit\"\r\n\t\t)\r\n\t).locationPeriod\n\n/*First Inpatient Intensive Care Unit returns the first intensive care unit for\nthe given encounter, without considering any immediately prior emergency\ndepartment visit.*/\r\n\r\ndefine function \"First Inpatient Intensive Care Unit\"(Encounter \"Encounter, Performed\"):\r\n\tFirst((Encounter.facilityLocations)HospitalLocation\r\n\t\t\twhere HospitalLocation.code in \"Intensive Care Unit\"\r\n\t\t\t\tand HospitalLocation.locationPeriod during Encounter.relevantPeriod\r\n\t\t\tsort by start of locationPeriod\r\n\t)\r\n", 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The measures and specifications are provided without warranty.", "name": "Disclaimer", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "DISC", "title": "Disclaimer" }, "value_obj": { "type": "ED", "value": "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.", "media_type": "text/plain" } }, { "code": "MSRSCORE", "name": "Measure Scoring", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "MSRSCORE", "title": "Measure Scoring" }, "value_obj": { "type": "CD", "system": "2.16.840.1.113883.1.11.20367", "code": "PROPOR", "title": "Proportion" } }, { "code": "MSRTYPE", "name": "Measure Type", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "MSRTYPE", "title": "Measure Type" }, "value_obj": { "type": "CD", "system": "2.16.840.1.113883.1.11.20368", "code": "PROCESS", "title": "PROCESS" } }, { "code": "STRAT", "value": "None", "name": "Stratification", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "STRAT", "title": "Stratification" }, "value_obj": { "type": "ED", "value": "None", "media_type": "text/plain" } }, { "code": "MSRADJ", "value": "None", "name": "Risk Adjustment", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "MSRADJ", "title": "Risk Adjustment" }, "value_obj": { "type": "ED", "value": "None", "media_type": "text/plain" } }, { "code": "MSRAGG", "value": "None", "name": "Rate Aggregation", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "MSRAGG", "title": "Rate Aggregation" }, "value_obj": { "type": "ED", "value": "None", "media_type": "text/plain" } }, { "code": "RAT", "value": "There is an extensive and consistent body of evidence supporting the use of statins for secondary prevention in patients with clinically evident atherosclerotic cardiovascular disease (ASCVD), which includes individuals with ischemic stroke due to large artery atherosclerosis, individuals with ischemic stroke due to intrinsic small vessel disease, and individuals with ischemic stroke not directly due to atherosclerosis but with clinically evident atherosclerotic disease in an uninvolved cerebral or noncerebral bed. Both women and men with clinical ASCVD are at increased risk for recurrent ASCVD and ASCVD death. High-intensity statin therapy should be initiated or continued as first-line therapy in women and men less than or equal to 75 years of age who have clinical ASCVD, unless contraindicated. In patients with clinical ASCVD and a contraindication to high-intensity statin therapy, moderate-intensity therapy should be considered as an alternative if it can be tolerated. In individuals greater than 75 years of age, the potential for ASCVD risk reduction benefits, adverse effects, drug-drug interactions, and patient preferences should be considered, and statin therapy individualized based on these considerations (Stone, 2013).", "name": "Rationale", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "RAT", "title": "Rationale" }, "value_obj": { "type": "ED", "value": "There is an extensive and consistent body of evidence supporting the use of statins for secondary prevention in patients with clinically evident atherosclerotic cardiovascular disease (ASCVD), which includes individuals with ischemic stroke due to large artery atherosclerosis, individuals with ischemic stroke due to intrinsic small vessel disease, and individuals with ischemic stroke not directly due to atherosclerosis but with clinically evident atherosclerotic disease in an uninvolved cerebral or noncerebral bed. Both women and men with clinical ASCVD are at increased risk for recurrent ASCVD and ASCVD death. High-intensity statin therapy should be initiated or continued as first-line therapy in women and men less than or equal to 75 years of age who have clinical ASCVD, unless contraindicated. In patients with clinical ASCVD and a contraindication to high-intensity statin therapy, moderate-intensity therapy should be considered as an alternative if it can be tolerated. In individuals greater than 75 years of age, the potential for ASCVD risk reduction benefits, adverse effects, drug-drug interactions, and patient preferences should be considered, and statin therapy individualized based on these considerations (Stone, 2013).", "media_type": "text/plain" } }, { "code": "CRS", "value": "For patients with stroke of atherosclerotic origin, intensive lipid lowering therapy with statins should be initiated", "name": "Clinical Recommendation Statement", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "CRS", "title": "Clinical Recommendation Statement" }, "value_obj": { "type": "ED", "value": "For patients with stroke of atherosclerotic origin, intensive lipid lowering therapy with statins should be initiated", "media_type": "text/plain" } }, { "code": "IDUR", "value": "Improvement noted as an increase in rate", "name": "Improvement Notation", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "IDUR", "title": "Improvement Notation" }, "value_obj": { "type": "ED", "value": "Improvement noted as an increase in rate", "media_type": "text/plain" } }, { "code": "REF", "value": "Stone NJ, Robinson J, Lichtenstein AH, Noel Bairey Merz C, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero Jr, ST, Smith SC, Watson K, Wilson PWF. \"Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Disease in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.\" [In eng]. Circulation 11, (Nov 2013): 1-84.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Stone NJ, Robinson J, Lichtenstein AH, Noel Bairey Merz C, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero Jr, ST, Smith SC, Watson K, Wilson PWF. \"Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Disease in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.\" [In eng]. Circulation 11, (Nov 2013): 1-84.", "media_type": "text/plain" } }, { "code": "REF", "value": "Amarenco, P., J. Bogousslavsky, A. Callahan, 3rd, L. B. Goldstein, M. Hennerici, A. E. Rudolph, H. Sillesen, et al. \"High-Dose Atorvastatin after Stroke or Transient Ischemic Attack.\" [In eng]. N Engl J Med 355, no. 6 (Aug 10 2006): 549-59", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Amarenco, P., J. Bogousslavsky, A. Callahan, 3rd, L. B. Goldstein, M. Hennerici, A. E. Rudolph, H. Sillesen, et al. \"High-Dose Atorvastatin after Stroke or Transient Ischemic Attack.\" [In eng]. N Engl J Med 355, no. 6 (Aug 10 2006): 549-59", "media_type": "text/plain" } }, { "code": "REF", "value": "Feher, A., G. Pusch, K. Koltai, A. Tibold, B. Gasztonyi, L. Szapary, and G. Feher. \"Statintherapy in the Primary and the Secondary Prevention of Ischaemic Cerebrovascular Diseases.\" [In eng]. Int J Cardiol 148, no. 2 (Apr 14 2011): 131-8.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Feher, A., G. Pusch, K. Koltai, A. Tibold, B. Gasztonyi, L. Szapary, and G. Feher. \"Statintherapy in the Primary and the Secondary Prevention of Ischaemic Cerebrovascular Diseases.\" [In eng]. Int J Cardiol 148, no. 2 (Apr 14 2011): 131-8.", "media_type": "text/plain" } }, { "code": "REF", "value": "Kernan, W.N., B. Ovbiagele, H. R. Black, D. M. Bravata, M. I. Chimowitz, M. D. Ezekowitz, M. C. Fang, M. Fisher, K. L. Furie, D. V. Heck, S. C. Johnston, S. E. Kasner, S. J. Kittner, P. H. Mitchell, M. W. Rich, D. Richardson, L. H. Schwamm, J. A. Wilson. \"Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association.\" [in eng.] Stroke 45, no. 7 (May 2014): 2160-223", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Kernan, W.N., B. Ovbiagele, H. R. Black, D. M. Bravata, M. I. Chimowitz, M. D. Ezekowitz, M. C. Fang, M. Fisher, K. L. Furie, D. V. Heck, S. C. Johnston, S. E. Kasner, S. J. Kittner, P. H. Mitchell, M. W. Rich, D. Richardson, L. H. Schwamm, J. A. Wilson. \"Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association.\" [in eng.] Stroke 45, no. 7 (May 2014): 2160-223", "media_type": "text/plain" } }, { "code": "REF", "value": "National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Adults Treatment of High Blood Cholesterol in Adults.\"Third Report of the National Cholesterol Education Program (Ncep) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel Iii) Final Report.\" [In eng]. Circulation 106, no. 25 (Dec 17 2002): 3143-421.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Adults Treatment of High Blood Cholesterol in Adults.\"Third Report of the National Cholesterol Education Program (Ncep) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel Iii) Final Report.\" [In eng]. Circulation 106, no. 25 (Dec 17 2002): 3143-421.", "media_type": "text/plain" } }, { "code": "REF", "value": "Squizzato, A., E. Romualdi, F. Dentali, and W. Ageno. \"Statins for Acute Ischemic Stroke.\" [In eng]. Cochrane Database Syst Rev, no. 8 (2011): CD007551.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Squizzato, A., E. Romualdi, F. Dentali, and W. Ageno. \"Statins for Acute Ischemic Stroke.\" [In eng]. Cochrane Database Syst Rev, no. 8 (2011): CD007551.", "media_type": "text/plain" } }, { "code": "DEF", "value": "None", "name": "Definition", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "DEF", "title": "Definition" }, "value_obj": { "type": "ED", "value": "None", "media_type": "text/plain" } }, { "code": "GUIDE", "value": "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.\n\nThe \"Medication, Discharge\" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use.", "name": "Guidance", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "GUIDE", "title": "Guidance" }, "value_obj": { "type": "ED", "value": "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.\n\nThe \"Medication, Discharge\" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use.", "media_type": "text/plain" } }, { "code": "TRANF", "value": "TBD", "name": "Transmission Format", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "TRANF", "title": "Transmission Format" }, "value_obj": { "type": "ED", "value": "TBD", "media_type": "text/plain" } }, { "code": "IPOP", "value": "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 measurement period", "name": "Initial Population", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "IPOP", "title": "Initial Population" }, "value_obj": { "type": "ED", "value": "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 measurement period", "media_type": "text/plain" } }, { "code": "DENOM", "value": "Patients with a principal diagnosis of ischemic stroke", "name": "Denominator", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "DENOM", "title": "Denominator" }, "value_obj": { "type": "ED", "value": "Patients with a principal diagnosis of ischemic stroke", "media_type": "text/plain" } }, { "code": "DENEX", "value": "*Patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations.\n*Patients with comfort measures documented\n*Patients discharged to another hospital\n*Patients who left against medical advice\n*Patients who expired\n*Patients discharged to home for hospice care\n*Patients discharged to a health care facility for hospice care", "name": "Denominator Exclusions", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "DENEX", "title": "Denominator Exclusions" }, "value_obj": { "type": "ED", "value": "*Patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations.\n*Patients with comfort measures documented\n*Patients discharged to another hospital\n*Patients who left against medical advice\n*Patients who expired\n*Patients discharged to home for hospice care\n*Patients discharged to a health care facility for hospice care", "media_type": "text/plain" } }, { "code": "NUMER", "value": "Patients prescribed or continuing to take statin medication at hospital discharge", "name": "Numerator", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "NUMER", "title": "Numerator" }, "value_obj": { "type": "ED", "value": "Patients prescribed or continuing to take statin medication at hospital discharge", "media_type": "text/plain" } }, { "code": "NUMEX", "value": "Not Applicable", "name": "Numerator Exclusions", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "NUMEX", "title": "Numerator Exclusions" }, "value_obj": { "type": "ED", "value": "Not Applicable", "media_type": "text/plain" } }, { "code": "DENEXCEP", "value": "*Patients with a reason for not prescribing statin medication at discharge\n*Patients with a maximum LDL-c result of less than 70 mg/dL <= 30 days prior to arrival or any time during the hospital stay", "name": "Denominator Exceptions", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "DENEXCEP", "title": "Denominator Exceptions" }, "value_obj": { "type": "ED", "value": "*Patients with a reason for not prescribing statin medication at discharge\n*Patients with a maximum LDL-c result of less than 70 mg/dL <= 30 days prior to arrival or any time during the hospital stay", "media_type": "text/plain" } }, { "code": "SDE", "value": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex", "name": "Supplemental Data Elements", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "SDE", "title": "Supplemental Data Elements" }, "value_obj": { "type": "ED", "value": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex", "media_type": "text/plain" } } ], "measure_period": { "type": "IVL_TS", "low": { "type": "TS", "value": "201201010000", "inclusive?": true, "derived?": false }, "high": { "type": "TS", "value": "201212312359", "inclusive?": true, "derived?": false }, "width": { "type": "PQ", "unit": "a", "value": "1", "inclusive?": true, "derived?": false } }, "measure_scoring": "PROPORTION", "population_criteria": { "IPP": { "conjunction?": true, "type": "IPP", "hqmf_id": "57FE43A4-CBE2-4E94-B271-60D3C4077789", "preconditions": [ { "id": 2, "preconditions": [ { "id": 1, "reference": "DischargedonStatinMedication__Initial_Population__0FCEF10B_44C1_4201_B48E_03B5EEBA15E1" } ], "conjunction_code": "allTrue" } ] }, "DENOM": { "conjunction?": true, "type": "DENOM", "hqmf_id": "342426D4-36EE-43DC-A11C-F83C0F3AEE81", "preconditions": [ { "id": 4, "preconditions": [ { "id": 3, "reference": "DischargedonStatinMedication__Denominator__0FCEF10B_44C1_4201_B48E_03B5EEBA15E1" } ], "conjunction_code": "allTrue" } ] }, "NUMER": { "conjunction?": true, "type": "NUMER", "hqmf_id": "A1560C0B-DE34-42FA-B2BB-7D0A559A8CB9", "preconditions": [ { "id": 6, "preconditions": [ { "id": 5, "reference": "DischargedonStatinMedication__Numerator__0FCEF10B_44C1_4201_B48E_03B5EEBA15E1" } ], "conjunction_code": "allTrue" } ] }, "DENEXCEP": { "conjunction?": true, "type": "DENEXCEP", "hqmf_id": "9C16306F-1ADD-4475-BF09-2DA51F56F160", "preconditions": [ { "id": 8, "preconditions": [ { "id": 7, "reference": "DischargedonStatinMedication__Denominator_Exceptions__0FCEF10B_44C1_4201_B48E_03B5EEBA15E1" } ], "conjunction_code": "atLeastOneTrue" } ] }, "DENEX": { "conjunction?": true, "type": "DENEX", "hqmf_id": "8F0CCD37-2974-4B86-A15A-9982FCA7DAB2", "preconditions": [ { "id": 10, "preconditions": [ { "id": 9, "reference": "DischargedonStatinMedication__Denominator_Exclusions__0FCEF10B_44C1_4201_B48E_03B5EEBA15E1" } ], "conjunction_code": "atLeastOneTrue" } ] } }, "population_sets": [ { "population_set_id": "PopulationCriteria1", "populations": { "DENEX": { "hqmf_id": "8F0CCD37-2974-4B86-A15A-9982FCA7DAB2", "library_name": "DischargedonStatinMedication", "statement_name": "Denominator Exclusions" }, "DENEXCEP": { "hqmf_id": "9C16306F-1ADD-4475-BF09-2DA51F56F160", "library_name": "DischargedonStatinMedication", "statement_name": "Denominator Exceptions" }, "DENOM": { "hqmf_id": "342426D4-36EE-43DC-A11C-F83C0F3AEE81", "library_name": "DischargedonStatinMedication", "statement_name": "Denominator" }, "IPP": { "hqmf_id": "57FE43A4-CBE2-4E94-B271-60D3C4077789", "library_name": "DischargedonStatinMedication", "statement_name": "Initial Population" }, "NUMER": { "hqmf_id": "A1560C0B-DE34-42FA-B2BB-7D0A559A8CB9", "library_name": "DischargedonStatinMedication", "statement_name": "Numerator" }, "_type": "CQM::ProportionPopulationMap" }, "title": "Population Criteria Section" } ], "source_data_criteria": [ { "codeListId": "2.16.840.1.114222.4.11.3591", "dataElementCodes": [ ], "description": "Patient Characteristic Payer: Payer", "hqmfOid": "2.16.840.1.113883.10.20.28.4.58", "id": "5d289cae31fe5f8b2b7e3a55", "qdmCategory": "patient_characteristic", "qdmStatus": "payer", "qdmTitle": "Patient Characteristic Payer", "qdmVersion": "5.5", "relevantPeriod": null, "_type": "QDM::PatientCharacteristicPayer" }, { "codeListId": "2.16.840.1.114222.4.11.837", "dataElementCodes": [ ], "description": "Patient Characteristic Ethnicity: Ethnicity", "hqmfOid": "2.16.840.1.113883.10.20.28.4.56", "id": "5d289cae31fe5f8b2b7e3a56", "qdmCategory": "patient_characteristic", "qdmStatus": "ethnicity", "qdmTitle": "Patient Characteristic Ethnicity", "qdmVersion": "5.5", "_type": "QDM::PatientCharacteristicEthnicity" }, { "codeListId": "2.16.840.1.113762.1.4.1", "dataElementCodes": [ ], "description": "Patient Characteristic Sex: ONCAdministrativeSex", "hqmfOid": "2.16.840.1.113883.10.20.28.4.55", "id": "5d289cae31fe5f8b2b7e3a57", "qdmCategory": "patient_characteristic", "qdmStatus": "gender", "qdmTitle": "Patient Characteristic Sex", "qdmVersion": "5.5", "_type": "QDM::PatientCharacteristicSex" }, { "admissionSource": null, "authorDatetime": null, "codeListId": "2.16.840.1.113883.3.117.1.7.1.292", "dataElementCodes": [ ], "description": "Encounter, Performed: EmergencyDepartmentVisit", "diagnoses": null, "dischargeDisposition": null, "facilityLocations": [ ], "hqmfOid": "2.16.840.1.113883.10.20.28.4.5", "id": "5d289cae31fe5f8b2b7e3a58", "lengthOfStay": null, "negationRationale": null, "participant": null, "priority": null, "qdmCategory": "encounter", "qdmStatus": "performed", "qdmTitle": "Encounter, Performed", "qdmVersion": "5.5", "relevantPeriod": null, "_type": "QDM::EncounterPerformed" }, { "admissionSource": null, "authorDatetime": null, "codeListId": "2.16.840.1.113883.3.117.1.7.1.424", "dataElementCodes": [ ], "description": "Encounter, Performed: Non-ElectiveInpatientEncounter", "diagnoses": null, "dischargeDisposition": null, "facilityLocations": [ ], "hqmfOid": "2.16.840.1.113883.10.20.28.4.5", "id": "5d289cae31fe5f8b2b7e3a59", "lengthOfStay": null, "negationRationale": null, "participant": null, "priority": null, "qdmCategory": "encounter", "qdmStatus": "performed", "qdmTitle": "Encounter, Performed", "qdmVersion": "5.5", "relevantPeriod": null, "_type": "QDM::EncounterPerformed" }, { "authorDatetime": null, "codeListId": "2.16.840.1.113883.3.117.1.7.1.215", "components": null, "dataElementCodes": [ ], "description": "Laboratory Test, Performed: LDL-c", "hqmfOid": "2.16.840.1.113883.10.20.28.4.42", "id": "5d289cae31fe5f8b2b7e3a5a", "method": null, "negationRationale": null, "performer": null, "qdmCategory": "laboratory_test", "qdmStatus": "performed", "qdmTitle": "Laboratory Test, Performed", "qdmVersion": "5.5", "reason": null, "referenceRange": null, "relevantDatetime": null, "relevantPeriod": null, "result": null, "resultDatetime": null, "status": null, "_type": "QDM::LaboratoryTestPerformed" }, { "authorDatetime": null, "codeListId": "2.16.840.1.113883.3.117.1.7.1.423", "dataElementCodes": [ ], "description": "Allergy/Intolerance: StatinAllergen", "hqmfOid": "2.16.840.1.113883.10.20.28.4.119", "id": "5d289cae31fe5f8b2b7e3a5b", "prevalencePeriod": null, "qdmCategory": "allergy", "qdmStatus": "intolerance", "qdmTitle": "Allergy/Intolerance", "qdmVersion": "5.5", "recorder": null, "severity": null, "type": null, "_type": "QDM::AllergyIntolerance" }, { "codeListId": "2.16.840.1.114222.4.11.836", "dataElementCodes": [ ], "description": "Patient Characteristic Race: Race", "hqmfOid": "2.16.840.1.113883.10.20.28.4.59", "id": "5d289cae31fe5f8b2b7e3a5c", "qdmCategory": "patient_characteristic", "qdmStatus": "race", "qdmTitle": "Patient Characteristic Race", "qdmVersion": "5.5", "_type": 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