{ "calculate_sdes": null, "calculation_method": "PATIENT", "cms_id": "CMS723v0", "component": false, "component_hqmf_set_ids": [ ], "composite": false, "composite_hqmf_set_id": null, "cql_libraries": [ { "cql": "library AnticoagulationTherapyforAtrialFibrillationFlutter version '0.0.009'\n\nusing QDM version '5.0.2'\n\ninclude MATGlobalCommonFunctions version '1.0.000' called global\n\nvalueset \"ONC Administrative Sex\": 'urn:oid:2.16.840.1.113762.1.4.1' \n\nvalueset \"Race\": 'urn:oid:2.16.840.1.114222.4.11.836' \n\nvalueset \"Ethnicity\": 'urn:oid:2.16.840.1.114222.4.11.837' \n\nvalueset \"Payer\": 'urn:oid:2.16.840.1.114222.4.11.3591' \n\nvalueset \"Anticoagulant Therapy\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.200' version 'urn:hl7:profile:Most%20Recent%20Code%20System%20Versions%20in%20VSAC' \n\nvalueset \"Atrial Fibrillation/Flutter\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.202' version 'urn:hl7:profile:Most%20Recent%20Code%20System%20Versions%20in%20VSAC' \n\nvalueset \"Medical Reason\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.473' version 'urn:hl7:profile:Most%20Recent%20Code%20System%20Versions%20in%20VSAC' \n\nvalueset \"Patient Refusal\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.93' version 'urn:hl7:profile:Most%20Recent%20Code%20System%20Versions%20in%20VSAC' \n\nvalueset \"Atrial Ablation\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.203' version 'urn:hl7:profile:Most%20Recent%20Code%20System%20Versions%20in%20VSAC' \n\nvalueset \"Non-Elective Inpatient Encounter\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.424' version 'urn:hl7:profile:Most%20Recent%20Code%20System%20Versions%20in%20VSAC' \n\nvalueset \"Comfort Measures\": 'urn:oid:1.3.6.1.4.1.33895.1.3.0.45' version 'urn:hl7:profile:Most%20Recent%20Code%20System%20Versions%20in%20VSAC' \n\nvalueset \"Patient Expired\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.309' version 'urn:hl7:profile:Most%20Recent%20Code%20System%20Versions%20in%20VSAC' \n\nvalueset \"Left Against Medical Advice\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.308' version 'urn:hl7:profile:Most%20Recent%20Code%20System%20Versions%20in%20VSAC' \n\nvalueset \"Discharged to Health Care Facility for Hospice Care\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.207' version 'urn:hl7:profile:Most%20Recent%20Code%20System%20Versions%20in%20VSAC' \n\nvalueset \"Discharge To Acute Care Facility\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.87' version 'urn:hl7:profile:Most%20Recent%20Code%20System%20Versions%20in%20VSAC' \n\nvalueset \"Discharged to Home for Hospice Care\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.209' version 'urn:hl7:profile:Most%20Recent%20Code%20System%20Versions%20in%20VSAC' \n\nvalueset \"Hemorrhagic Stroke\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.212' version 'urn:hl7:profile:Most%20Recent%20Code%20System%20Versions%20in%20VSAC' \n\nvalueset \"Ischemic Stroke\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.247' version 'urn:hl7:profile:Most%20Recent%20Code%20System%20Versions%20in%20VSAC' \n\nparameter \"Measurement Period\" Interval\n\ncontext Patient\n\ndefine \"SDE Ethnicity\": [\"Patient Characteristic Ethnicity\": \"Ethnicity\"]\n\ndefine \"SDE Payer\": [\"Patient Characteristic Payer\": \"Payer\"]\n\ndefine \"SDE Race\": [\"Patient Characteristic Race\": \"Race\"]\n\ndefine \"SDE Sex\": [\"Patient Characteristic Sex\": \"ONC Administrative Sex\"]\n\ndefine \"Initial Population\": \"Encounter with Principal Diagnosis and Age\"\n\ndefine \"Encounter with Atrial Ablation Procedure\": \"Encounter with Principle Diagnosis of Ischemic Stroke\" NonElectiveEncounter\n with [\"Procedure, Performed\": \"Atrial Ablation\"] AtrialAblation\n such that AtrialAblation.relevantPeriod starts before start of NonElectiveEncounter.relevantPeriod\n\ndefine \"Current Diagnosis Atrial FibrillationFlutter\": \"Encounter with Principle Diagnosis of Ischemic Stroke\" NonElectiveEncounter\nwhere NonElectiveEncounter.diagnosis in \"Atrial Fibrillation/Flutter\"\n\ndefine \"Encounter with Principle Diagnosis of Ischemic Stroke\": \"Encounter with Principal Diagnosis and Age\" NonElectiveEncounter\r\nwhere NonElectiveEncounter.principalDiagnosis in \"Ischemic Stroke\"\n\ndefine \"Non Elective Inpatient Encounter\": [\"Encounter, Performed\": \"Non-Elective Inpatient Encounter\"] NonElectiveEncounter\r\n where NonElectiveEncounter.lengthOfStay <= 120 days \r\n and NonElectiveEncounter.relevantPeriod ends during \"Measurement Period\"\n\ndefine \"Denominator\": \"Encounter with Atrial Ablation Procedure\"\nunion\n\"History of Atrial FibrillationFlutter\"\nunion\n\"Current Diagnosis Atrial FibrillationFlutter\"\n\ndefine \"Anticoagulant Therapy at Discharge\": [\"Medication, Discharge\": \"Anticoagulant Therapy\"] Anticoagulant\n\ndefine \"Numerator\": \"Denominator\" NonElectiveEncounter\n with \"Anticoagulant Therapy at Discharge\" Anticoagulant\n such that Anticoagulant.authorDatetime during NonElectiveEncounter.relevantPeriod\n\ndefine \"Anticoagulant Not Given at Discharge\": [\"Medication, Not Discharged\": \"Anticoagulant Therapy\"] Anticoagulant\n where Anticoagulant.negationRationale in \"Medical Reason\"\n or Anticoagulant.negationRationale in \"Patient Refusal\"\n\ndefine \"Denominator Exceptions\": \"Denominator\" NonElectiveEncounter\n with \"Anticoagulant Not Given at Discharge\" Anticoagulant\n such that Anticoagulant.authorDatetime during NonElectiveEncounter.relevantPeriod\n\ndefine \"Intervention Comfort Measures\": [\"Intervention, Order\": \"Comfort Measures\"]\n union [\"Intervention, Performed\": \"Comfort Measures\"]\n\ndefine \"History of Atrial FibrillationFlutter\": \"Encounter with Principle Diagnosis of Ischemic Stroke\" NonElectiveEncounter\n with [\"Diagnosis\": \"Atrial Fibrillation/Flutter\"] AtrialFibrillationFlutter\n such that AtrialFibrillationFlutter.prevalencePeriod starts on or before end of NonElectiveEncounter.relevantPeriod\n\ndefine \"Encounter with Principal Diagnosis and Age\": \"Non Elective Inpatient Encounter\" NonElectiveEncounter\r\n with [\"Patient Characteristic Birthdate\"] P\r\n such that global.\"CalendarAgeInYearsAt\"(P.birthDatetime, start of NonElectiveEncounter.relevantPeriod) >= 18\r\nwhere (NonElectiveEncounter.principalDiagnosis in \"Hemorrhagic Stroke\"\r\nor NonElectiveEncounter.principalDiagnosis in \"Ischemic Stroke\")\n\n/*testing hospitalization function with comfort measures*/\ndefine \"Comfort Measures during Hospitalization\": \"Denominator\" NonElectiveEncounter\n with \"Intervention Comfort Measures\" ComfortMeasure\n such that Coalesce(start of ComfortMeasure.relevantPeriod, ComfortMeasure.authorDatetime) during global.\"Hospitalization\"(NonElectiveEncounter)\n\ndefine \"Denominator Exclusions1\": distinct ((\r\n\"Denominator\" Encounter\r\n\twhere Encounter.dischargeDisposition in \"Discharge To Acute Care Facility\"\r\n\tor Encounter.dischargeDisposition in \"Left Against Medical Advice\"\r\n\tor Encounter.dischargeDisposition in \"Patient Expired\"\r\n\tor Encounter.dischargeDisposition in \"Discharged to Home for Hospice Care\"\r\n\tor Encounter.dischargeDisposition in \"Discharged to Health Care Facility for Hospice Care\"\r\n )\r\nunion \"Comfort Measures during Hospitalization\"\r\n)\n\n", "elm": { "library": { "identifier": { "id": "AnticoagulationTherapyforAtrialFibrillationFlutter", "version": "0.0.009" }, "schemaIdentifier": { "id": "urn:hl7-org:elm", "version": "r1" }, "usings": { "def": [ { "localIdentifier": "System", "uri": "urn:hl7-org:elm-types:r1" }, { "localId": "1", "localIdentifier": "QDM", "uri": "urn:healthit-gov:qdm:v5_0_1_draft", "version": "5.0.2" } ] }, "includes": { "def": [ { "localId": "2", "localIdentifier": "global", "path": "MATGlobalCommonFunctions", "version": "1.0.000" } ] }, "parameters": { "def": [ { "localId": "23", "name": "Measurement Period", "accessLevel": "Public", "parameterTypeSpecifier": { "localId": "22", "type": "IntervalTypeSpecifier", "pointType": { "localId": "21", "name": "{urn:hl7-org:elm-types:r1}DateTime", "type": "NamedTypeSpecifier" } } } ] }, "valueSets": { "def": [ { "localId": "3", "name": "ONC Administrative Sex", "id": "2.16.840.1.113762.1.4.1", "accessLevel": "Public" }, { "localId": "4", "name": "Race", "id": "2.16.840.1.114222.4.11.836", "accessLevel": "Public" }, { "localId": "5", "name": "Ethnicity", "id": "2.16.840.1.114222.4.11.837", "accessLevel": "Public" }, { "localId": "6", "name": "Payer", "id": "2.16.840.1.114222.4.11.3591", "accessLevel": "Public" }, { "localId": "7", "name": "Anticoagulant Therapy", "id": "2.16.840.1.113883.3.117.1.7.1.200", "version": null, "accessLevel": "Public", "profile": "Most Recent Code System Versions in VSAC" }, { "localId": "8", "name": "Atrial Fibrillation/Flutter", "id": "2.16.840.1.113883.3.117.1.7.1.202", "version": null, "accessLevel": "Public", "profile": "Most Recent Code System Versions in VSAC" }, { "localId": "9", "name": "Medical Reason", "id": "2.16.840.1.113883.3.117.1.7.1.473", "version": null, "accessLevel": "Public", "profile": "Most Recent Code System Versions in VSAC" }, { "localId": "10", "name": "Patient Refusal", "id": "2.16.840.1.113883.3.117.1.7.1.93", "version": null, "accessLevel": "Public", "profile": "Most Recent Code System Versions in VSAC" }, { "localId": "11", "name": "Atrial Ablation", "id": "2.16.840.1.113883.3.117.1.7.1.203", "version": null, "accessLevel": "Public", "profile": "Most Recent Code System Versions in VSAC" }, { "localId": "12", "name": "Non-Elective Inpatient Encounter", "id": "2.16.840.1.113883.3.117.1.7.1.424", "version": null, "accessLevel": "Public", "profile": "Most Recent Code System Versions in VSAC" }, { "localId": "13", "name": "Comfort Measures", "id": "1.3.6.1.4.1.33895.1.3.0.45", "version": null, "accessLevel": "Public", "profile": "Most Recent Code System Versions in VSAC" }, { "localId": "14", "name": "Patient Expired", "id": "2.16.840.1.113883.3.117.1.7.1.309", "version": null, "accessLevel": "Public", "profile": "Most Recent Code System Versions in VSAC" }, { "localId": "15", "name": "Left Against Medical Advice", "id": "2.16.840.1.113883.3.117.1.7.1.308", "version": null, "accessLevel": "Public", "profile": "Most Recent Code System Versions in VSAC" }, { "localId": "16", "name": "Discharged to Health Care Facility for Hospice Care", "id": "2.16.840.1.113883.3.117.1.7.1.207", "version": null, "accessLevel": "Public", "profile": "Most Recent Code System Versions in VSAC" }, { "localId": "17", "name": "Discharge To Acute Care Facility", "id": "2.16.840.1.113883.3.117.1.7.1.87", "version": null, "accessLevel": "Public", "profile": "Most Recent Code System Versions in VSAC" }, { "localId": "18", "name": "Discharged to Home for Hospice Care", "id": "2.16.840.1.113883.3.117.1.7.1.209", "version": null, "accessLevel": "Public", "profile": "Most Recent Code System Versions in VSAC" }, { "localId": "19", "name": "Hemorrhagic Stroke", "id": "2.16.840.1.113883.3.117.1.7.1.212", "version": null, "accessLevel": "Public", "profile": "Most Recent Code System Versions in VSAC" }, { "localId": "20", "name": "Ischemic Stroke", "id": "2.16.840.1.113883.3.117.1.7.1.247", "version": null, "accessLevel": "Public", "profile": "Most Recent Code System Versions in VSAC" } ] }, "statements": { "def": [ { "name": "Patient", "context": "Patient", "expression": { "type": "SingletonFrom", "operand": { "dataType": "{urn:healthit-gov:qdm:v5_0_1_draft}Patient", "templateId": "Patient", "type": "Retrieve" } } }, { "localId": "25", "name": "SDE Ethnicity", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "25", "s": [ { "value": [ "define ", "\"SDE Ethnicity\"", ": " ] }, { "r": "24", "s": [ { "value": [ "[", "\"Patient Characteristic Ethnicity\"", ": " ] }, { "s": [ { "value": [ "\"Ethnicity\"" ] } ] }, { "value": [ "]" ] } ] } ] } } ], "expression": { "localId": "24", "dataType": "{urn:healthit-gov:qdm:v5_0_1_draft}PatientCharacteristicEthnicity", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Ethnicity", "type": "ValueSetRef" } } }, { "localId": "27", "name": "SDE Payer", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "27", "s": [ { "value": [ "define ", "\"SDE Payer\"", ": " ] }, { "r": "26", "s": [ { "value": [ "[", "\"Patient Characteristic Payer\"", ": " ] }, { "s": [ { "value": [ "\"Payer\"" ] } ] }, { "value": [ "]" ] } ] } ] } } ], "expression": { "localId": "26", "dataType": "{urn:healthit-gov:qdm:v5_0_1_draft}PatientCharacteristicPayer", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Payer", "type": "ValueSetRef" } } }, { "localId": "29", "name": "SDE Race", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "29", "s": [ { "value": [ "define ", "\"SDE Race\"", ": " ] }, { "r": "28", "s": [ { "value": [ "[", "\"Patient Characteristic Race\"", ": " ] }, { "s": [ { "value": [ "\"Race\"" ] } ] }, { "value": [ "]" ] } ] } ] } } ], "expression": { "localId": "28", "dataType": "{urn:healthit-gov:qdm:v5_0_1_draft}PatientCharacteristicRace", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Race", "type": "ValueSetRef" } } }, { "localId": "31", "name": "SDE Sex", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "31", "s": [ { "value": [ "define ", "\"SDE Sex\"", ": " ] }, { "r": "30", "s": [ { "value": [ "[", "\"Patient Characteristic Sex\"", ": " ] }, { "s": [ { "value": [ "\"ONC Administrative Sex\"" ] } ] }, { "value": [ "]" ] } ] } ] } } ], "expression": { "localId": "30", "dataType": "{urn:healthit-gov:qdm:v5_0_1_draft}PatientCharacteristicSex", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "ONC Administrative Sex", "type": "ValueSetRef" } } }, { "localId": "44", "name": "Non Elective Inpatient Encounter", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "44", "s": [ { "value": [ "define ", "\"Non Elective Inpatient Encounter\"", ": " ] }, { "r": "43", "s": [ { "s": [ { "r": "33", "s": [ { "r": "32", "s": [ { "r": "32", "s": [ { "value": [ "[", "\"Encounter, Performed\"", ": " ] }, { "s": [ { "value": [ "\"Non-Elective Inpatient Encounter\"" ] } ] }, { "value": [ "]" ] } ] } ] }, { "value": [ " ", "NonElectiveEncounter" ] } ] } ] }, { "value": [ "\r\n " ] }, { "r": "42", "s": [ { "value": [ "where " ] }, { "r": "42", "s": [ { "r": "37", "s": [ { "r": "35", "s": [ { "r": "34", "s": [ { "value": [ "NonElectiveEncounter" ] } ] }, { "value": [ "." ] }, { "r": "35", "s": [ { "value": [ "lengthOfStay" ] } ] } ] }, { "value": [ " ", "<=", " " ] }, { "r": "36", "s": [ { "value": [ "120 ", "days" ] } ] } ] }, { "value": [ " \r\n and " ] }, { "r": "41", "s": [ { "r": "39", "s": [ { "r": "38", "s": [ { "value": [ "NonElectiveEncounter" ] } ] }, { "value": [ "." ] }, { "r": "39", "s": [ { "value": [ "relevantPeriod" ] } ] } ] }, { "value": [ " ", "ends during", " " ] }, { "r": "40", "s": [ { "value": [ "\"Measurement Period\"" ] } ] } ] } ] } ] } ] } ] } } ], "expression": { "localId": "43", "type": "Query", "source": [ { "localId": "33", "alias": "NonElectiveEncounter", "expression": { "localId": "32", "dataType": "{urn:healthit-gov:qdm:v5_0_1_draft}PositiveEncounterPerformed", "templateId": "PositiveEncounterPerformed", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Non-Elective Inpatient Encounter", "type": "ValueSetRef" } } } ], "relationship": [ ], "where": { "localId": "42", "type": "And", "operand": [ { "localId": "37", "type": "LessOrEqual", "operand": [ { "localId": "35", "path": "lengthOfStay", "scope": "NonElectiveEncounter", "type": "Property" }, { "localId": "36", "value": 120, "unit": "days", "type": "Quantity" } ] }, { "localId": "41", "type": "In", "operand": [ { "type": "End", "operand": { "localId": "39", "path": "relevantPeriod", "scope": "NonElectiveEncounter", "type": "Property" } }, { "localId": "40", "name": "Measurement Period", "type": "ParameterRef" } ] } ] } } }, { "localId": "69", "name": "Encounter with Principal Diagnosis and Age", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "69", "s": [ { "value": [ "define ", "\"Encounter with Principal Diagnosis and Age\"", ": " ] }, { "r": "68", "s": [ { "s": [ { "r": "46", "s": [ { "r": "45", "s": [ { "s": [ { "value": [ "\"Non Elective Inpatient Encounter\"" ] } ] } ] }, { "value": [ " ", "NonElectiveEncounter" ] } ] } ] }, { "value": [ "\r\n " ] }, { "r": "58", "s": [ { "value": [ "with " ] }, { "r": "48", "s": [ { "r": "47", "s": [ { "r": "47", "s": [ { "value": [ "[", "\"Patient Characteristic Birthdate\"", "]" ] } ] } ] }, { "value": [ " ", "P" ] } ] }, { "value": [ "\r\n such that " ] }, { "r": "57", "s": [ { "r": "55", "s": [ { "r": "49", "s": [ { "value": [ "global" ] } ] }, { "value": [ "." ] }, { "r": "55", "s": [ { "value": [ "\"CalendarAgeInYearsAt\"", "(" ] }, { "r": "51", "s": [ { "r": "50", "s": [ { "value": [ "P" ] } ] }, { "value": [ "." ] }, { "r": "51", "s": [ { "value": [ "birthDatetime" ] } ] } ] }, { "value": [ ", " ] }, { "r": "54", "s": [ { "value": [ "start of " ] }, { "r": "53", "s": [ { "r": "52", "s": [ { "value": [ "NonElectiveEncounter" ] } ] }, { "value": [ "." ] }, { "r": "53", "s": [ { "value": [ "relevantPeriod" ] } ] } ] } ] }, { "value": [ ")" ] } ] } ] }, { "value": [ " ", ">=", " ", "18" ] } ] } ] }, { "value": [ "\r\n" ] }, { "r": "67", "s": [ { "value": [ "where " ] }, { "r": "67", "s": [ { "value": [ "(" ] }, { "r": "67", "s": [ { "r": "62", "s": [ { "r": "60", "s": [ { "r": "59", "s": [ { "value": [ "NonElectiveEncounter" ] } ] }, { "value": [ "." ] }, { "r": "60", "s": [ { "value": [ "principalDiagnosis" ] } ] } ] }, { "value": [ " in " ] }, { "r": "61", "s": [ { "value": [ "\"Hemorrhagic Stroke\"" ] } ] } ] }, { "value": [ "\r\nor " ] }, { "r": "66", "s": [ { "r": "64", "s": [ { "r": "63", "s": [ { "value": [ "NonElectiveEncounter" ] } ] }, { "value": [ "." ] }, { "r": "64", "s": [ { "value": [ "principalDiagnosis" ] } ] } ] }, { "value": [ " in " ] }, { "r": "65", "s": [ { "value": [ "\"Ischemic Stroke\"" ] } ] } ] } ] }, { "value": [ ")" ] } ] } ] } ] } ] } } ], "expression": { "localId": "68", "type": "Query", "source": [ { "localId": "46", "alias": "NonElectiveEncounter", "expression": { "localId": "45", "name": "Non Elective Inpatient Encounter", "type": "ExpressionRef" } } ], "relationship": [ { "localId": "58", "alias": "P", "type": "With", "expression": { "localId": "47", "dataType": "{urn:healthit-gov:qdm:v5_0_1_draft}PatientCharacteristicBirthdate", "type": "Retrieve" }, "suchThat": { "localId": "57", "type": "GreaterOrEqual", "operand": [ { "localId": "55", "name": "CalendarAgeInYearsAt", "libraryName": "global", "type": "FunctionRef", "operand": [ { "localId": "51", "path": "birthDatetime", "scope": "P", "type": "Property" }, { "localId": "54", "type": "Start", "operand": { "localId": "53", "path": "relevantPeriod", "scope": "NonElectiveEncounter", "type": "Property" } } ] }, { "localId": "56", "valueType": "{urn:hl7-org:elm-types:r1}Integer", "value": "18", "type": "Literal" } ] } } ], "where": { "localId": "67", "type": "Or", "operand": [ { "localId": "62", "type": "InValueSet", "code": { "localId": "60", "path": "principalDiagnosis", "scope": "NonElectiveEncounter", "type": "Property" }, "valueset": { "localId": "61", "name": "Hemorrhagic Stroke" } }, { "localId": "66", "type": "InValueSet", "code": { "localId": "64", "path": "principalDiagnosis", "scope": "NonElectiveEncounter", "type": "Property" }, "valueset": { "localId": "65", "name": "Ischemic Stroke" } } ] } } }, { "localId": "71", "name": "Initial Population", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "71", "s": [ { "value": [ "define ", "\"Initial 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Diagnosis Atrial FibrillationFlutter", "statement_references": [ { "hqmf_id": null, "library_name": "AnticoagulationTherapyforAtrialFibrillationFlutter", "statement_name": "Encounter with Principle Diagnosis of Ischemic Stroke" } ] }, { "statement_name": "History of Atrial FibrillationFlutter", "statement_references": [ { "hqmf_id": null, "library_name": "AnticoagulationTherapyforAtrialFibrillationFlutter", "statement_name": "Encounter with Principle Diagnosis of Ischemic Stroke" } ] }, { "statement_name": "Denominator", "statement_references": [ { "hqmf_id": null, "library_name": "AnticoagulationTherapyforAtrialFibrillationFlutter", "statement_name": "Encounter with Atrial Ablation Procedure" }, { "hqmf_id": null, "library_name": "AnticoagulationTherapyforAtrialFibrillationFlutter", "statement_name": "History of Atrial FibrillationFlutter" }, { "hqmf_id": null, "library_name": "AnticoagulationTherapyforAtrialFibrillationFlutter", "statement_name": "Current Diagnosis Atrial FibrillationFlutter" } ] }, { "statement_name": "Anticoagulant Therapy at Discharge" }, { "statement_name": "Numerator", "statement_references": [ { "hqmf_id": null, "library_name": "AnticoagulationTherapyforAtrialFibrillationFlutter", "statement_name": "Denominator" }, { "hqmf_id": null, "library_name": "AnticoagulationTherapyforAtrialFibrillationFlutter", "statement_name": "Anticoagulant Therapy at Discharge" } ] }, { "statement_name": "Anticoagulant Not Given at Discharge" }, { "statement_name": "Denominator Exceptions", "statement_references": [ { "hqmf_id": null, "library_name": "AnticoagulationTherapyforAtrialFibrillationFlutter", "statement_name": "Denominator" }, { "hqmf_id": null, "library_name": "AnticoagulationTherapyforAtrialFibrillationFlutter", "statement_name": "Anticoagulant Not Given at Discharge" } ] }, { "statement_name": "Intervention Comfort Measures" }, { "statement_name": "Comfort Measures during Hospitalization", "statement_references": [ { "hqmf_id": null, "library_name": "AnticoagulationTherapyforAtrialFibrillationFlutter", "statement_name": "Denominator" }, { "hqmf_id": null, "library_name": "AnticoagulationTherapyforAtrialFibrillationFlutter", "statement_name": "Intervention Comfort Measures" }, { "hqmf_id": null, "library_name": "MATGlobalCommonFunctions", "statement_name": "Hospitalization" } ] }, { "statement_name": "Denominator Exclusions1", "statement_references": [ { "hqmf_id": null, "library_name": "AnticoagulationTherapyforAtrialFibrillationFlutter", "statement_name": "Denominator" }, { "hqmf_id": null, "library_name": "AnticoagulationTherapyforAtrialFibrillationFlutter", "statement_name": "Comfort Measures during Hospitalization" } ] } ] }, { "cql": "library MATGlobalCommonFunctions version '1.0.000'\n\nusing QDM version '5.0.2'\n\ncodesystem \"LOINC:2.46\": 'urn:oid:2.16.840.1.113883.6.1' version 'urn:hl7:version:2.46'\n\ncodesystem \"SNOMEDCT:2016-03\": 'urn:oid:2.16.840.1.113883.6.96' version 'urn:hl7:version:2016-03'\n\nvalueset \"Emergency Department Visit\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.292' \n\ncode \"Birthdate\": '21112-8' from \"LOINC:2.46\" display 'Birth date'\n\ncode \"Dead\": '419099009' from \"SNOMEDCT:2016-03\" display 'Dead'\n\nparameter \"Measurement Period\" Interval\n\ncontext Patient\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,\ngiven the DateTime @2012-01-01T06:30:00.0Z, this function will return\n@2012-01-01T00:00:00.0Z.*/\ndefine function \"ToDate\"(DateTime DateTime ): DateTime(year from DateTime, month from DateTime, day from DateTime, 0, 0, 0, 0, timezone from DateTime)\n\n/*CalendarAgeInYearsAt calculates the calendar age (meaning the age without\nconsidering time components) in years.*/\ndefine function \"CalendarAgeInYearsAt\"(BirthDateTime DateTime, AsOf DateTime ): years between ToDate(BirthDateTime) and ToDate(AsOf)\n\n/*CalendarAgeInMonthsAt calculates the calendar age (meaning the age without considering time components) in months.*/\ndefine function \"CalendarAgeInMonthsAt\"(BirthDateTime DateTime, AsOf DateTime ): months between ToDate(BirthDateTime) and ToDate(AsOf)\n\n/*CalendarAgeInDaysAt calculates the calendar age (meaning the age without\nconsidering time components) in days.*/\ndefine function \"CalendarAgeInDaysAt\"(BirthDateTime DateTime, AsOf DateTime ): days between ToDate(BirthDateTime) and ToDate(AsOf)\n\n/*CalendarAgeInYears calculates the calendar age (meaning the age without\nconsidering time components) in years as of today.*/\ndefine function \"CalendarAgeInYears\"(BirthDateTime DateTime ): CalendarAgeInYearsAt(BirthDateTime, Today())\n\n/*CalendarAgeInMonths calculates the calendar age (meaning the age without\nconsidering time components) in months as of today.*/\ndefine function \"CalendarAgeInMonths\"(BirthDateTime DateTime ): CalendarAgeInMonthsAt(BirthDateTime, Today())\n\n/*CalendarAgeInDays calculates the calendar age (meaning the age without\nconsidering time components) in days as of today.*/\ndefine function \"CalendarAgeInDays\"(BirthDateTime DateTime ): CalendarAgeInDaysAt(BirthDateTime, Today())\n\n/*TotalLengthOfStay calculates the difference in calendar days between the\nstart and end of the given stay interval.*/\ndefine function \"TotalLengthOfStay\"(Stay Interval ): difference in days between start of Stay and end of Stay\n\n/*Hospitalization returns the total interval for admission to discharge for\nthe given encounter, or for the admission of any immediately prior emergency \ndepartment visit to the discharge of the given encounter.*/\ndefine function \"Hospitalization\"(Encounter \"Encounter, Performed\" ): (\r\n singleton from (\r\n [\"Encounter, Performed\": \"Emergency Department Visit\"] EDVisit\r\n where EDVisit.relevantPeriod ends 1 hour or less on or before start of Encounter.relevantPeriod\r\n )\r\n ) X\r\n return if X is null then Encounter.relevantPeriod\r\n else Interval[start of X.relevantPeriod, end of Encounter.relevantPeriod]\n\n", "elm": { "library": { "identifier": { "id": "MATGlobalCommonFunctions", "version": "1.0.000" }, "schemaIdentifier": { "id": "urn:hl7-org:elm", "version": "r1" }, "usings": { "def": [ { "localIdentifier": "System", "uri": "urn:hl7-org:elm-types:r1" }, { "localId": "1", "localIdentifier": "QDM", "uri": "urn:healthit-gov:qdm:v5_0_1_draft", "version": 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"419099009", "display": "Dead", "accessLevel": "Public", "codeSystem": { "localId": "7", "name": "SNOMEDCT:2016-03" } } ] }, "statements": { "def": [ { "name": "Patient", "context": "Patient", "expression": { "type": "SingletonFrom", "operand": { "dataType": "{urn:healthit-gov:qdm:v5_0_1_draft}Patient", "templateId": "Patient", "type": "Retrieve" } } }, { "localId": "26", "name": "ToDate", "context": "Patient", "accessLevel": "Public", "type": "FunctionDef", "annotation": [ { "type": "Annotation", "s": { "r": "26", "s": [ { "value": [ "define function ", "\"ToDate\"", "(", "DateTime", " " ] }, { "r": "12", "s": [ { "value": [ "DateTime" ] } ] }, { "value": [ " ): " ] }, { "r": "25", "s": [ { "r": "25", "s": [ { "value": [ "DateTime", "(" ] }, { "r": "14", "s": [ { "value": [ "year from " ] }, { "r": "13", "s": [ { "value": [ "DateTime" ] } ] } ] }, { "value": [ ", " ] }, { "r": "16", "s": [ { "value": [ "month from " ] }, { "r": "15", "s": [ { "value": [ "DateTime" ] } ] } ] }, { 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"Today", "ref_id": "53" }, { "children": [ { "text": " )" } ] } ], "node_type": "FunctionRef", "ref_id": "54" } ], "node_type": "FunctionRef", "ref_id": "54" } ], "ref_id": "55" } ], "define_name": "CalendarAgeInYears" }, { "children": [ { "children": [ { "children": [ { "text": " define function \"CalendarAgeInMonths\"(BirthDateTime " } ] }, { "children": [ { "children": [ { "text": "DateTime" } ] } ], "ref_id": "56" }, { "children": [ { "text": " ): " } ] }, { "children": [ { "children": [ { "children": [ { "text": "CalendarAgeInMonthsAt(" } ] }, { "children": [ { "children": [ { "text": " BirthDateTime" } ] } ], "node_type": "OperandRef", "ref_id": "57" }, { "children": [ { "text": " , " } ] }, { "children": [ { "children": [ { "text": "Today()" } ] } ], "node_type": "Today", "ref_id": "58" }, { "children": [ { "text": " )" } ] } ], "node_type": "FunctionRef", "ref_id": "59" } ], "node_type": "FunctionRef", "ref_id": "59" } ], "ref_id": "60" } ], "define_name": "CalendarAgeInMonths" }, { "children": [ { "children": [ { "children": [ { "text": " define function \"CalendarAgeInDays\"(BirthDateTime " } ] }, { "children": [ { "children": [ { "text": "DateTime" } ] } ], "ref_id": "61" }, { "children": [ { "text": " ): " } ] }, { "children": [ { "children": [ { "children": [ { "text": "CalendarAgeInDaysAt(" } ] }, { "children": [ { "children": [ { "text": " BirthDateTime" } ] } ], "node_type": "OperandRef", "ref_id": "62" }, { "children": [ { "text": " , " } ] }, { "children": [ { "children": [ { "text": "Today()" } ] } ], "node_type": "Today", "ref_id": "63" }, { "children": [ { "text": " )" } ] } ], "node_type": "FunctionRef", "ref_id": "64" } ], "node_type": "FunctionRef", "ref_id": "64" } ], "ref_id": "65" } ], "define_name": "CalendarAgeInDays" }, { "children": [ { "children": [ { "children": [ { "text": " define function \"TotalLengthOfStay\"(Stay " } ] }, { "children": [ { "children": [ { "text": "Interval<" } ] }, { "children": [ { "children": [ { "text": " DateTime" } ] } ], "ref_id": "66" }, { "children": [ { "text": " >" } ] } ], "ref_id": "67" }, { "children": [ { "text": " ): " } ] }, { "children": [ { "children": [ { "children": [ { "text": "difference in days between " } ] }, { "children": [ { "children": [ { "text": "start of " } ] }, { "children": [ { "children": [ { "text": "Stay" } ] } ], "node_type": "OperandRef", "ref_id": "68" } ], "node_type": "Start", "ref_id": "69" }, { "children": [ { "text": " and " } ] }, { "children": [ { "children": [ { "text": "end of " } ] }, { "children": [ { "children": [ { "text": "Stay" } ] } ], "node_type": "OperandRef", "ref_id": "70" } ], "node_type": "End", "ref_id": "71" } ], "node_type": "DifferenceBetween", "ref_id": "72" } ], "node_type": "DifferenceBetween", "ref_id": "72" } ], "ref_id": "73" } ], "define_name": "TotalLengthOfStay" }, { "children": [ { "children": [ { "children": [ { "text": " define function \"Hospitalization\"(Encounter " } ] }, { "children": [ { "children": [ { "text": "\"Encounter, Performed\"" } ] } ], "ref_id": "74" }, { "children": [ { "text": " ): " } ] }, { "children": [ { "children": [ { "children": [ { "children": [ { "children": [ { "children": [ { "text": "( \n " } ] }, { "children": [ { "children": [ { "text": "singleton from " } ] }, { "children": [ { "children": [ { "text": "( \n " } ] }, { "children": [ { "children": [ { "children": [ { "children": [ { "children": [ { "children": [ { "text": "[\"Encounter, Performed\": " } ] }, { "children": [ { "children": [ { "text": "\"Emergency Department Visit\"" } ] } ] }, { "children": [ { "text": " ]" } ] } ], "node_type": "Retrieve", "ref_id": "75" } ], "node_type": "Retrieve", "ref_id": "75" }, { "children": [ { "text": " EDVisit" } ] } ], "ref_id": "76" } ] }, { "children": [ { "text": " \n " } ] }, { "children": [ { "children": [ { "text": "where " } ] }, { "children": [ { "children": [ { "children": [ { "children": [ { "text": "EDVisit" } ] } ], "ref_id": "77" }, { "children": [ { "text": "." } ] }, { "children": [ { "children": [ { "text": "relevantPeriod" } ] } ], "node_type": "Property", "ref_id": "78" } ], "node_type": "Property", "ref_id": "78" }, { "children": [ { "text": " " } ] }, { "children": [ { "children": [ { "text": "ends " } ] }, { "children": [ { "children": [ { "text": "1 hour" } ] } ], "node_type": "Quantity", "ref_id": "82" }, { "children": [ { "text": " or less on or before" } ] } ], "ref_id": "83" }, { "children": [ { "text": " " } ] }, { "children": [ { "children": [ { "text": "start of " } ] }, { "children": [ { "children": [ { "children": [ { "text": "Encounter" } ] } ], "ref_id": "79" }, { "children": [ { "text": "." } ] }, { "children": [ { "children": [ { "text": "relevantPeriod" } ] } ], "node_type": "Property", "ref_id": "80" } ], "node_type": "Property", "ref_id": "80" } ], "node_type": "Start", "ref_id": "81" } ], "ref_id": "83" } ], "ref_id": "83" } ], "node_type": "Query", "ref_id": "84" }, { "children": [ { "text": " \n )" } ] } ], "node_type": "Query", "ref_id": "84" } ], "node_type": "SingletonFrom", "ref_id": "85" }, { "children": [ { "text": " \n )" } ] } ], "node_type": "SingletonFrom", "ref_id": "85" }, { "children": [ { "text": " X" } ] } ], "ref_id": "86" } ] }, { "children": [ { "text": " \n " } ] }, { "children": [ { "children": [ { "text": "return " } ] }, { "children": [ { "children": [ { "text": "if " } ] }, { "children": [ { "children": [ { "children": [ { "text": "X" } ] } ], "node_type": "AliasRef", "ref_id": "87" }, { "children": [ { "text": " is null" } ] } ], "node_type": "IsNull", "ref_id": "88" }, { "children": [ { "text": " then " } ] }, { "children": [ { "children": [ { "children": [ { "text": "Encounter" } ] } ], "ref_id": "89" }, { "children": [ { "text": "." } ] }, { "children": [ { "children": [ { "text": "relevantPeriod" } ] } ], "ref_id": "90" } ], "ref_id": "90" }, { "children": [ { "text": " \n else " } ] }, { "children": [ { "children": [ { "text": "Interval[" } ] }, { "children": [ { "children": [ { "text": " start of " } ] }, { "children": [ { "children": [ { "children": [ { "text": "X" } ] } ], "ref_id": "91" }, { "children": [ { "text": "." } ] }, { "children": [ { "children": [ { "text": "relevantPeriod" } ] } ], "node_type": "Property", "ref_id": "92" } ], "node_type": "Property", "ref_id": "92" } ], "ref_id": "93" }, { "children": [ { "text": " , " } ] }, { "children": [ { "children": [ { "text": "end of " } ] }, { "children": [ { "children": [ { "children": [ { "text": "Encounter" } ] } ], "ref_id": "94" }, { "children": [ { "text": "." } ] }, { "children": [ { "children": [ { "text": "relevantPeriod" } ] } ], "node_type": "Property", "ref_id": "95" } ], "node_type": "Property", "ref_id": "95" } ], "ref_id": "96" }, { "children": [ { "text": " ]" } ] } ], "ref_id": "97" } ], "node_type": "If", "ref_id": "98" } ], "ref_id": "99" } ], "node_type": "Query", "ref_id": "100" } ], "node_type": "Query", "ref_id": "100" } ], "ref_id": "101" } ], "define_name": "Hospitalization" } ], "identifier": { "id": "MATGlobalCommonFunctions", "version": "1.0.000" } }, "is_main_library": false, "is_top_level": true, "library_name": "MATGlobalCommonFunctions", "library_version": "1.0.000", "statement_dependencies": [ { "statement_name": "CalendarAgeInYearsAt", "statement_references": [ { "hqmf_id": null, "library_name": "MATGlobalCommonFunctions", "statement_name": "ToDate" } ] }, { "statement_name": "ToDate" }, { "statement_name": "Hospitalization" } ] } ], "created_at": null, "description": "Ischemic stroke patients with atrial fibrillation/flutter who are prescribed or continuing to take anticoagulation therapy at hospital discharge", "hqmf_id": "40280582-5C27-8179-015C-319B52CF0120", "hqmf_set_id": "9DD5F699-F535-48BB-8140-306C656A587E", "hqmf_version_number": "0", "main_cql_library": "AnticoagulationTherapyforAtrialFibrillationFlutter", "measure_attributes": [ { "code": "OTH", "value": "723", "name": "eMeasure Identifier (Measure Authoring Tool)", "code_obj": { "type": "CD", "null_flavor": "OTH", "original_text": "eMeasure Identifier (Measure Authoring Tool)" }, "value_obj": { "type": "ED", "value": "723", "media_type": "text/plain" } }, { "code": "OTH", "value": "Not Applicable", "name": "NQF Number", "code_obj": { "type": "CD", "null_flavor": "OTH", "original_text": "NQF Number" }, "value_obj": { "type": "ED", "value": "Not Applicable", "media_type": "text/plain" } }, { "code": "COPY", "value": "Measure specifications are in the Public Domain.\n\nLOINC(R) is a registered trademark of the Regenstrief Institute.\n\nThis material contains SNOMED Clinical Terms(R) (SNOMED CT(C)) copyright 2004-2016 International Health Terminology Standards Development Organization. All rights reserved.", "name": "Copyright", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "COPY", "title": "Copyright" }, "value_obj": { "type": "ED", "value": "Measure specifications are in the Public Domain.\n\nLOINC(R) is a registered trademark of the Regenstrief Institute.\n\nThis material contains SNOMED Clinical Terms(R) (SNOMED CT(C)) copyright 2004-2016 International Health Terminology Standards Development Organization. All rights reserved.", "media_type": "text/plain" } }, { "code": "DISC", "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.", "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": "Nonvalvular atrial fibrillation (NVAF) is a common arrhythmia and an important risk factor for stroke. It is one of several conditions and lifestyle factors that have been identified as risk factors for stroke. It has been estimated that over 2 million adults in the United States have NVAF. While the median age of patients with atrial fibrillation is 75 years, the incidence increases with advancing age. For example, The Framingham Heart Study noted a dramatic increase in stroke risk associated with atrial fibrillation with advancing age, from 1.5% for those 50 to 59 years of age to 23.5% for those 80 to 89 years of age. Furthermore, a prior stroke or transient ischemic attack (TIA) are among a limited number of predictors of high stroke risk within the population of patients with atrial fibrillation. Therefore, much emphasis has been placed on identifying methods for preventing recurrent ischemic stroke as well as preventing first stroke. Prevention strategies focus on the modifiable risk factors such as hypertension, smoking, and atrial fibrillation. Analysis of five placebo-controlled clinical trials investigating the efficacy of warfarin in the primary prevention of thromboembolic stroke, found the relative risk of thromboembolic stroke was reduced by 68% for atrial fibrillation patients treated with warfarin. The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk-atrial fibrillation patients with TIA or prior stroke.", "name": "Rationale", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "RAT", "title": "Rationale" }, "value_obj": { "type": "ED", "value": "Nonvalvular atrial fibrillation (NVAF) is a common arrhythmia and an important risk factor for stroke. It is one of several conditions and lifestyle factors that have been identified as risk factors for stroke. It has been estimated that over 2 million adults in the United States have NVAF. While the median age of patients with atrial fibrillation is 75 years, the incidence increases with advancing age. For example, The Framingham Heart Study noted a dramatic increase in stroke risk associated with atrial fibrillation with advancing age, from 1.5% for those 50 to 59 years of age to 23.5% for those 80 to 89 years of age. Furthermore, a prior stroke or transient ischemic attack (TIA) are among a limited number of predictors of high stroke risk within the population of patients with atrial fibrillation. Therefore, much emphasis has been placed on identifying methods for preventing recurrent ischemic stroke as well as preventing first stroke. Prevention strategies focus on the modifiable risk factors such as hypertension, smoking, and atrial fibrillation. Analysis of five placebo-controlled clinical trials investigating the efficacy of warfarin in the primary prevention of thromboembolic stroke, found the relative risk of thromboembolic stroke was reduced by 68% for atrial fibrillation patients treated with warfarin. The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk-atrial fibrillation patients with TIA or prior stroke.", "media_type": "text/plain" } }, { "code": "CRS", "value": "The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk atrial fibrillation patients with TIA or prior stroke", "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": "The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk atrial fibrillation patients with TIA or prior stroke", "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": "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": "Goldstein, L. B., R. Adams, M. J. Alberts, L. J. Appel, L. M. Brass, C. D. Bushnell, A. Culebras, et al. \"Primary Prevention of Ischemic Stroke: A Guideline from the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology Affirms the Value of This Guideline.\" [In eng]. Stroke 37, no. 6 (Jun 2006): 1583-633.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Goldstein, L. B., R. Adams, M. J. Alberts, L. J. Appel, L. M. Brass, C. D. Bushnell, A. Culebras, et al. \"Primary Prevention of Ischemic Stroke: A Guideline from the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology Affirms the Value of This Guideline.\" [In eng]. Stroke 37, no. 6 (Jun 2006): 1583-633.", "media_type": "text/plain" } }, { "code": "REF", "value": "Jauch, E. C., J. L. Saver, H. P. Adams, Jr., A. Bruno, J. J. Connors, B. M. Demaerschalk, P. Khatri, et al. \"Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association.\" [In Eng]. Stroke (Jan 31 2013).", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Jauch, E. C., J. L. Saver, H. P. Adams, Jr., A. Bruno, J. J. Connors, B. M. Demaerschalk, P. Khatri, et al. \"Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association.\" [In Eng]. Stroke (Jan 31 2013).", "media_type": "text/plain" } }, { "code": "REF", "value": "Saxena, R., and P. J. Koudstaal. \"Anticoagulants for Preventing Stroke in Patients with Nonrheumatic Atrial Fibrillation and a History of Stroke or Transient Ischemic Attack (Review).\" Cochrane Database Syst Rev, no. 4 (2011): CD000185.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Saxena, R., and P. J. Koudstaal. \"Anticoagulants for Preventing Stroke in Patients with Nonrheumatic Atrial Fibrillation and a History of Stroke or Transient Ischemic Attack (Review).\" Cochrane Database Syst Rev, no. 4 (2011): CD000185.", "media_type": "text/plain" } }, { "code": "REF", "value": "Wann, L. S., A. B. Curtis, K. A. Ellenbogen, N. A. Estes, 3rd, M. D. Ezekowitz, W. M. Jackman, C. T. January, et al. \"2011 Accf/Aha/Hrs Focused Update on the Management of Patients with Atrial Fibrillation (Update on Dabigatran): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.\" [In eng]. J Am Coll Cardiol 57, no. 11 (Mar 15 2011): 1330-7.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Wann, L. S., A. B. Curtis, K. A. Ellenbogen, N. A. Estes, 3rd, M. D. Ezekowitz, W. M. Jackman, C. T. January, et al. \"2011 Accf/Aha/Hrs Focused Update on the Management of Patients with Atrial Fibrillation (Update on Dabigatran): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.\" [In eng]. J Am Coll Cardiol 57, no. 11 (Mar 15 2011): 1330-7.", "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, and a history of atrial ablation, or current or history of atrial fibrillation/flutter", "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, and a history of atrial ablation, or current or history of atrial fibrillation/flutter", "media_type": "text/plain" } }, { "code": "DENEX", "value": "*Patients with comfort measures documented\n*Patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations\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 with comfort measures documented\n*Patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations\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 anticoagulation therapy 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 anticoagulation therapy 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 documented reason for not prescribing anticoagulation therapy at discharge", "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 documented reason for not prescribing anticoagulation therapy at discharge", "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": "01B24ECE-AFD8-455A-8BD6-5A25E8140E29", "preconditions": [ { "id": 2, "preconditions": [ { "id": 1, "reference": "AnticoagulationTherapyforAtrialFibrillationFlutter__Initial_Population__F2F9D317_51D2_42B7_8136_481CF3D0D938" } ], "conjunction_code": "allTrue" } ] }, "DENOM": { "conjunction?": true, "type": "DENOM", "hqmf_id": "6D2B4FB4-927B-4A06-AABD-5A8292456B13", "preconditions": [ { "id": 4, "preconditions": [ { "id": 3, "reference": "AnticoagulationTherapyforAtrialFibrillationFlutter__Denominator__F2F9D317_51D2_42B7_8136_481CF3D0D938" } ], "conjunction_code": "allTrue" } ] }, "NUMER": { "conjunction?": true, "type": "NUMER", "hqmf_id": "6BB70950-043A-42EC-BE2F-220B07DD032B", "preconditions": [ { "id": 6, "preconditions": [ { "id": 5, "reference": "AnticoagulationTherapyforAtrialFibrillationFlutter__Numerator__F2F9D317_51D2_42B7_8136_481CF3D0D938" } ], "conjunction_code": "allTrue" } ] }, "DENEXCEP": { "conjunction?": true, "type": "DENEXCEP", "hqmf_id": "FBEF99C5-E341-4787-A5BF-7CE998479227", "preconditions": [ { "id": 8, "preconditions": [ { "id": 7, "reference": "AnticoagulationTherapyforAtrialFibrillationFlutter__Denominator_Exceptions__F2F9D317_51D2_42B7_8136_481CF3D0D938" } ], "conjunction_code": "atLeastOneTrue" } ] }, "DENEX": { "conjunction?": true, "type": "DENEX", "hqmf_id": "E07B6982-75C9-4FB1-804D-1B1B58C368BD", "preconditions": [ { "id": 10, "preconditions": [ { "id": 9, "reference": "AnticoagulationTherapyforAtrialFibrillationFlutter__Denominator_Exclusions1__F2F9D317_51D2_42B7_8136_481CF3D0D938" } ], "conjunction_code": "atLeastOneTrue" } ] } }, "population_sets": [ { "population_set_id": "PopulationCriteria1", "populations": { "DENEX": { "hqmf_id": "E07B6982-75C9-4FB1-804D-1B1B58C368BD", "library_name": "AnticoagulationTherapyforAtrialFibrillationFlutter", "statement_name": "Denominator Exclusions1" }, "DENEXCEP": { "hqmf_id": "FBEF99C5-E341-4787-A5BF-7CE998479227", "library_name": "AnticoagulationTherapyforAtrialFibrillationFlutter", "statement_name": "Denominator Exceptions" }, "DENOM": { "hqmf_id": "6D2B4FB4-927B-4A06-AABD-5A8292456B13", "library_name": "AnticoagulationTherapyforAtrialFibrillationFlutter", "statement_name": "Denominator" }, "IPP": { "hqmf_id": "01B24ECE-AFD8-455A-8BD6-5A25E8140E29", "library_name": "AnticoagulationTherapyforAtrialFibrillationFlutter", "statement_name": "Initial Population" }, "NUMER": { "hqmf_id": "6BB70950-043A-42EC-BE2F-220B07DD032B", "library_name": "AnticoagulationTherapyforAtrialFibrillationFlutter", "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": "5d289cdb31fe5f8b990524a7", "qdmCategory": "patient_characteristic", "qdmStatus": "payer", "qdmTitle": "Patient Characteristic Payer", "qdmVersion": "5.5", "relevantPeriod": null, "_type": "QDM::PatientCharacteristicPayer" }, { "anatomicalLocationSite": null, "authorDatetime": null, "codeListId": "2.16.840.1.113883.3.117.1.7.1.203", "components": null, "dataElementCodes": [ ], "description": "Procedure, Performed: AtrialAblation", "hqmfOid": "2.16.840.1.113883.10.20.28.4.67", "id": "5d289cdb31fe5f8b990524a8", "incisionDatetime": null, "method": null, "negationRationale": null, "performer": null, "priority": null, "qdmCategory": "procedure", "qdmStatus": "performed", "qdmTitle": "Procedure, Performed", "qdmVersion": "5.5", "rank": null, "reason": null, "relevantDatetime": null, "relevantPeriod": null, "result": null, "status": null, "_type": "QDM::ProcedurePerformed" }, { "authorDatetime": null, "codeListId": "1.3.6.1.4.1.33895.1.3.0.45", "dataElementCodes": [ ], "description": "Intervention, Order: ComfortMeasures", "hqmfOid": "2.16.840.1.113883.10.20.28.4.35", "id": "5d289cdb31fe5f8b990524a9", "negationRationale": null, "qdmCategory": "intervention", "qdmStatus": "order", "qdmTitle": "Intervention, Order", "qdmVersion": "5.5", "reason": null, "requester": null, "_type": "QDM::InterventionOrder" }, { "authorDatetime": null, "codeListId": "1.3.6.1.4.1.33895.1.3.0.45", "dataElementCodes": [ ], "description": "Intervention, Performed: ComfortMeasures", "hqmfOid": "2.16.840.1.113883.10.20.28.4.36", "id": "5d289cdb31fe5f8b990524aa", "negationRationale": null, "performer": null, "qdmCategory": "intervention", "qdmStatus": "performed", "qdmTitle": "Intervention, Performed", "qdmVersion": "5.5", "reason": null, "relevantDatetime": null, "relevantPeriod": null, "result": null, "status": null, "_type": "QDM::InterventionPerformed" }, { "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": "5d289cdb31fe5f8b990524ab", "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": "5d289cdb31fe5f8b990524ac", "qdmCategory": "patient_characteristic", "qdmStatus": "gender", "qdmTitle": "Patient Characteristic Sex", "qdmVersion": "5.5", "_type": "QDM::PatientCharacteristicSex" }, { "admissionSource": null, "authorDatetime": null, "codeListId": "2.16.840.1.113883.3.117.1.7.1.424", "dataElementCodes": [ ], "description": 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null, "_type": "QDM::MedicationDischarge" }, { "authorDatetime": null, "codeListId": "2.16.840.1.113883.3.117.1.7.1.200", "dataElementCodes": [ ], "daysSupplied": null, "description": "Medication, Discharge: AnticoagulantTherapy", "dosage": null, "frequency": null, "hqmfOid": "2.16.840.1.113883.10.20.28.4.48", "id": "5d289cdb31fe5f8b990524af", "negationRationale": null, "prescriber": null, "qdmCategory": "medication", "qdmStatus": "discharge", "qdmTitle": "Medication, Discharge", "qdmVersion": "5.5", "recorder": null, "refills": null, "route": null, "supply": null, "_type": "QDM::MedicationDischarge" }, { "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": "5d289cdb31fe5f8b990524b0", "qdmCategory": "patient_characteristic", "qdmStatus": "race", "qdmTitle": "Patient Characteristic Race", "qdmVersion": "5.5", "_type": "QDM::PatientCharacteristicRace" }, { "anatomicalLocationSite": null, "authorDatetime": null, "codeListId": "2.16.840.1.113883.3.117.1.7.1.202", "dataElementCodes": [ ], "description": "Diagnosis: AtrialFibrillation/Flutter", "hqmfOid": "2.16.840.1.113883.10.20.28.4.110", "id": "5d289cdb31fe5f8b990524b1", "prevalencePeriod": null, "qdmCategory": "condition", "qdmTitle": "Diagnosis", "qdmVersion": "5.5", "qrdaOid": "2.16.840.1.113883.10.20.24.3.135", "recorder": null, "severity": null, "_type": "QDM::Diagnosis" }, { "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": "5d289cdb31fe5f8b990524b2", "lengthOfStay": null, "negationRationale": null, "participant": null, "priority": null, "qdmCategory": "encounter", "qdmStatus": "performed", "qdmTitle": "Encounter, Performed", "qdmVersion": "5.5", "relevantPeriod": null, "_type": "QDM::EncounterPerformed" } ], "title": "Anticoagulation Therapy for Atrial Fibrillation/Flutter", "updated_at": null, "value_set_ids": [ "5d289cdb31fe5f8b9905249c", "5d289cdb31fe5f8b9905249d", "5d289cdb31fe5f8b9905249e", "5d289cdb31fe5f8b9905249f", "5d289cdb31fe5f8b990524a0", "5d289cdb31fe5f8b990524a1", "5d289cdb31fe5f8b990524a2", "5d289cdb31fe5f8b990524a3", "5d289cdb31fe5f8b990524a4", "5d289cdb31fe5f8b990524a5", "5d289cdb31fe5f8b990524a6" ] }