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EXM105-8.2.000.cql
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EXM105-8.2.000.cql
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library EXM105 version '8.2.000'
/*
Based on CMS105v8 - Discharged on Statin Medication
Author: TJC
*/
using FHIR version '4.0.1'
include FHIRHelpers version '4.0.1'
include MATGlobalCommonFunctions version '5.0.000' called Global
include SupplementalDataElements version '2.0.0' called SDE
include TJCOverall version '5.0.000' called TJC
codesystem "LOINC": 'http://loinc.org'
codesystem "SNOMEDCT": 'http://snomed.info/sct/731000124108'
codesystem "Diagnosis Role": 'http://terminology.hl7.org/CodeSystem/diagnosis-role'
codesystem "RequestIntent": 'http://terminology.hl7.org/CodeSystem/request-intent'
valueset "Comfort Measures": 'http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45'
valueset "Discharged to Health Care Facility for Hospice Care": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.207'
valueset "Discharge To Acute Care Facility": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87'
valueset "Discharged to Home for Hospice Care": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.209'
valueset "Emergency Department Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292'
valueset "Ethnicity": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.837'
valueset "Ischemic Stroke": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247'
valueset "Hemorrhagic Stroke": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.212'
valueset "LDL-c": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.215'
valueset "Left Against Medical Advice": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.308'
valueset "Medical Reason": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.473'
valueset "Non-Elective Inpatient Encounter": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424'
valueset "Observation Services": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143'
valueset "ONC Administrative Sex": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1'
valueset "Patient Expired": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309'
valueset "Patient Refusal": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93'
valueset "Payer": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591'
valueset "Race": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.836'
valueset "Statin Allergen": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.423'
valueset "Statin Grouper": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.19'
code "Birthdate": '21112-8' from "LOINC" display 'Birth date'
code "Dead": '419099009' from "SNOMEDCT" display 'Dead'
code "Billing": 'billing' from "Diagnosis Role" display 'Billing'
code "Order": 'order' from "RequestIntent" display 'Order'
parameter "Measurement Period" Interval<DateTime>
default Interval[@2019-01-01T00:00:00.0, @2020-01-01T00:00:00.0)
context Patient
define "SDE Ethnicity":
SDE."SDE Ethnicity"
define "SDE Payer":
SDE."SDE Payer"
define "SDE Race":
SDE."SDE Race"
define "SDE Sex":
SDE."SDE Sex"
define "Initial Population":
TJC."Encounter with Principal Diagnosis and Age"
define "Denominator":
TJC."Ischemic Stroke Encounter"
define "Denominator Exclusion":
TJC."Ischemic Stroke Encounters with Discharge Disposition"
union TJC."Comfort Measures during Hospitalization"
define "Numerator":
TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
with "Statin at Discharge" DischargeStatin
such that DischargeStatin.authoredOn during day of Global."Normalize Interval"(IschemicStrokeEncounter.period)
// NOTE: Added check for Statin.status in { 'active', 'completed' }
// Discussion about whether to check for both active and completed, versus just specifying active
// Also discussion about whether to use "Community" or "Discharge"
// Suggest using both since there is potential overlap and even some instances that would have both codes
// Will keep both and followup with Pharmacy to verify the approach
// NOTE: Changed intent to only "order", since we're specifically looking for authorized prescriptions
define "Statin at Discharge":
["MedicationRequest": medication in "Statin Grouper"] Statin
//Note: expressed as an or with equivalence semantics pending resolution of potential CQL issue.
where exists (Statin.category C where FHIRHelpers.ToConcept(C) ~ Global."Community" or FHIRHelpers.ToConcept(C) ~ Global."Discharge")
and Statin.status in { 'active', 'completed' }
and Statin.intent = 'order'
define "Denominator Exception":
(
TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
with "Statin Not Given at Discharge" NoDischargeStatin
such that NoDischargeStatin.authoredOn during day of IschemicStrokeEncounter.period
) union
(
TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
with "Statin Allergy" StatinAllergy
such that Global."Normalize Interval"(StatinAllergy.onset) starts on or before end of IschemicStrokeEncounter.period
) union
"Encounter with Max LDL less than 70 mg per dL"
// NOTE: Added status check and category check, consider define Statin Medication Request for reuse
define "Statin Not Given at Discharge":
["MedicationRequest": medication in "Statin Grouper"] NoStatin
where NoStatin.doNotPerform is true
and (
NoStatin.reasonCode in "Medical Reason"
or NoStatin.reasonCode in "Patient Refusal"
)
//Note: expressed as an or with equivalence semantics pending resolution of potential CQL issue.
and exists (NoStatin.category C where FHIRHelpers.ToConcept(C) ~ Global."Community" or FHIRHelpers.ToConcept(C) ~ Global."Discharge")
and NoStatin.status = 'completed'
and NoStatin.intent = 'order'
// NOTE: Added clinicalStatus and verificationStatus check
define "Statin Allergy":
["AllergyIntolerance": "Statin Allergen"] StatinAllergy
where (StatinAllergy.clinicalStatus is null or FHIRHelpers.ToConcept(StatinAllergy.clinicalStatus) ~ Global."allergy-active")
and FHIRHelpers.ToConcept(StatinAllergy.verificationStatus) in { Global."allergy-unconfirmed", Global."allergy-confirmed" }
// NOTE: Added check for status in final or amended
define "Encounter with Max LDL less than 70 mg per dL":
TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
where Max(
["Observation": "LDL-c"] Ldl
where Ldl.status in { 'final', 'amended' }
and Ldl.issued during Interval[IschemicStrokeEncounter.period.start - 30 days, IschemicStrokeEncounter.period.end]
return Ldl.value as Quantity
) < 70 'mg/dL'