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Annual Update
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Resolution: Resolved
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Minor
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None
Consider the following excerpt from the Denominator Exclusions criteria of CMS100v3 (AMI-2):
- AND: "Occurrence A of Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Occurrence A of Intervention, Performed: Comfort Measures" starts after start of "Occurrence A of Encounter, Performed: Emergency Department Visit"
In the second criterion, due to the use of "starts after start", comfort measures provided any time after the start of the ED encounter, even months later, unrelated to this episode of care, will exclude this inpatient encounter from the Denominator. This surely is not the desired behavior.
Proposed fix: The comparison could simply be changed from "starts after start" to "starts during". That would yield consistency with a similar pair of criteria in the population which look for comfort measures provided during the inpatient encounter. But presumably, when the inpatient encounter is preceded by an ED encounter, the exclusion should be satisfied by comfort measures initiated any time during the episode of care, not just during the ED encounter. Thus this issue could be resolved by leaving "starts after start" intact and adding another criterion to cover the other boundary:
- AND: "Occurrence A of Intervention, Performed: Comfort Measures" starts before or during "Occurrence A of Encounter, Performed: Encounter Inpatient"
Impact on other issues: CQM-1089 proposes the removal of "Occurrence A" from instances of Intervention Performed for this measure, while the fix for this issue requires "Occurrence A" for the criteria discussed herein, seemingly countering the argument in CQM-1089. However, the second instance of "Occurrence A of Intervention, Performed" in the measure, the one compared against the inpatient encounter, still does not need "Occurrence A", so the proposal in CQM-1089 to remove "Occurrence A" from that criterion stands.
- relates to
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CQM-1296 Difference in logic for Comfort Measures Only in AMI-2 and AMI-10
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- Closed
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