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  1. eCQM Issue Tracker
  2. CQM-1194

Guidance on meaning of Occurrence A vs. Occurrence B in PN6

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    • Icon: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals
    • Resolution: Resolved
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    • Guidance
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    • CMS188v4NQF0147
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      Thank you for your questions. As an answer to your first question: after careful review, it has been determined that Occurrence B of the Encounter Inpatient is not necessary as this is an episode of care measure which looks at only one episode of care, Occurrence A of the Encounter Inpatient. The Occurrence B of the Encounter Inpatient data element and the associated logic will be removed during the next eligible hospital eCQM annual update.
      To answer your second question, a patient must be admitted or transferred to the ICU within the first 24 hours after arrival at the hospital, and this can include arrival at the ED. The logic as it is written will be evaluated and if necessary be changed to meet the intent of the measure during the next eligible hospital eCQM annual update. This will include, as in the answer to your first question, removing the Occurrence B of the Encounter Inpatient and all associated logic.
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      Thank you for your questions. As an answer to your first question: after careful review, it has been determined that Occurrence B of the Encounter Inpatient is not necessary as this is an episode of care measure which looks at only one episode of care, Occurrence A of the Encounter Inpatient. The Occurrence B of the Encounter Inpatient data element and the associated logic will be removed during the next eligible hospital eCQM annual update. To answer your second question, a patient must be admitted or transferred to the ICU within the first 24 hours after arrival at the hospital, and this can include arrival at the ED. The logic as it is written will be evaluated and if necessary be changed to meet the intent of the measure during the next eligible hospital eCQM annual update. This will include, as in the answer to your first question, removing the Occurrence B of the Encounter Inpatient and all associated logic.
    • CMS188v1/NQF0147

      I know the creation of Occurrence A vs. Occurrence B of Encounter Performed Inpatient was meant to make things more clear in the Pneumonia measure, but I need some additional information before that goal is achieved.

      When we see a statement like this:

      ◾OR: "Occurrence B of Encounter, Performed: Encounter Inpatient" <= 24 hour(s) starts before start of "Occurrence A of Encounter, Performed: ICU Admission or Transfer"

      What is the time element that the "Occurrence B of Encounter, Performed: Encounter Inpatient" is referring to? Is it the arrival Date Time to ED part of the Occurrence B or is it the inpatient Admit Date Time of an encounter that also had an ED visit?

      If we backup and look at the whole logic statement (see attached screenshot):

      ◾AND: "Occurrence A of Encounter, Performed: ICU Admission or Transfer"
      ◾AND:
      ◾OR: "Occurrence B of Encounter, Performed: Encounter Inpatient" <= 24 hour(s) starts before start of "Occurrence A of Encounter, Performed: ICU Admission or Transfer"
      ◾OR: "Occurrence B of Encounter, Performed: Encounter Inpatient" starts concurrent with "Occurrence A of Encounter, Performed: ICU Admission or Transfer"
      ◾ <= 24 hour(s) starts after start of "Occurrence A of Encounter, Performed: Emergency Department Visit"

      Am I correct in thinking that what that says in English is: You have a transfer to ICU that occurred <= 24 hours after Arrival Date Time at the ED AND started either <= 24 hours after Inpatient Admit Date Time OR concurrent with Inpatient Admit Date Time?

      If I could get the answers to these two questions I think I should be good with interpreting the rest of the measure.

        1. PN6_Denominator1_Logic.PNG
          69 kB
          Gregory Magazu

            JLeflore Joelencia Leflore
            gmagazu Gregory Magazu (Inactive)
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