AND NOT condition of STK5 denominator exclusion

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    • Type: Implementation Problem
    • Resolution: Answered
    • Priority: Minor
    • Component/s: Measure
    • Sajith
    • MEDHOST Inc.
    • Understanding AND NOT condition of STK5 denominator exclusion
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      You are correct, in a case where a patient is not admitted via the ED, the AND NOT statement would evaluate to true. Below, we provide additional guidance as to the length of stay denominator exclusion logic.

      You reference one of two logic statements in the denominator exclusion that are intended to exclude patients with a length of stay <2 days. For STK 5, the intent is to only exclude patients with a total length of stay of <2 days, including ED visit (if there is one). For the eCQM we needed to model both the scenarios of admission via the ED as well as direct admits.

      The statement you reference addresses direct admits:

       

      •AND: Intersection of:
      ◦Occurrence A of $EncounterInpatientNonElective
      ◦"Encounter, Performed: Non-Elective Inpatient Encounter (length of stay < 2 day(s))"
      •AND NOT: "Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatientNonElective
      The following statement addresses patients who were admitted via the ED:

       

      •OR: "Encounter, Performed: Emergency Department Visit" satisfies all
      ◦<= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatientNonElective
      ◦< 2 day(s) starts before end of Occurrence A of $EncounterInpatientNonElective
      Show
      You are correct, in a case where a patient is not admitted via the ED, the AND NOT statement would evaluate to true. Below, we provide additional guidance as to the length of stay denominator exclusion logic. You reference one of two logic statements in the denominator exclusion that are intended to exclude patients with a length of stay <2 days. For STK 5, the intent is to only exclude patients with a total length of stay of <2 days, including ED visit (if there is one). For the eCQM we needed to model both the scenarios of admission via the ED as well as direct admits. The statement you reference addresses direct admits:   •AND: Intersection of: ◦Occurrence A of $EncounterInpatientNonElective ◦"Encounter, Performed: Non-Elective Inpatient Encounter (length of stay < 2 day(s))" •AND NOT: "Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatientNonElective The following statement addresses patients who were admitted via the ED:   •OR: "Encounter, Performed: Emergency Department Visit" satisfies all ◦<= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatientNonElective ◦< 2 day(s) starts before end of Occurrence A of $EncounterInpatientNonElective
    • Impacting measure calculation

      IN STK5, we have below condition for denominator exclusion.

      AND NOT: "Occurrence A of Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before start of "Occurrence A of Encounter, Performed: Non-Elective Inpatient Encounter"

      We can evaluate ED end date within one hour only if patient is admitted through ED and transferred to IP.

      In a case where patient is not admitted to ED, we will not be able to compare times. Should this condition be calculated as true in this case (since its AND NOT)?

            Assignee:
            Joelencia Leflore
            Reporter:
            Sajith Sathyapal (Inactive)
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