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Type: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals
Resolution: Answered
Priority: Major
Component/s: Measure
Labels:
- CQM
- LOGIC
- Measure

Solution:

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Thank you for your question. Here are the answers to your questions. While we are able to provide guidance on questions on measure specification logic, we are unable to provide guidance on test cases.

Please review the responses to you your questions, based on what we are able to respond to.

Query 1: From a clinical perspective, there should be only one ED visit for an encounter. We changed the operator from Singleton() in the 2019 reporting year to Last() in the 2020 reporting period to account for cases where more than one ED visit occurs within the 1 hour prior to the inpatient encounter.

Query 2: The logic statement (start of Encounter.relevantPeriod + 2 days) refers to the calendar day after the inpatient admissiondate.

Query 3: The logic statement Interval[Global."ToDate"(end of AnesthesiaProcedure.relevantPeriod), Global."ToDate"(end of AnesthesiaProcedure.relevantPeriod+ 2 days)) is looking for the timeframe on the day of end of procedure date to the calendar day after end of procedure date. For example, the procedure ends 1/1/2019 13:30, this function will return any time on the day of 1/1/2019 to any time on the day of 1/2/2019.

Query 4: The same concept is applied to this logic statement, Interval[Global."ToDate"(start of QualifyingEncounter.relevantPeriod)), Global."ToDate"( start of QualifyingEncounter.relevantPeriod) + 2 days)) ". It will be looking for any time on the day of the IP encounter admission date to any time on the day after admission.

Query 5: Your interpretations are correct.

Query 6: If "start of Encounter.relevantPeriod = 12/12/2019 13:00:00" so start of "Encounter.relevantPeriod + 2 days" = 12/12/2019 0:00:00 to 12/13/2019 23:59:59, this means that any time on 12/12/2019 and 12/13/2019 would qualify.
Same concept is applied to this scenario. If StartValue = end of AnesthesiaProcedure.relevantPeriod which is 12/12/2019 13:00:00 so (StartValue + 2 days)) = 12/12/2019 0:00:00 to 12/13/2019 23:59:59, this means that any time on 12/12/2019 and 12/13/2019 would qualify.

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Thank you for your question. Here are the answers to your questions. While we are able to provide guidance on questions on measure specification logic, we are unable to provide guidance on test cases. Please review the responses to you your questions, based on what we are able to respond to. Query 1: From a clinical perspective, there should be only one ED visit for an encounter. We changed the operator from Singleton() in the 2019 reporting year to Last() in the 2020 reporting period to account for cases where more than one ED visit occurs within the 1 hour prior to the inpatient encounter. Query 2: The logic statement (start of Encounter.relevantPeriod + 2 days) refers to the calendar day after the inpatient admissiondate. Query 3: The logic statement Interval[Global."ToDate"(end of AnesthesiaProcedure.relevantPeriod), Global."ToDate"(end of AnesthesiaProcedure.relevantPeriod+ 2 days)) is looking for the timeframe on the day of end of procedure date to the calendar day after end of procedure date. For example, the procedure ends 1/1/2019 13:30, this function will return any time on the day of 1/1/2019 to any time on the day of 1/2/2019. Query 4: The same concept is applied to this logic statement, Interval[Global."ToDate"(start of QualifyingEncounter.relevantPeriod)), Global."ToDate"( start of QualifyingEncounter.relevantPeriod) + 2 days)) ". It will be looking for any time on the day of the IP encounter admission date to any time on the day after admission. Query 5: Your interpretations are correct. Query 6: If "start of Encounter.relevantPeriod = 12/12/2019 13:00:00" so start of "Encounter.relevantPeriod + 2 days" = 12/12/2019 0:00:00 to 12/13/2019 23:59:59, this means that any time on 12/12/2019 and 12/13/2019 would qualify. Same concept is applied to this scenario. If StartValue = end of AnesthesiaProcedure.relevantPeriod which is 12/12/2019 13:00:00 so (StartValue + 2 days)) = 12/12/2019 0:00:00 to 12/13/2019 23:59:59, this means that any time on 12/12/2019 and 12/13/2019 would qualify.
Measure Type:
EH
2020 Reporting Period EH/CAH eCQMs:

CMS108v8/NQFna

Hi Team,

We have a query related to few functions for CMS108v8:

Query 1:

Global.HospitalizationWithObservation(Encounter "Encounter, Performed")

Encounter Visit
let ObsVisit: Last(["Encounter, Performed": "Observation Services"] LastObs
where LastObs.relevantPeriod ends 1 hour or less on or before start of Visit.relevantPeriod
sort by
end of relevantPeriod
),
VisitStart: Coalesce(start of ObsVisit.relevantPeriod, start of Visit.relevantPeriod),
EDVisit: Last(["Encounter, Performed": "Emergency Department Visit"] LastED
where LastED.relevantPeriod ends 1 hour or less on or before VisitStart
sort by
end of relevantPeriod
)
return Interval[Coalesce(start of EDVisit.relevantPeriod, VisitStart),
end of Visit.relevantPeriod]

In the above function please confirm whether we need to create multiple ED/Obs entries to test the LastED or LastObs cases as highlighted below.
If Yes, then how are we supposed to create multiple ED/Obs entries Kindly help us with examples because as per our understanding there can be only one ED location for an encounter

Query2:

During VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)
Interval[Global."ToDate"(start of Global."HospitalizationWithObservation"(Encounter)), Global."ToDate"(start of Encounter.relevantPeriod + 2 days))

Interpretation:
Interval[Global."ToDate"(start of EDVisit.relevantPeriod (Enounter)), Global."ToDate"(start of Encounter.relevantPeriod + 2 days)]
where LastED.relevantPeriod ends 1 hour or less on or before Coalesce(start of ObsVisit.relevantPeriod, start of Visit.relevantPeriod)
OR
Interval[Global."ToDate"(start of ObsVisit.relevantPeriod (Enounter)), Global."ToDate"(start of Encounter.relevantPeriod + 2 days)]
where LastObs.relevantPeriod ends 1 hour or less on or before start of Visit.relevantPeriod
OR
Interval[Global."ToDate"(start of Visit.relevantPeriod (Enounter)), Global."ToDate"(start of Encounter.relevantPeriod + 2 days)]

If the above interpretation is correct, then kindly confirm whether the highlighted encounter would be respective ED/Obs/IP encounter

Query3:
During TJC."CalendarDayOfOrDayAfter" ( end of AnesthesiaProcedure.relevantPeriod)
Interval[Global."ToDate"(StartValue), Global."ToDate"(StartValue + 2 days)) ( end of AnesthesiaProcedure.relevantPeriod)

Kindly confirm if StartValue = end of AnesthesiaProcedure.relevantPeriod in above scenario

+Query4: +
TJC."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.relevantPeriod)
Interval[Global."ToDate"(StartValue), Global."ToDate"(StartValue + 2 days)) "(start of QualifyingEncounter.relevantPeriod)

Kindly confirm whether the Qualifying encounter highlighted above will be only IP or it can be anyone from ED/Obs/IP

Query5:
TJC."CalendarDayOfOrDayAfter"(start of Global."HospitalizationWithObservation")

Interpretation:
Interval[Global."ToDate"(StartValue), Global."ToDate"(StartValue + 2 days)) (start of EDVisit.relevantPeriod)
OR
Interval[Global."ToDate"(StartValue), Global."ToDate"(StartValue + 2 days)) (start of ObsVisit.relevantPeriod)
OR
Interval[Global."ToDate"(StartValue), Global."ToDate"(StartValue + 2 days)) (start of Visit.relevantPeriod)

Kindly confirm if the above Interpretation is correct.

Query6:

No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure, Performed": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
"No VTE Prophylaxis Medication or Device Due to Patient Refusal" PatientRefusal
where AnesthesiaProcedure.relevantPeriod ends 1 day after day of start of QualifyingEncounter.relevantPeriod
and PatientRefusal.authorDatetime during TJC."CalendarDayOfOrDayAfter"(
end of AnesthesiaProcedure.relevantPeriod
)
return QualifyingEncounter

TJC.CalendarDayOfOrDayAfter(StartValue DateTime)

Interval[Global."ToDate"(StartValue), Global."ToDate"(StartValue + 2 days))

For the above condition consider if the start value is Anesthesia end date which is on 01/16/2019 13:00:00, so TJC.CalendarDayOfOrDayAfter(StartValue DateTime) will be calculated as below:

"Interval [Global."ToDate"(StartValue), Global."ToDate"(StartValue + 2 days))"

As per our understanding the "ToDate" operator converts the value of its argument to a Date value & the interval is starting with square bracket "[" and ending with parantheses ")" which means Interval [Global."ToDate"(StartValue), Global."ToDate"(StartValue + 2 days)) will be calculated as below:

Interval [Global. "ToDate (01/16/2019 13:00:00), Global."ToDate"(01/16/2019 13:00:00 + 2 days)) so the Interval which needs to be considered is from 01/16/2019 till 01/17/2019 since the ToDate operator converts the argument to Date and "+2 days" is closed with ")" parantheses which means less then 2 days should be added.

Please let us know if our understanding is correct or not

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