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Type: Other
Resolution: Referred to External Party for Resolution
Priority: Moderate
Component/s: None
Labels:
- CRP

CRP Overview:

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Brief description of measure:
CMS347: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period:
*Adults aged >= 21 years who were previously diagnosed with or currently have an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD); OR
*Adults aged >= 21 years who have ever had a fasting or direct low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial or pure hypercholesterolemia; OR
*Adults aged 40-75 years with a diagnosis of diabetes with a fasting or direct LDL-C level of 70-189 mg/dL.

Description of issue:
Since the publication of the 2018 ACC/AHA Cholesterol Guidelines, stakeholders have inquired whether the measure will be updated to align with the information included in the recommendations. During the fall of 2020, the expert work group and measure steward agreed it is important to update this measure and its requirements to incorporate recommendations and specifications included in the 2018 ACC/AHA Cholesterol Guidelines.

The most recent guidelines will have a significant impact on the measure language and technical specifications.

This CRP ticket captures the logic and value set changes related to updating the measure to align with the 2018 ACC/AHA Cholesterol Guidelines. Additional tickets have been logged to highlight relevant changes to the header.

CURRENT POPULATION 1 CRITERIA:
Initial Population
         exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
        where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 21)
      and exists "Qualifying Encounter During Measurement Period"

Denominator
    "Initial Population"
      and exists "ASCVD Diagnosis or Procedure Before End of Measurement Period"

Denominator Exceptions
    "Patient Has Order for or Receiving Hospice Care or Palliative Care"
      or "Has ESRD"
      or "Has Hepatitis or Liver Disease"
      or exists "Adverse Reaction to Statin"
      or exists "Allergy or Intolerance to Statin"

CURRENT POPULATION 2 CRITERIA:
Initial Population
    exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
        where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 21)
      and exists "Qualifying Encounter During Measurement Period"

Denominator
    "Initial Population"
      and ( exists "Current or Prior LDL Result Greater Than or Equal To 190"
          or "Has Hypercholesterolemia" )
      and not exists "ASCVD Diagnosis or Procedure Before End of Measurement Period"

Denominator Exceptions
    "Patient Has Order for or Receiving Hospice Care or Palliative Care"
      or "Has ESRD"
      or "Has Hepatitis or Liver Disease"
      or exists "Adverse Reaction to Statin"
      or exists "Allergy or Intolerance to Statin"

CURRENT POPULATION 3 CRITERIA:
Initial Population
    exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
        where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 21)
      and exists "Qualifying Encounter During Measurement Period"

Denominator
    "Initial Population"
      and exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
          where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 40
            and Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) <= 75 )
      and "Has Diabetes"
      and "Highest LDL Result Within 3 Years is Greater Than or Equal To 70 and Less Than 190" is not null
      and not exists "ASCVD Diagnosis or Procedure Before End of Measurement Period"
      and not exists "Current or Prior LDL Result Greater Than or Equal To 190"
      and not "Has Hypercholesterolemia"

Denominator Exceptions
    "Patient Has Order for or Receiving Hospice Care or Palliative Care"
      or "Has ESRD"
      or "Has Hepatitis or Liver Disease"
      or exists "Adverse Reaction to Statin"
      or exists "Allergy or Intolerance to Statin"
      or "Most Recent LDL Result Within 3 Years is Less Than 70"

Goal of review:
Obtain clinical and technical feedback.

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Brief description of measure: CMS347: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period: *Adults aged >= 21 years who were previously diagnosed with or currently have an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD); OR *Adults aged >= 21 years who have ever had a fasting or direct low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial or pure hypercholesterolemia; OR *Adults aged 40-75 years with a diagnosis of diabetes with a fasting or direct LDL-C level of 70-189 mg/dL. Description of issue: Since the publication of the 2018 ACC/AHA Cholesterol Guidelines, stakeholders have inquired whether the measure will be updated to align with the information included in the recommendations. During the fall of 2020, the expert work group and measure steward agreed it is important to update this measure and its requirements to incorporate recommendations and specifications included in the 2018 ACC/AHA Cholesterol Guidelines. The most recent guidelines will have a significant impact on the measure language and technical specifications. This CRP ticket captures the logic and value set changes related to updating the measure to align with the 2018 ACC/AHA Cholesterol Guidelines. Additional tickets have been logged to highlight relevant changes to the header. CURRENT POPULATION 1 CRITERIA: Initial Population          exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate         where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 21)       and exists "Qualifying Encounter During Measurement Period" Denominator     "Initial Population"       and exists "ASCVD Diagnosis or Procedure Before End of Measurement Period" Denominator Exceptions     "Patient Has Order for or Receiving Hospice Care or Palliative Care"       or "Has ESRD"       or "Has Hepatitis or Liver Disease"       or exists "Adverse Reaction to Statin"       or exists "Allergy or Intolerance to Statin" CURRENT POPULATION 2 CRITERIA: Initial Population     exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate         where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 21)       and exists "Qualifying Encounter During Measurement Period" Denominator     "Initial Population"       and ( exists "Current or Prior LDL Result Greater Than or Equal To 190"           or "Has Hypercholesterolemia" )       and not exists "ASCVD Diagnosis or Procedure Before End of Measurement Period" Denominator Exceptions     "Patient Has Order for or Receiving Hospice Care or Palliative Care"       or "Has ESRD"       or "Has Hepatitis or Liver Disease"       or exists "Adverse Reaction to Statin"       or exists "Allergy or Intolerance to Statin" CURRENT POPULATION 3 CRITERIA: Initial Population     exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate         where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 21)       and exists "Qualifying Encounter During Measurement Period" Denominator     "Initial Population"       and exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate           where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 40             and Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) <= 75 )       and "Has Diabetes"       and "Highest LDL Result Within 3 Years is Greater Than or Equal To 70 and Less Than 190" is not null       and not exists "ASCVD Diagnosis or Procedure Before End of Measurement Period"       and not exists "Current or Prior LDL Result Greater Than or Equal To 190"       and not "Has Hypercholesterolemia" Denominator Exceptions     "Patient Has Order for or Receiving Hospice Care or Palliative Care"       or "Has ESRD"       or "Has Hepatitis or Liver Disease"       or exists "Adverse Reaction to Statin"       or exists "Allergy or Intolerance to Statin"       or "Most Recent LDL Result Within 3 Years is Less Than 70" Goal of review: Obtain clinical and technical feedback.
CRP Recommendations:

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Proposed solution:
Value set changes:
   - Hypercholesterolemia value set (OID: 2.16.840.1.113762.1.4.1047.100) – remove concepts related to pure hypercholesterolemia

PROPOSED POPULATION 1:
Initial Population
    exists "ASCVD Diagnosis or Procedure before End of Measurement Period"

Denominator
    "Initial Population 1"

Denominator Exceptions
    exists "Allergy to Statin"
      or "Patient Has Order or Receiving Hospice Care or Palliative Care"
      or "Has Hepatitis or Liver Disease Diagnosis"
      or "Has Statin Associated Muscle Symptoms"
      or "Has ESRD Diagnosis"
      or "Has Adverse Reaction to Statin"

PROPOSED POPULATION CRITERIA 2:
    Initial Population
     ( "Patients Age 20 Years and Older with LDL Cholesterol Result Greater than or Equal to 190"
        or exists "Hypercholesterolemia Diagnosis")
      and exists "Qualifying Encounter during Measurement Period"

Denominator
    "Initial Population 2"

Denominator Exceptions
    exists "Allergy to Statin"
      or "Patient Has Order or Receiving Hospice Care or Palliative Care"
      or "Has Hepatitis or Liver Disease Diagnosis"
      or "Has Statin Associated Muscle Symptoms"
      or "Has ESRD Diagnosis"
      or "Has Adverse Reaction to Statin"

PROPOSED POPULATION 3 CRITERIA:
Initial Population
    "Patients Age 40 to 75 years and a Diagnosis of Diabetes"
      and exists "Qualifying Encounter during Measurement Period"

Denominator
    "Initial Population 3"

Denominator Exceptions
    exists "Allergy to Statin"
      or "Patient Has Order or Receiving Hospice Care or Palliative Care"
      or "Has Hepatitis or Liver Disease Diagnosis"
      or "Has Statin Associated Muscle Symptoms"
      or "Has ESRD Diagnosis"
      or "Has Adverse Reaction to Statin"
      or "Has Diabetes Diagnosis and LDL Less than 70"

Create new definitions that are used within those noted above:
Patients Age 20 or Older at Start of Measurement Period
    exists ["Patient Characteristic Birthdate": "Birth date"] BirthDate
      where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 20

Patients Age 20 Years and Older with LDL Cholesterol Result Greater than or Equal to 190
    "Patients Age 20 or Older at Start of Measurement Period"
      and exists ( "LDL Result Greater Than or Equal To 190"
        union "Hypercholesterolemia Diagnosis" ) LDLOrHyperCholesterolemia
      and not exists "ASCVD Diagnosis or Procedure before End of Measurement Period"

Patients Age 40 to 75 years and a Diagnosis of Diabetes
    exists ["Patient Characteristic Birthdate": "Birth date"] BirthDate
      where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 40
        and Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) <= 75
        and "Has Diabetes Diagnosis"
        and ( not exists "ASCVD Diagnosis or Procedure before End of Measurement Period"
            and not exists "LDL Result Greater Than or Equal To 190"
            and not exists "Hypercholesterolemia Diagnosis")

Has Diabetes Diagnosis and LDL Less than 70
    "Has Diabetes Diagnosis"
      and "Most Recent LDL Result Less Than 70 before End of Measurement Period"

Rationale for change:
These logic updates align the measure’s technical specifications with the updated 2018 ACC/AHA Cholesterol Guidelines.

Show
Proposed solution: Value set changes:    - Hypercholesterolemia value set (OID: 2.16.840.1.113762.1.4.1047.100) – remove concepts related to pure hypercholesterolemia PROPOSED POPULATION 1: Initial Population     exists "ASCVD Diagnosis or Procedure before End of Measurement Period" Denominator     "Initial Population 1" Denominator Exceptions     exists "Allergy to Statin"       or "Patient Has Order or Receiving Hospice Care or Palliative Care"       or "Has Hepatitis or Liver Disease Diagnosis"       or "Has Statin Associated Muscle Symptoms"       or "Has ESRD Diagnosis"       or "Has Adverse Reaction to Statin" PROPOSED POPULATION CRITERIA 2:     Initial Population      ( "Patients Age 20 Years and Older with LDL Cholesterol Result Greater than or Equal to 190"         or exists "Hypercholesterolemia Diagnosis")       and exists "Qualifying Encounter during Measurement Period" Denominator     "Initial Population 2" Denominator Exceptions     exists "Allergy to Statin"       or "Patient Has Order or Receiving Hospice Care or Palliative Care"       or "Has Hepatitis or Liver Disease Diagnosis"       or "Has Statin Associated Muscle Symptoms"       or "Has ESRD Diagnosis"       or "Has Adverse Reaction to Statin" PROPOSED POPULATION 3 CRITERIA: Initial Population     "Patients Age 40 to 75 years and a Diagnosis of Diabetes"       and exists "Qualifying Encounter during Measurement Period" Denominator     "Initial Population 3" Denominator Exceptions     exists "Allergy to Statin"       or "Patient Has Order or Receiving Hospice Care or Palliative Care"       or "Has Hepatitis or Liver Disease Diagnosis"       or "Has Statin Associated Muscle Symptoms"       or "Has ESRD Diagnosis"       or "Has Adverse Reaction to Statin"       or "Has Diabetes Diagnosis and LDL Less than 70" Create new definitions that are used within those noted above: Patients Age 20 or Older at Start of Measurement Period     exists ["Patient Characteristic Birthdate": "Birth date"] BirthDate       where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 20 Patients Age 20 Years and Older with LDL Cholesterol Result Greater than or Equal to 190     "Patients Age 20 or Older at Start of Measurement Period"       and exists ( "LDL Result Greater Than or Equal To 190"         union "Hypercholesterolemia Diagnosis" ) LDLOrHyperCholesterolemia       and not exists "ASCVD Diagnosis or Procedure before End of Measurement Period" Patients Age 40 to 75 years and a Diagnosis of Diabetes     exists ["Patient Characteristic Birthdate": "Birth date"] BirthDate       where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 40         and Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) <= 75         and "Has Diabetes Diagnosis"         and ( not exists "ASCVD Diagnosis or Procedure before End of Measurement Period"             and not exists "LDL Result Greater Than or Equal To 190"             and not exists "Hypercholesterolemia Diagnosis") Has Diabetes Diagnosis and LDL Less than 70     "Has Diabetes Diagnosis"       and "Most Recent LDL Result Less Than 70 before End of Measurement Period" Rationale for change: These logic updates align the measure’s technical specifications with the updated 2018 ACC/AHA Cholesterol Guidelines.

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