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  1. eCQM Issue Tracker
  2. CQM-456

PN6 Check for Active Diagnosis of Presumptive Pneumonia in Non-ICU location Logic unclear

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    • Icon: Annual Update Annual Update
    • Resolution: Fixed
    • Icon: Minor Minor
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    • Tamara Bailey
    • 520.750.4324
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      During the 2014 Annual Update, the logic was updated to incorporate updates to the measure based on Measure Steward input. The logic was also simplified.

      After careful review, it was determined that clarification of this question and intent is necessary. A logic update occurred during the April 2013 update to address vendor difficulty related to the timing of the diagnostic study and subsequent result. The denominator logic related to “Diagnostic Study result: Hospital Chest xray/CT scan (result: ‘Hospital Measures-Radiologic findings consistent with pneumonia’)” was moved to a denominator exclusion and the logic related to a study “<=24 hours prior to the encounter was removed.
      • The new denominator exclusion logic is as follows:
      o “Diagnostic Study result: Hospital Chest x-ray/CT scan (result: ‘Hospital Measures-Radiologic finding normal ’)”.
      • The chest x-ray/CT scan finding specifications require this diagnostic study to occur during the encounter, not within a location, therefore there would be no need to constrain the logic to a particular location. The locations are incorporated to constrain the locations to ED, Non-ICU, and ICU.


      Regarding logic related to Diagnostic Study, Result, the location was removed in the April 2014 annual update for clarity.
      Original Logic:
      o OR: "Diagnostic Study, Result: Hospital Measures-Chest x-ray (result: 'Hospital Measures-Radiological findings consistent with pneumonia')" during "Occurrence A of Encounter, Performed: Encounter Inpatient (facility location arrival datetime, facility location: 'Hospital Measures-ICU Locations')"
      Updated logic:
      o OR: "Diagnostic Study, Result: Hospital Measures-Chest x-ray (result: 'Hospital Measures-Radiological findings consistent with pneumonia')" during "Occurrence A of Encounter, Performed: Encounter Inpatient."

      Regarding logic related to "Presumptive Pneumonia- NonICU" location
      Original Logic:
      o AND: "Occurrence A of Diagnosis, Active: Hospital Measures-Presumptive pneumonia" starts after the start of "Occurrence A of Encounter, Performed: Encounter Inpatient (facility location: 'Hospital Measures-Non-ICU Locations', facility location arrival datetime)"

      An additional logic statement was added for clarity as follows:
      o AND: "Occurrence A of Diagnosis, Active: Hospital Measures-Presumptive pneumonia" starts after the start of "Occurrence A of Encounter, Performed: Encounter Inpatient (facility location: 'Hospital Measures-Non-ICU Locations', facility location arrival datetime)"
      o AND: "Occurrence A of Diagnosis, Active: Hospital Measures-Presumptive pneumonia" starts before the end of "Occurrence A of Encounter, Performed: Encounter Inpatient (facility location: 'Hospital Measures-Non-ICU Locations', facility location arrival datetime departure datetime)"




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      During the 2014 Annual Update, the logic was updated to incorporate updates to the measure based on Measure Steward input. The logic was also simplified. After careful review, it was determined that clarification of this question and intent is necessary. A logic update occurred during the April 2013 update to address vendor difficulty related to the timing of the diagnostic study and subsequent result. The denominator logic related to “Diagnostic Study result: Hospital Chest xray/CT scan (result: ‘Hospital Measures-Radiologic findings consistent with pneumonia’)” was moved to a denominator exclusion and the logic related to a study “<=24 hours prior to the encounter was removed. • The new denominator exclusion logic is as follows: o “Diagnostic Study result: Hospital Chest x-ray/CT scan (result: ‘Hospital Measures-Radiologic finding normal ’)”. • The chest x-ray/CT scan finding specifications require this diagnostic study to occur during the encounter, not within a location, therefore there would be no need to constrain the logic to a particular location. The locations are incorporated to constrain the locations to ED, Non-ICU, and ICU. Regarding logic related to Diagnostic Study, Result, the location was removed in the April 2014 annual update for clarity. Original Logic: o OR: "Diagnostic Study, Result: Hospital Measures-Chest x-ray (result: 'Hospital Measures-Radiological findings consistent with pneumonia')" during "Occurrence A of Encounter, Performed: Encounter Inpatient (facility location arrival datetime, facility location: 'Hospital Measures-ICU Locations')" Updated logic: o OR: "Diagnostic Study, Result: Hospital Measures-Chest x-ray (result: 'Hospital Measures-Radiological findings consistent with pneumonia')" during "Occurrence A of Encounter, Performed: Encounter Inpatient." Regarding logic related to "Presumptive Pneumonia- NonICU" location Original Logic: o AND: "Occurrence A of Diagnosis, Active: Hospital Measures-Presumptive pneumonia" starts after the start of "Occurrence A of Encounter, Performed: Encounter Inpatient (facility location: 'Hospital Measures-Non-ICU Locations', facility location arrival datetime)" An additional logic statement was added for clarity as follows: o AND: "Occurrence A of Diagnosis, Active: Hospital Measures-Presumptive pneumonia" starts after the start of "Occurrence A of Encounter, Performed: Encounter Inpatient (facility location: 'Hospital Measures-Non-ICU Locations', facility location arrival datetime)" o AND: "Occurrence A of Diagnosis, Active: Hospital Measures-Presumptive pneumonia" starts before the end of "Occurrence A of Encounter, Performed: Encounter Inpatient (facility location: 'Hospital Measures-Non-ICU Locations', facility location arrival datetime departure datetime)"

      AND: "Diagnosis, Active: Hospital Measures-Presumptive pneumonia" starts during "Occurrence A of Encounter, Performed: Encounter Inpatient (facility location: 'Hospital Measures-Non-ICU Locations', facility location arrival datetime)"

      I'm assuming that this logic is attempting to find if a diagnosis of Pneumonia was found while the patient was in the Non-ICU location, before they were transfered to ICU, not just at any time during the encounter? If that's the case, I would think that a check for 'starts during' needs to have the 'facility location end datetime' specified as well?

      There are other sections of logic checking for things occuring during the Non-ICU location that are similarly unclear:

      ■OR: "Diagnostic Study, Result: Hospital Measures-Chest xray (result: 'Hospital Measures-Radiological findings consistent with pneumonia')" during "Occurrence A of Encounter, Performed: Encounter Inpatient (facility location arrival datetime, facility location: 'Hospital Measures-ICU Locations')"

      ■OR: "Diagnostic Study, Result: Hospital Measures-CT scan including chest (result: 'Hospital Measures-Radiological findings consistent with pneumonia')" during "Occurrence A of Encounter, Performed: Encounter Inpatient (facility location arrival datetime, facility location: 'Hospital Measures-Non-ICU Locations')"

            abt.associate Abt Associate (Inactive)
            tamarabailey Tamara Bailey (Inactive)
            Abt Associate (Inactive), Deborah Krauss (Inactive)
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