Brief Description of Measure:

CMS138 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user

Three rates are reported:

a. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period

b. Percentage of patients aged 18 years and older who were identified as a tobacco user who received tobacco cessation intervention

c. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user

Description of Issue:
​The current measure logic only looks for tobacco cessation interventions in the current measurement period. We heard feedback from the field that this was an issue because people may be identified as tobacco users and could have already started tobacco cessation therapies.

Proposed Solution:

​We have updated the language in the guidance and numerator sections, as well as the logic to allow for a 6 month look back for tobacco cessation therapies, as well as through the current measurement period. We believe this will allow for greater flexibility in implementation and capture more patients in the numerator.

Current description:
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period if identified as a tobacco user

Three rates are reported:
a. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period
b. Percentage of patients aged 18 years and older who were identified as a tobacco user who received tobacco cessation intervention
c. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user

Proposed description:
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user

Three rates are reported:
a. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period
b. Percentage of patients aged 18 years and older who were identified as a tobacco user during the measurement period who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period
c. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation during the measurement period or in the six months prior to the measurement period intervention if identified as a tobacco user

Current Numerator statement:
Population 1:
Patients who were screened for tobacco use at least once during the measurement period

Population 2:
Patients who received tobacco cessation intervention

Population 3:
Patients who were screened for tobacco use at least once during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user

Proposed Numerator Statement:
Population 1:
Patients who were screened for tobacco use at least once during the measurement period

Population 2:
Patients who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period

Population 3:
Patients who were screened for tobacco use at least once during the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period if identified as a tobacco user

Current logic for Tobacco Cessation Counseling Given:
Tobacco Cessation Counseling Given
["Intervention, Performed": "Tobacco Use Cessation Counseling"] TobaccoCessationCounseling
where Global."NormalizeInterval" ( TobaccoCessationCounseling.relevantDatetime, TobaccoCessationCounseling.relevantPeriod ) during "Measurement Period"

Proposed logic for Tobacco Cessation Counseling Given:
Tobacco Cessation Counseling Given
["Intervention, Performed": "Tobacco Use Cessation Counseling"] TobaccoCessationCounseling
where Global."NormalizeInterval" ( TobaccoCessationCounseling.relevantDatetime, TobaccoCessationCounseling.relevantPeriod ) during day of Interval[start of "Measurement Period" - 6 months, end of "Measurement Period"]

Current logic for Tobacco Cessation Pharmacotherapy Ordered:
Tobacco Cessation Pharmacotherapy Ordered
["Medication, Order": "Tobacco Use Cessation Pharmacotherapy"] CessationPharmacotherapyOrdered
where CessationPharmacotherapyOrdered.authorDatetime during "Measurement Period"

Proposed logic for Tobacco Cessation Pharmacotherapy Ordered:
Tobacco Cessation Pharmacotherapy Ordered
["Medication, Order": "Tobacco Use Cessation Pharmacotherapy"] CessationPharmacotherapyOrdered
where CessationPharmacotherapyOrdered.authorDatetime during day of Interval[start of "Measurement Period" - 6 months, end of "Measurement Period"]

Current Logic for active Pharmacotherapy:
Active Pharmacotherapy for Tobacco Cessation

["Medication, Active": "Tobacco Use Cessation Pharmacotherapy"] TakingCessationPharmacotherapy
where Global."NormalizeInterval" ( TakingCessationPharmacotherapy.relevantDatetime, TakingCessationPharmacotherapy.relevantPeriod ) overlaps after "Measurement Period"

Proposed Logic for Active Pharmacotherapy:
Active Pharmacotherapy for Tobacco Cessation

["Medication, Active": "Tobacco Use Cessation Pharmacotherapy"] TakingCessationPharmacotherapy
where Global."NormalizeInterval" ( TakingCessationPharmacotherapy.relevantDatetime, TakingCessationPharmacotherapy.relevantPeriod ) during day of Interval[start of "Measurement Period" - 6 months, end of "Measurement Period"]

Rationale for Change:
*​​​*The intent of the measure is to assess whether a patient has been screened for tobacco use and if identified as a tobacco user, has received a tobacco cessation intervention during the measurement period. However, since patients may have a history of tobacco use, and therefore, might have received a tobacco cessation intervention in the months before the start of the measurement period.