Brief Description of Measure:

CMS66: Functional Status Assessment for Total Knee Replacement:

Percentage of patients 18 years of age and older who received an elective primary total knee arthroplasty (TKA) and completed a functional status assessment within 90 days prior to the surgery and in the 270-365 days after the surgery

CMS56: Functional Status Assessment for Total Hip Replacement

Percentage of patients 18 years of age and older who received an elective primary total hip arthroplasty (THA) and completed a functional status assessment within 90 days prior to the surgery and in the 270-365 days after the surgery

CMS117: Childhood Immunization Status

Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three or four H influenza type B (Hib); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday

CMS147: Preventive Care and Screening: Influenza Immunization

Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization

Description of Issue:
Currently, some of our measures' logic only looks for either the relevantDatetime or the relevantPeriod. We have heard feedback from implementers they may only have one (e.g., their systems to not capture both a relevantDatetime and the relevantPeriod). CMS 56, CMS 66, CMS 117, and CMS 147 are currently specified to capture only one of the timing attributes.

Proposed Solution:
​In order to respond to implementer feedback, and gain some consistency across measures, we plan to add the 'NormalizeInterval' function to more measures and datatypes.

For example, in CMS 56, we plan to add 'NormalizeInterval' to the Procedure datatype in order to allow for greater flexibility for implementers. Below is an example of the planned logic update and application of the function in CMS 56:

CURRENT LOGIC:
Has THA with Initial and Follow Up HOOS Assessments
exists ( "Total Hip Arthroplasty Procedure" TotalHip
with "Time HOOS Total Assessment Completed" InitialHipAssessmentHOOS
such that TotalHip.relevantPeriod starts 90 days or less on or after InitialHipAssessmentHOOS
with "Time HOOS Total Assessment Completed" FollowupHipAssessmentHOOS
such that FollowupHipAssessmentHOOS in Interval[
end of TotalHip.relevantPeriod + 270 days,
end of TotalHip.relevantPeriod + 365 days])

PROPOSED LOGIC:
Has THA with Initial and Follow Up HOOS Assessments
exists ( ("Total Hip Arthroplasty Procedure" THAProcedure
return Global.”NormalizeInterval”(THAProcedure.relevantDatetime, THAProcedure.relevantPeriod )) TotalHip
with "Time HOOS Total Assessment Completed" InitialHipAssessmentHOOS
such that TotalHip starts 90 days or less on or after InitialHipAssessmentHOOS
with "Time HOOS Total Assessment Completed" FollowupHipAssessmentHOOS
such that FollowupHipAssessmentHOOS during day of Interval[
end of TotalHip + 270 days,
end of TotalHip + 365 days])

Rationale for Change:
This change will allow for greater flexibility in implementation to look for either a single point in time or an interval.