Brief Description of Measure:

​CMS136: Follow-Up Care for Children Prescribed ADHD Medication (ADD):
Percentage of children 6-12 years of age and newly dispensed a medication for attention-deficit/hyperactivity disorder (ADHD) who had appropriate follow-up care. Two rates are reported.
a. Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-Day Initiation Phase.
b. Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.

Description of Issue:

The standards team expressed concerns with using Medication Active relevantPeriod to calculate cumulative medication duration as records may not contain a period stop date, which could incur an inaccurate duration calculation
 
Given that QDM datatype 'Medication, Order' (prescriptions) can be used to project cumulative medication duration, e.g., dosage instruction, and is most closely aligned with measure intent, we will utilize it for specifying Initial Population 2 requirement.
Methods for calculating cumulative medication duration using 'Medication, Order' are outlined in QDM 5.6 Section 5.7.3 (https://ecqi.healthit.gov/sites/default/files/QDM-v5.6-508.pdf).

Proposed Solution:

​Before

define "Has ADHD Cumulative Medication Duration Greater Than or Equal to 210 Days"
"Cumulative Medication Duration"("ADHD Medications Taken within 300 Days after First ADHD Medication Dispensed")>= 210

define "ADHD Medications Taken within 300 Days after First ADHD Medication Dispensed":
["Medication, Active": "ADHD Medications"] ActiveADHDMedications
  with "First ADHD Medication Dispensed during Intake Period" InitialADHDMedication
    such that Global."NormalizeInterval" ( ActiveADHDMedications.relevantDatetime, ActiveADHDMedications.relevantPeriod ) starts 300 days or less on or after day of InitialADHDMedication.relevantDatetime

define function "Cumulative Medication Duration"(Medication List<"Medication, Active">):
Sum((collapse(Medication.relevantPeriod))MedicationPeriod
    return all duration in days of MedicationPeriod
)

After

define "Has ADHD Cumulative Medication Duration Greater Than or Equal to 210 Days":
"CumulativeDuration" ( "ADHD Medications Taken on IPSD or during Continuation and Maintenance Phase" ) >= 210

define "ADHD Medications Taken on IPSD or during Continuation and Maintenance Phase":
"ADHD Medication Prescribed during Intake Period" ADHDMedication
  let IPSD: ADHDMedication.authorDatetime,
  IPSDAndContinuationMaintenancePhase: Interval[IPSD, IPSD + 300 days]
  return "MedicationOrderPeriod"(ADHDMedication)
    intersect IPSDAndContinuationMaintenancePhase

//Additional information about the "MedicationOrderPeriod" and "CumulativeDuration" functions are available at: https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/blob/master/Source/Cooking%20With%20CQL/49/36_CumulativeMedicationDuration.cql

Rationale for Change:

The goal of this change is to improve accuracy of cumulative medication duration calculation based on a prescription event.