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  1. eCQM Issue Tracker
  2. CQM-4884

Revise logic to remove potential double count of patients with LVSD

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    • EP/EC eCQMs
    • Status: Open
    • Moderate
    • Resolution: Unresolved
    • None

    Description

      Brief Description of Measure:

      ​CMS145: Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF less than 40%):
      Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have a prior MI or a current or prior LVEF <40% who were prescribed beta-blocker therapy

      Description of Issue:

      The intent of the measure is to include patients with Moderate or severe LVSD in Population 1 and limit Population 2 to patients with a history of MI without Moderate or Severe LVSD. However, it has been noted that ​patients are being included in both populations due to the current structure of the LVSD diagnosis in the definition.
      The current logic captures patients with LVSD findings if the diagnosis Date/Time is after the Qualifying CAD Encounter. This erroneously captures patients in both Populations 1 and 2, as the intent of the measure is to include patients with Moderate or Severe LVSD in Population 1 and not Population 2.

      Proposed Solution:

      Update the denominator logic for Population 2 so that patients with LVSD will not be captured in the denominator.
      Current Denominator Definition:
        "Qualifying CAD Encounter" EncounterWithCADProxy
          with ["Diagnosis": "Myocardial Infarction"] MyocardialInfarction
            such that MyocardialInfarction.prevalencePeriod starts 3 years or less before day of start of EncounterWithCADProxy.relevantPeriod
          without "Moderate or Severe LVSD Findings" LVSDFindings
            such that Coalesce(LVSDFindings.prevalencePeriod, Global."NormalizeInterval"(LVSDFindings.relevantDatetime, LVSDFindings.relevantPeriod))starts before
            end of EncounterWithCADProxy.relevantPeriod
      Proposed Update:
      "Qualifying CAD Encounter" EncounterWithCADProxy
        with ["Diagnosis": "Myocardial Infarction"] MyocardialInfarction
          such that MyocardialInfarction.prevalencePeriod starts 3 years or less before day of start of EncounterWithCADProxy.relevantPeriod
            and not exists "Moderate or Severe LVSD Findings"

      Rationale for Change:

      ​The proposed change will prevent patients with Moderate or Severe LVSD Findings from being captured in the denominator of Population 2, regardless of the timing of the diagnosis/findings.
       

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            khancock Mathematica EC eCQM Team
            sgearhart Mathematica EH eCQM Team
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            Dates

              Created:
              Updated: