Brief Description of Measure:

CMS124: Cervical Cancer Screening:
Percentage of women 21-64 years of age who were screened for cervical cancer using either of the following criteria:

• Women age 21-64 who had cervical cytology performed within the last 3 years
• Women age 30-64 who had cervical human papillomavirus (HPV) testing performed within the last 5 years

CMS130: Colorectal Cancer Screening:
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer

Description of Issue:

There is a one second difference from the intended screening timeframes indicated in CMS134 and CMS130.
 
In CMS124, the logic for "Cervical Cytology Within 3 Years" uses the syntax "3 years or less on or before the end of measurement period", which could count 12/31/2019 11:59PM when the end of the measurement period is 12/31/2022 11:59PM. The intent of the measure is to count pap tests during the measurement period or two years prior to the measurement, which is 1/1/2020 12:00AM -12/31/2022 11:59PM.
 
Similarly, in CMS130, the logic for "CT Colonography Performed" uses the syntax "5 years or less on or before end of measurement period", which could count 12/31/2017 11:59PM when the end of the measurement period is 12/31/2022 11:59PM. The intent of the measure is to count CT colonography during the measurement period or 4 years prior to the measurement period, which is 1/1/2018 12:00AM - 12/31/2022 11:59PM.
 
To improve the precision of the screening timeframe, we propose to specify with "intervals" instead of using the syntax "X years or less on or before...".

Proposed Solution:

​CMS124

Current:
Cervical Cytology Within 3 Years =
  ["Laboratory Test, Performed": "Pap Test"] CervicalCytology
    where Global."LatestOf" ( CervicalCytology.relevantDatetime, CervicalCytology.relevantPeriod ) 3 years or less on or before
    end of "Measurement Period"
      and CervicalCytology.result is not null

HPV Test Within 5 Years for Women Age 30 and Older =
  ["Laboratory Test, Performed": "HPV Test"] HPVTest
    with ["Patient Characteristic Birthdate": "Birth date"] BirthDate
      such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, HPVTest.relevantDatetime ) >= 30
    where Global."LatestOf" ( HPVTest.relevantDatetime, HPVTest.relevantPeriod ) 5 years or less on or before
    end of "Measurement Period"
      and HPVTest.result is not null

Proposed:
Cervical Cytology Within 3 Years =
  ["Laboratory Test, Performed": "Pap Test"] CervicalCytology
    where Global."LatestOf" ( CervicalCytology.relevantDatetime, CervicalCytology.relevantPeriod ) during day of Interval[start of "Measurement Period" - 2 years,
    end of "Measurement Period"]
      and CervicalCytology.result is not null

HPV Test Within 5 Years for Women Age 30 and Older =
  ["Laboratory Test, Performed": "HPV Test"] HPVTest
    with ["Patient Characteristic Birthdate": "Birth date"] BirthDate
      such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, HPVTest.relevantDatetime ) >= 30
    where Global."LatestOf" ( HPVTest.relevantDatetime, HPVTest.relevantPeriod ) during day of Interval[start of "Measurement Period" - 4 years,
    end of "Measurement Period"]
      and HPVTest.result is not null

CMS130

Current:
Fecal Immunochemical Test DNA Performed =
  ["Laboratory Test, Performed": "FIT DNA"] FitDNA
    where FitDNA.result is not null
      and Global."LatestOf" ( FitDNA.relevantDatetime, FitDNA.relevantPeriod ) 3 years or less on or before
      end of "Measurement Period"

CT Colonography Performed =
  ["Diagnostic Study, Performed": "CT Colonography"] Colonography
    where Global."NormalizeInterval" ( Colonography.relevantDatetime, Colonography.relevantPeriod ) ends 5 years or less on or before
    end of "Measurement Period"

Flexible Sigmoidoscopy Performed =
  ["Procedure, Performed": "Flexible Sigmoidoscopy"] FlexibleSigmoidoscopy
    where Global."NormalizeInterval" ( FlexibleSigmoidoscopy.relevantDatetime, FlexibleSigmoidoscopy.relevantPeriod ) ends 5 years or less on or before
    end of "Measurement Period"

Colonoscopy Performed =
  ["Procedure, Performed": "Colonoscopy"] Colonoscopy
    where Global."NormalizeInterval" ( Colonoscopy.relevantDatetime, Colonoscopy.relevantPeriod ) ends 10 years or less on or before
    end of "Measurement Period"

Proposed:
Fecal Immunochemical Test DNA Performed =
  ["Laboratory Test, Performed": "FIT DNA"] FitDNA
    where FitDNA.result is not null
      and Global."LatestOf" ( FitDNA.relevantDatetime, FitDNA.relevantPeriod ) during day of Interval[start of "Measurement Period" - 2 years,
      end of "Measurement Period"]

CT Colonography Performed =
  ["Diagnostic Study, Performed": "CT Colonography"] Colonography
    where Global."NormalizeInterval" ( Colonography.relevantDatetime, Colonography.relevantPeriod ) ends during day of Interval[start of "Measurement Period" - 4 years,
    end of "Measurement Period"]

Flexible Sigmoidoscopy Performed =
  ["Procedure, Performed": "Flexible Sigmoidoscopy"] FlexibleSigmoidoscopy
    where Global."NormalizeInterval" ( FlexibleSigmoidoscopy.relevantDatetime, FlexibleSigmoidoscopy.relevantPeriod ) ends during day of Interval[start of "Measurement Period" - 4 years,
    end of "Measurement Period"]

Colonoscopy Performed =
  ["Procedure, Performed": "Colonoscopy"] Colonoscopy
    where Global."NormalizeInterval" ( Colonoscopy.relevantDatetime, Colonoscopy.relevantPeriod ) ends during day of Interval[start of "Measurement Period" - 9 years,
    end of "Measurement Period"]

Rationale for Change:

This change would precisely express the intended screening timeframe required by the measures.