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  1. eCQM Issue Tracker
  2. CQM-4906

Consider excluding patients discharged against medical advice



    • EH/CAH eCQMs
    • Status: Open
    • Moderate
    • Resolution: Unresolved
    • None


      Brief Description of Measure:

      ​CMS506: Safe Use of Opioids - Concurrent Prescribing
      Proportion of inpatient hospitalizations for patients 18 years of age and older prescribed, or continued on, two or more opioids or an opioid and benzodiazepine concurrently at discharge

      Description of Issue:

      ​The measure does not currently have a denominator exclusion for patients that leave their inpatient stay against medical advice; these patients may count towards the numerator. A Jira user noted that hospitals may not have the time or process in place to reconcile medications for patients that leave the hospital against medical advice. Should the measure exclude these patients? If so, do you agree with the logic and value set used to exclude them?

      Proposed Solution:

      ​Add a denominator exclusion to the measure for patients discharged against medical advice:
      Proposed denominator exclusion language:
       Inpatient hospitalizations where patients have cancer that begins prior to or during the encounter or are receiving palliative or hospice care (including comfort measures, terminal care, and dying care) during the encounter, patients discharged to another inpatient care facility, patients who are discharged against medical advice, and patients who expire during the inpatient stay.​
      Proposed logic:​
      Denominator Exclusions
      /Excludes encounters of patients with cancer, sickle cell disease with crisis, patients who left against medical advice, expired, or who are receiving medication-assisted treatment or palliative or hospice care at the time of the encounter/
      "Observation or ED Visits with Age Greater than or Equal to 18" ObservationEDVisit
      where exists ( ["Diagnosis": "All Primary and Secondary Cancer"] Cancer
      where Cancer.prevalencePeriod overlaps ObservationEDVisit.relevantPeriod
      or exists ( "Observation or ED Visits with Age Greater than or Equal to 18" ObservationEDVisit
      where ObservationEDVisit.dischargeDisposition in "Discharge To Acute Care Facility"
      or ObservationEDVisit.dischargeDisposition in "Hospice Care Referral or Admission"
      or ObservationEDVisit.dischargeDisposition in "Patient Expired"
      or ObservationEDVisit.dischargeDisposition in "Left Against Medical Advice"​

      Proposed value set: valueset "Left Against Medical Advice" (2.16.840.1.113883.​

      Rationale for Change:

      ​The intent of the measure is to discourage clinicians from discharging patients receiving two or more opioids or an opioid and benzodiazepine. If clinicians are unable to review and update the patient's medication before discharge because the patient leaves against medical advice, hospitals should not be penalized in the measure score.




            sgearhart Mathematica EH eCQM Team
            sgearhart Mathematica EH eCQM Team
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