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  1. eCQM Issue Tracker
  2. CQM-4944

Apply constraints to the lookback period for palliative or hospice care to remove indefinite lookback

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Details

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

    Description

      Brief Description of Measure:
      CMS159: Depression Remission at Twelve Months:
      The percentage of adolescent patients 12 to 17 years of age and adult patients 18 years of age or older with major depression or dysthymia who reached remission 12 months (+/- 60 days) after an index event.

      Description of Issue:
      ​The measure currently has a lookback period for palliative and hospice care that includes any time before or during the measurement period. Stakeholders identified this extended lookback period as burdensome and not aligned with the CQM version of the measure. Measure developers also identified the extended lookback as unnecessary to meet the measure intent.

      Current header:
      Denominator Exclusions
      1: Patients who died
      2: Patients who received hospice or palliative care services
      3: Patients who were permanent nursing home residents
      4: Patients with a diagnosis of bipolar disorder
      5: Patients with a diagnosis of personality disorder emotionally labile
      6: Patients with a diagnosis of schizophrenia or psychotic disorder
      7: Patients with a diagnosis of pervasive developmental disorder

      Current logic (example):
      Has An Order For Palliative or Hospice Care =
         exists ( ["Intervention, Order": "Palliative or Hospice Care"] PalliativeCareOrder
             where Global."ToDate" ( PalliativeCareOrder.authorDatetime ) occurs on or before end of "Measure Assessment Period"

      Proposed Solution:
      ​The measure developer is proposing to align the eCQM version of the measure with the CQM version by restricting the lookback period for palliaitve and hospice services to the denominator identification period and the measurement assessment period.

      Propose revising second Denominator Exclusions statement in the header:
      ...
      2: Patients who received hospice or palliative care services between the beginning of the denominator identification period and the end of the measure assessment period
      ...

      Proposed logic:

      OPTION ONE:
      exists ( ["Intervention, Order": "Palliative or Hospice Care"] PalliativeCareOrder
      where ToDate( PalliativeCareOrder.authorDatetime ) during "Measure Assessment Period"
      or ToDate( PalliativeCareOrder.authorDatetime ) during "Denominator Identification Period")

      OPTION TWO:
      exists ( ["Intervention, Order": "Palliative or Hospice Care"] PalliativeCareOrder
      where ToDate(PalliativeCareOrder.authorDatetime ) occurs 26 months or less before
      end of "Measure Assessment Period")

      OPTION THREE:
      exists ( ["Intervention, Order": "Palliative or Hospice Care"] PalliativeCareOrder
      where ToDate( PalliativeCareOrder.authorDatetime ) occurs during Interval[start of "Measure Assessment Period" - 14 months,
      end of "Measurement Period"])

      The measure developer has proposed three options for how the logic could be revised, and seeks input from the CRP community for which option would be preferable to reduce implementation burden.

      Rationale for Change:
      ​The purpose of restricting the palliative and hospice care lookback is to align with the CQM version of the measure and to reduce burden on reporters. 

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            khancock Mathematica EC eCQM Team
            khancock Mathematica EC eCQM Team
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            Dates

              Created:
              Updated: