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  2. CQM-4951

Revise logic to accurately reflect count of medication duration in days

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

    Description

      Brief Description of Measure:
      ​CMS249: Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture:
      Percentage of female patients 50 to 64 years of age without select risk factors for osteoporotic fracture who received an order for a dual-energy x-ray absorptiometry (DXA) scan during the measurement period

      Description of Issue:
      During internal review, the measure developer determined that the current logic does not calculate medication active days as intended. It uses duration "in days of...", which returns the number of whole calendar days, which is different from calculating number of calendar days covered.

      For example, to illustrate the difference, given the following Medication Active periods, the duration, or number of whole calendar days, are 9 days and 2 days, totaling to 11 days, whereas the number of calendar days covered are 10 and 3, totaling to 13 days.
       
      1/1/2012 1pm-1/10/2012 1:15pm
      1/11/2012 2pm-1/13/2012 2:15pm
      Note: These findings are tested and evaluated using the Bonnie QDM v5.0.0 tool.
       
      Since the intent is to evaluate the number of calendar days active on glucocorticoids, the logic will be updated to express the intent.
      The updated logic will use "difference in days of...", which returns the number of day boundaries crossed, and then use "+1" day to account for the total calendar period. For example, the difference in 1/11/2012 2:00pm to 1/13/2012 2:15pm is 2 days; to account for total calendar days covered, add 2 days plus 1 day. The updated logic will also use "collapse... per day" to ensure that overlapping days are not double counted.
       
      For more information on "duration" operator, please see: https://cql.hl7.org/09-b-cqlreference.html#duration.
      For more information on "difference" operator, please see: https://cql.hl7.org/09-b-cqlreference.html#difference.

      Proposed Solution:
      ​//Before
      define "Glucocorticoid Active Medication Duration in Days":
        ( collapse ( ["Medication, Active": "Glucocorticoids (oral only)"] Glucocorticoid
            where Glucocorticoid.relevantPeriod starts before
            end of "Measurement Period"
        ).relevantPeriod ) GlucocorticoidIntervals
          return duration in days of ( GlucocorticoidIntervals
              intersect Interval[Patient.birthDatetime,
              end of "Measurement Period"]
          )

      //After
      define "Glucocorticoid Active Medication Duration in Days":
      ( collapse ( ["Medication, Active": "Glucocorticoids (oral only)"] Glucocorticoid
          where Glucocorticoid.relevantPeriod starts before
          end of "Measurement Period"
      ).relevantPeriod per day ) GlucocorticoidIntervals
        return difference in days of ( GlucocorticoidIntervals
            intersect Interval[Patient.birthDatetime,
            end of "Measurement Period"]
        ) + 1

      Rationale for Change:
      ​The goal of this change is to bring logic expression into alignment with measure intent.

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            khancock Mathematica EC eCQM Team
            khancock Mathematica EC eCQM Team
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            Dates

              Created:
              Updated: