Brief Description of Measure:
​CMS646: Intravesical Bacillus-Calmette-Guerin for non-muscle invasive bladder cancer:
Percentage of patients initially diagnosed with non-muscle invasive bladder cancer and who received intravesical Bacillus-Calmette-Guerin (BCG) within 6 months of bladder cancer staging.

Description of Issue:
​​Opportunity to improve logic that will be explored in the future, after assessing the currently planned changes to the measure logic.

Proposed Solution:
​
o Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Urothelial Cell Carcinoma Diagnosis Before Start of Staging
 
 exists ( ( ( ["Diagnosis": "HIV"]
       union ["Diagnosis": "Immunocompromised Conditions"]
       union ["Diagnosis": "Mixed histology urothelial cell carcinoma for Urology Care"] ) ExclusionDiagnosis
       with "Most Recent Bladder Cancer Staging Procedure" BladderCancerStaging
         such that ExclusionDiagnosis.prevalencePeriod starts on or before start of Global."NormalizeInterval" ( BladderCancerStaging.relevantDatetime, BladderCancerStaging.relevantPeriod )
   )
 )
 
o  Has Excluding Chemotherapy for Advanced Cancer Medication or Radiotherapy Procedure Six Months or Less Before Staging
 
 exists ( ( ( ["Medication, Active": "Chemotherapy for Advanced Cancer"]
       union ["Procedure, Performed": "Combined radiotherapy (procedure)"] ) ExclusionDiagnosis
       with "Most Recent Bladder Cancer Staging Procedure" BladderCancerStaging
         such that ExclusionDiagnosis.relevantPeriod starts 6 months or less before Global."NormalizeInterval" ( BladderCancerStaging.relevantDatetime, BladderCancerStaging.relevantPeriod )
   )
 )
o Denominator Exclusion
 
 exists "Acute Tuberculosis Diagnosis"
   or exists "Immunosuppressive Drugs"
   or exists "Cystectomy Done"
   or "Has Excluding  HIV, Immunocompromised Conditions or Mixed Histology Urothelial Cell Carcinoma Diagnosis Before Start of Staging"
   or "Has Excluding Chemotherapy for Advanced Cancer Medication or Radiotherapy Procedure Six Months or Less Before

Rationale for Change:
​Groups like definitions with timing to eliminate a long list.