Brief Description of Measure:

CMS22: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented:
Percentage of patient visits for patients aged 18 years and older seen during the measurement period who were screened for high blood pressure AND a recommended follow-up plan is documented, as indicated, if blood pressure is pre-hypertensive or hypertensive

​Description of Issue:

​The Preventive Care and Screening: Screening for High Blood Pressure and Follow Up Measure includes blood pressure rescreening when an initial blood pressure screening is categorized as elevated or as hypertensive. This logic is informed by clinical guidelines that recommend confirmation of an initial blood pressure reading prior to starting treatment. 
 
A stakeholder expressed concern that the Quality Data Model (QDM) datatype, 'Intervention, Order', used to capture follow-up blood pressure rescreenings for patients with elevated and hypertensive blood pressure readings, would not capture evidence of compliance, as there often may not be an order, per se, in electronic medical record systems. 
 
To date we are unaware of any issue capturing this follow-up blood pressure rescreening. In practice some clinicians use a nurse order to facilitate rescreening at the prescribed time. To account for those settings where a nurse order may not be in use, we propose an addition to the logic that will reflect clinical workflow and rescreening conducted by the provider.
 
We would appreciate feedback on a plan to keep the logic using the 'Intervention, Order' datatype and adding a new definition [Follow Up Blood Pressure Reading Encounter] to be used for all follow up encounters to capture blood pressure readings. In particular, we propose using the 'Physical Exam, Performed' QDM datatype to capture systolic and diastolic blood pressure readings within the timeframes given under the current specifications.

Proposed Solution:

Add the following definition to the numerator criteria for blood pressure rescreening:
Follow Up Blood Pressure Reading Encounter
( "Qualifying Encounter during Measurement Period" FollowUpEncounter
    let FollowUpSystolicBP: Last(["Physical Exam, Performed": "Systolic blood pressure"] RecheckSystolicBP
        where Global."NormalizeInterval"(RecheckSystolicBP.relevantDatetime, RecheckSystolicBP.relevantPeriod)ends during FollowUpEncounter.relevantPeriod
        sort by start of Global."NormalizeInterval"(relevantDatetime, relevantPeriod)   ),
    FollowUpDiastolicBP: Last(["Physical Exam, Performed": "Diastolic blood pressure"] RecheckDiastolicBP
        where Global."NormalizeInterval"(RecheckDiastolicBP.relevantDatetime, RecheckDiastolicBP.relevantPeriod)ends during FollowUpEncounter.relevantPeriod
        sort by start of Global."NormalizeInterval"(relevantDatetime, relevantPeriod)    )
    where FollowUpSystolicBP.result > 0 'mm[Hg]'
      and FollowUpDiastolicBP.result > 0 'mm[Hg]')
 
Add the following definitions or incorporate displayed logic into existing definitions to capture the time constraints for relevant follow up:
 
Follow Up Elevated BP Reading Encounter
"Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80" ElevatedBPEncounter
  with "Follow Up Blood Pressure Reading Encounter" FollowUpElevatedBPEncounter
    such that FollowUpElevatedBPEncounter.relevantPeriod starts during Interval[
    end of ElevatedBPEncounter.relevantPeriod + 2 months, 
    end of ElevatedBPEncounter.relevantPeriod + 6 months]
 
Follow Up First Hypertensive Reading Encounter
"Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80" FirstHypertensiveReadingEncounter
  with "Follow Up Blood Pressure Reading Encounter" FollowUpReadingEncounter
    such that FollowUpReadingEncounter.relevantPeriod starts during Interval[
    end of FirstHypertensiveReadingEncounter.relevantPeriod + 1 day, 
    end of FirstHypertensiveReadingEncounter.relevantPeriod + 28 days]
 
This will impact the numerator definition, but representation may vary based on how best to streamline logic.

Rationale for Change:

Improve numerator compliance.