Brief Description of Measure:

​CMS56: Functional Status Assessment for Total Hip Replacement:
Percentage of patients 18 years of age and older who received an elective primary total hip arthroplasty (THA) and completed a functional status assessment within 90 days prior to the surgery and in the 270-365 days after the surgery
CMS66: Functional Status Assessment for Total Knee Replacement:
Percentage of patients 18 years of age and older who received an elective primary total knee arthroplasty (TKA) and completed a functional status assessment within 90 days prior to the surgery and in the 270-365 days after the surgery

Description of Issue:

The intent of this measure is to exclude lower body fractures that are on the same day (within 24 hours) of the total hip or knee arthroplastry operation to avoid including hip or knee replacements due to a traumatic injury.
 
Through an implementer's comment in regards to the measure logic, the measure developer realized the current logic, as specified in CQM-4829 and that recently went through CRP, does not meet the intent of the measure. ​
 
The current logic does not exclude patients that had two lower fractures exactly 24 hours apart. The proposed logic updates will ensure that any lower body fractures that occur within 24 hours of the THA/TKA would be excluded.

Proposed Solution:

​CMS 56 - Definition "Has Total Hip Arthroplasty with 2 or More Lower Body Fractures"
Current logic:
   exists ( "Total Hip Arthroplasty Procedure" THAProcedure
      where Count(["Diagnosis": "Fracture - Lower Body"] LowerBodyFracture
          where LowerBodyFracture.prevalencePeriod starts less than 1 day on or before start of THAProcedure.relevantPeriod
       )>= 2)
 
Proposed logic:
   exists ( "Total Hip Arthroplasty Procedure" THAProcedure
       where Count(["Diagnosis": "Lower Body Fracture"] LowerBodyFracture
           where LowerBodyFracture.prevalencePeriod starts 24 hours or less on or before start of Global."NormalizeInterval"(THAProcedure.relevantDatetime, THAProcedure.relevantPeriod)
       )>= 2)

CMS 66 - Definition "Has Total Knee Arthroplasty with 2 or More Lower Body Fractures"
Current logic:
   exists ( "Total Knee Arthroplasty Procedure" TKAProcedure
       where Count(["Diagnosis": "Fracture - Lower Body"] LowerBodyFracture
           where LowerBodyFracture.prevalencePeriod starts less than 1 day on or before TKAProcedure.relevantPeriod
       )>= 2)
 
Proposed logic:
   exists ( "Total Knee Arthroplasty Procedure" TKAProcedure
       where Count(["Diagnosis": "Lower Body Fracture"] LowerBodyFracture
           where LowerBodyFracture.prevalencePeriod starts 24 hours or less on or before start of Global."NormalizeInterval"(TKAProcedure.relevantDatetime, TKAProcedure.relevantPeriod)
       )>= 2)

Rationale for Change:

The planned updates will bring the measure logic in alignment with measure intent, to exclude patients who have 2 lower body fractures exactly 24 hours of the TKA/THA.