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EH/CAH eCQMs
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Resolution: Answered
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Moderate
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None
Brief Description of Measure:
CMS144: Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction:
Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed beta-blocker therapy either within a 12-month period when seen in the outpatient setting OR at each hospital discharge
CMS145: Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF less than 40%):
Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have a prior MI or a current or prior LVEF <40% who were prescribed beta-blocker therapy
Description of Issue:
Device, Applied to be replaced with Procedure, Performed in Cardiac Pacer Implanted expressions to align with current QDM. Also updated so that normalize interval can be used. Before, "overlaps after" was being used, which prevented the use of normalized interval. "Overlaps after" was replaced with "before end of" which allows for use of normalized interval and also ensures device placement at the time of encounter.
The datatype "Device, Applied" is retired from Quality Data Model (QDM) v5.6, the version of the standard to be used for this annual update. Therefore, this datatype will be replaced with "Procedure, Performed" in the Cardiac Pacer Implanted expressions.
Also updated so that normalize interval can be used. Before, "overlaps after" was being used, which prevented the use of the Normalize Interval function. The measure steward proposes replacing the timing of "overlaps after" with "before end of" which allows for use of the Normalize Interval function, and also ensures device placement at the time of encounter.
Proposed Solution:
CURRENT LOGIC FOR CMS 144:
Has Cardiac Pacer Device Implanted Inpatient
exists ["Device, Applied": "Cardiac Pacer"] ImplantedCardiacPacer
with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter
such that ImplantedCardiacPacer.relevantPeriod overlaps after ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod
or ImplantedCardiacPacer.relevantDatetime before
end of ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod
Has Cardiac Pacer Device Implanted Outpatient
exists ["Device, Applied": "Cardiac Pacer"] ImplantedCardiacPacer
with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
such that ImplantedCardiacPacer.relevantPeriod overlaps after ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
or ImplantedCardiacPacer.relevantDatetime before
end of ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
PROPOSED LOGIC FOR CMS 144
Has Cardiac Pacer Device Implanted Inpatient
exists ["Procedure, Performed": "Cardiac Pacer"] ImplantedCardiacPacer
with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter
such that ( Global."NormalizeInterval" ( ImplantedCardiacPacer.relevantDatetime, ImplantedCardiacPacer.relevantPeriod ) ) before end of ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod
Has Cardiac Pacer Device Implanted Outpatient
exists ["Procedure, Performed": "Cardiac Pacer"] ImplantedCardiacPacer
with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
such that ( Global."NormalizeInterval" ( ImplantedCardiacPacer.relevantDatetime, ImplantedCardiacPacer.relevantPeriod ) ) before end of ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
CURRENT LOGIC FOR CMS 145:
Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Moderate or Severe LVSD
exists ["Device, Applied": "Cardiac Pacer"] ImplantedCardiacPacer
with "Qualifying CAD Encounter and Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
such that ImplantedCardiacPacer.relevantPeriod overlaps after CADEncounterModerateOrSevereLVSD.relevantPeriod
or ImplantedCardiacPacer.relevantDatetime before
end of CADEncounterModerateOrSevereLVSD.relevantPeriod
Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Prior MI
exists ["Device, Applied": "Cardiac Pacer"] ImplantedCardiacPacer
with "Qualifying CAD Encounter and Prior MI" CADEncounterMI
such that ImplantedCardiacPacer.relevantPeriod overlaps after CADEncounterMI.relevantPeriod
or ImplantedCardiacPacer.relevantDatetime before
end of CADEncounterMI.relevantPeriod
PROPOSED LOGIC FOR CMS 145:
Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Moderate or Severe LVSD
exists ["Procedure, Performed": "Cardiac Pacer"] ImplantedCardiacPacer
with "Qualifying CAD Encounter and Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
such that ( Global."NormalizeInterval" ( ImplantedCardiacPacer.relevantDatetime, ImplantedCardiacPacer.relevantPeriod ) ) before
end of CADEncounterModerateOrSevereLVSD.relevantPeriod
Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Prior MI
exists ["Procedure, Performed": "Cardiac Pacer"] ImplantedCardiacPacer
with "Qualifying CAD Encounter and Prior MI" CADEncounterMI
such that ( Global."NormalizeInterval" ( ImplantedCardiacPacer.relevantDatetime, ImplantedCardiacPacer.relevantPeriod ) ) before
end of CADEncounterMI.relevantPeriod
Rationale for Change:
The datatype "Device, Applied" is retired from QDM v5.6 and is recommended to be replaced with "Procedure, Performed", and updating the measure to use Normalize Interval allows flexibility when the information is captured as an interval or a single point in time.