PN6 CMS188v3/NQF0147 Clarification of intent of logic: Chest Xray/CT During Encounter, or during location?

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    • Type: Annual Update
    • Resolution: Delivered
    • Priority: Minor
    • Component/s: Measure
    • None
    • Tamara Bailey
    • 520.750.4324
    • Midas+
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      Thank you for your question. The chest x-ray/CT scan can occur anytime during the encounter. Also, as indicated in the “ Clinical Quality eMeasure Logic and Implementation Guidance v1.3” document published with the April 2013 eMeasure Updates, the encounter begins when the patient presents to the ED or is directly admitted and continues through the inpatient discharge.

      For clarity, during the next update, the “location arrival time” will be removed from the logic statements regarding “Diagnostic Study, Result” for ED, NonICU, and ICU locations.
      For example: OR: "Diagnostic Study, Result: Hospital Measures-Chest xray SM-CT (result: 'Hospital Measures-Radiological findings normal')" during "Occurrence A of Encounter, Performed: Encounter Inpatient (facility location: 'Hospital Measures-ICU Locations')"
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      Thank you for your question. The chest x-ray/CT scan can occur anytime during the encounter. Also, as indicated in the “ Clinical Quality eMeasure Logic and Implementation Guidance v1.3” document published with the April 2013 eMeasure Updates, the encounter begins when the patient presents to the ED or is directly admitted and continues through the inpatient discharge. For clarity, during the next update, the “location arrival time” will be removed from the logic statements regarding “Diagnostic Study, Result” for ED, NonICU, and ICU locations. For example: OR: "Diagnostic Study, Result: Hospital Measures-Chest xray SM-CT (result: 'Hospital Measures-Radiological findings normal')" during "Occurrence A of Encounter, Performed: Encounter Inpatient (facility location: 'Hospital Measures-ICU Locations')"

      In the denominator exclusions the logic for Chest Xrays and CT scans looks like so:

      If patient was a direct admission to ICU (no ED, no Non-ICU location):

      OR: "Diagnostic Study, Result: Hospital Measures-Chest xray SM-CT (result: 'Hospital Measures-Radiological findings normal')" during "Occurrence A of Encounter, Performed: Encounter Inpatient (facility location arrival datetime, facility location: 'Hospital Measures-ICU Locations')"

      Does this mean that the Chest Xray has to occur during the ENCOUNTER? or during the time the patient was in the ICU Location?

      The abstraction guidelines for the legacy measure decision point "Chest Xray" indicates that the xray is "through acute inpatient discharge", which would make me think that the CQM should also be any time within the encounter, but then if you look at the logic for a patient who started in an ED Encounter and then was admitted as an inpatient to Non-ICU (or ICU) the logic says this:

      OR: "Diagnostic Study, Result: Hospital Measures-Chest xray SM-CT (result: 'Hospital Measures-Radiological findings normal')" during "Occurrence A of Encounter, Performed: Hospital Measures - Encounter ED (facility location arrival datetime)"

      Which seems to indicate that it would only exclude those patients if the Chest Xray was during the ED encounter before they were inpatients?

            Assignee:
            Abt Associate (Inactive)
            Reporter:
            Tamara Bailey (Inactive)
            Abt Associate (Inactive), Deborah Krauss (Inactive)
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