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  2. CQM-5562

CRP: Update Cumulative Medication Duration function to calculate maximum daily frequency

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    • Resolution: Resolved
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      Brief Description of Measure:
      CMS128: Percentage of patients 18 years of age and older who were treated with antidepressant medication, had a diagnosis of major depression, and who remained on an antidepressant medication treatment. Two rates are reported.
      a. Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks).
      b. Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months).

      CMS136: Percentage of children 6-12 years of age and newly prescribed a medication for attention-deficit/hyperactivity disorder (ADHD) who had appropriate follow-up care. Two rates are reported.
      a. Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-Day Initiation Phase.
      b. Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.

      CMS156: Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported.
      1. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class.
      2. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses.
      3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators).

      Description of Issue:
      The CumulativeMedicationDuration library function, "CodeToDaily", returns the equivalent daily frequency of a given code. For example, SNOMED-CT code 229797004 "once daily (qualifier value)" results in 1.0 and SNOMED-CT code 396107007 "One to two times a day (qualifier value)" results in 2.0. For codes representing hour ranges, the description of the function states that "for ranges, the upper range is used". However, this could result in inconsistent conversion of codes into either minimum or maximum frequency. For example, using the upper range for code "One to two times a day…" results in maximum frequency of 2.0, and using the upper range for code "Every three to four hours" results in minimum frequency of 6.0 (i.e., every four hours).

      Goal of Review:
      Obtain technical feedback
      Show
      Brief Description of Measure: CMS128: Percentage of patients 18 years of age and older who were treated with antidepressant medication, had a diagnosis of major depression, and who remained on an antidepressant medication treatment. Two rates are reported. a. Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks). b. Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months). CMS136: Percentage of children 6-12 years of age and newly prescribed a medication for attention-deficit/hyperactivity disorder (ADHD) who had appropriate follow-up care. Two rates are reported. a. Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-Day Initiation Phase. b. Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended. CMS156: Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported. 1. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. 2. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses. 3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators). Description of Issue: The CumulativeMedicationDuration library function, "CodeToDaily", returns the equivalent daily frequency of a given code. For example, SNOMED-CT code 229797004 "once daily (qualifier value)" results in 1.0 and SNOMED-CT code 396107007 "One to two times a day (qualifier value)" results in 2.0. For codes representing hour ranges, the description of the function states that "for ranges, the upper range is used". However, this could result in inconsistent conversion of codes into either minimum or maximum frequency. For example, using the upper range for code "One to two times a day…" results in maximum frequency of 2.0, and using the upper range for code "Every three to four hours" results in minimum frequency of 6.0 (i.e., every four hours). Goal of Review: Obtain technical feedback
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      Proposed Solution:
      ​//Before
      /*@description: Returns the equivalent daily frequency (as a decimal) of the given code
      @comment: Note that for ranges, the upper range is used. E.g. `Every two to four hours` results in `6.0` and `One to two` times a day results in `2.0`.*/

      define function "CodeToDaily"(Frequency Code ):
       
        case

          when Frequency ~ "Once daily (qualifier value)" then 1.0
            […]
          when Frequency ~ "Every seventy two hours (qualifier value)" then 0.34
          when Frequency ~ "Every forty eight hours (qualifier value)" then 0.5
          when Frequency ~ "Every eight to twelve hours (qualifier value)" then 2.0
          when Frequency ~ "Every six to eight hours (qualifier value)" then 3.0
          when Frequency ~ "Every three to four hours (qualifier value)" then 6.0
          when Frequency ~ "Every three to six hours (qualifier value)" then 4.0
          when Frequency ~ "Every two to four hours (qualifier value)" then 6.0
             […]
        end

      //After
      /*@description: Returns the equivalent daily frequency (as a decimal) of the given code
      @comment: Note that for ranges, the boundary resulting in the highest frequency result is used. E.g. `Every two to four hours` results in `12.0` and `One to two` times a day results in `2.0`.*/

      define function "CodeToDaily"(Frequency Code ):
        case
          when Frequency ~ "Once daily (qualifier value)" then 1.0
             […]
          when Frequency ~ "Every seventy two hours (qualifier value)" then 0.33
          when Frequency ~ "Every forty eight hours (qualifier value)" then 0.5
          when Frequency ~ "Every eight to twelve hours (qualifier value)" then 3.0
          when Frequency ~ "Every six to eight hours (qualifier value)" then 4.0
          when Frequency ~ "Every three to four hours (qualifier value)" then 8.0
          when Frequency ~ "Every three to six hours (qualifier value)" then 8.0
          when Frequency ~ "Every two to four hours (qualifier value)" then 12.0
             […]
        end

      Rationale for Change:
      This issue was discussed with and supported by the eCQM Work Group community and QDM standards team on 4/21/2022. The recommendation is to update the function logic so that maximum frequency, hence highest dose, is consistently calculated; this would also align with the Morphine Milligram Equivalent (MME) calculation logic: http://fhir.org/guides/cdc/opioid-mme-r4/3.0.0/. The other recommendation is to update the description to “for ranges, the boundary resulting in the highest frequency is used” and correct a calculation that was incorrectly rounded up instead of down, i.e., “every 72 hours” results in 0.33 instead of 0.34.
      Show
      Proposed Solution: ​//Before /*@description: Returns the equivalent daily frequency (as a decimal) of the given code @comment: Note that for ranges, the upper range is used. E.g. `Every two to four hours` results in `6.0` and `One to two` times a day results in `2.0`.*/ define function "CodeToDaily"(Frequency Code ):     case     when Frequency ~ "Once daily (qualifier value)" then 1.0       […]     when Frequency ~ "Every seventy two hours (qualifier value)" then 0.34     when Frequency ~ "Every forty eight hours (qualifier value)" then 0.5     when Frequency ~ "Every eight to twelve hours (qualifier value)" then 2.0     when Frequency ~ "Every six to eight hours (qualifier value)" then 3.0     when Frequency ~ "Every three to four hours (qualifier value)" then 6.0     when Frequency ~ "Every three to six hours (qualifier value)" then 4.0     when Frequency ~ "Every two to four hours (qualifier value)" then 6.0        […]   end //After /*@description: Returns the equivalent daily frequency (as a decimal) of the given code @comment: Note that for ranges, the boundary resulting in the highest frequency result is used. E.g. `Every two to four hours` results in `12.0` and `One to two` times a day results in `2.0`.*/ define function "CodeToDaily"(Frequency Code ):   case     when Frequency ~ "Once daily (qualifier value)" then 1.0        […]     when Frequency ~ "Every seventy two hours (qualifier value)" then 0.33     when Frequency ~ "Every forty eight hours (qualifier value)" then 0.5     when Frequency ~ "Every eight to twelve hours (qualifier value)" then 3.0     when Frequency ~ "Every six to eight hours (qualifier value)" then 4.0     when Frequency ~ "Every three to four hours (qualifier value)" then 8.0     when Frequency ~ "Every three to six hours (qualifier value)" then 8.0     when Frequency ~ "Every two to four hours (qualifier value)" then 12.0        […]   end Rationale for Change: This issue was discussed with and supported by the eCQM Work Group community and QDM standards team on 4/21/2022. The recommendation is to update the function logic so that maximum frequency, hence highest dose, is consistently calculated; this would also align with the Morphine Milligram Equivalent (MME) calculation logic:  http://fhir.org/guides/cdc/opioid-mme-r4/3.0.0/ . The other recommendation is to update the description to “for ranges, the boundary resulting in the highest frequency is used” and correct a calculation that was incorrectly rounded up instead of down, i.e., “every 72 hours” results in 0.33 instead of 0.34.

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          edave Mathematica EC eCQM Team
          edave Mathematica EC eCQM Team
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