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  2. CQM-5563

CRP: Expand codes using 'Diagnosis' datatype to capture Palliative Care

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    • Other
    • Resolution: Resolved
    • Moderate
    • None
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      Brief Description of Measure:
      CMS69: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
      CMS122: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
      CMS124: Cervical Cancer Screening
      CMS125: Breast Cancer Screening
      CMS130: Colorectal Cancer Screening
      CMS131: Diabetes: Eye Exam
      CMS134: Diabetes: Medical Attention for Nephropathy
      CMS156: Use of High-Risk Medications in Older Adults
      CMS165: Controlling High Blood Pressure

      Description of Issue:
      ​​​The current value set used to express "Palliative Care Intervention" and "Intervention, Performed" is "Palliative Care Intervention" value set (OID: 2.16.840.1.113883.3.464.1003.198.12.1135). Upon reviewing the codes, the measure developer found that there are SNOMED-CT finding codes within the value set. The measure developer believes these codes could better capture patients with a palliative care diagnosis if they exist in a stand alone value set. 

      The measure logic would introduce a new value set that is created from existing SNOMED-CT codes currently applied to the 'Intervention, Performed' QDM datatype, and absorbing the ICD-10-CM direct reference code for 'Encounter for palliative care' using the 'Diagnosis' QDM datatype.

      Goal of Review:
      Obtain clinical and technical feedback
      Show
      Brief Description of Measure: CMS69: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan CMS122: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) CMS124: Cervical Cancer Screening CMS125: Breast Cancer Screening CMS130: Colorectal Cancer Screening CMS131: Diabetes: Eye Exam CMS134: Diabetes: Medical Attention for Nephropathy CMS156: Use of High-Risk Medications in Older Adults CMS165: Controlling High Blood Pressure Description of Issue: ​​​The current value set used to express "Palliative Care Intervention" and "Intervention, Performed" is "Palliative Care Intervention" value set (OID: 2.16.840.1.113883.3.464.1003.198.12.1135). Upon reviewing the codes, the measure developer found that there are SNOMED-CT finding codes within the value set. The measure developer believes these codes could better capture patients with a palliative care diagnosis if they exist in a stand alone value set.  The measure logic would introduce a new value set that is created from existing SNOMED-CT codes currently applied to the 'Intervention, Performed' QDM datatype, and absorbing the ICD-10-CM direct reference code for 'Encounter for palliative care' using the 'Diagnosis' QDM datatype. Goal of Review: Obtain clinical and technical feedback
    • Hide
      Proposed Solution:
      ​Palliative Care logic before:
      define "Palliative Care in the Measurement Period":
        exists ( ["Assessment, Performed": "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"] PalliativeAssessment
            where Global."NormalizeInterval"(PalliativeAssessment.relevantDatetime, PalliativeAssessment.relevantPeriod) overlaps "Measurement Period"
        )
        or exists (["Diagnosis": "Encounter for palliative care"] PalliativeDiagnosis
        where PalliativeDiagnosis.prevalencePeriod overlaps "Measurement Period")
          or exists ( ["Encounter, Performed": "Palliative Care Encounter"] PalliativeEncounter
              where PalliativeEncounter.relevantPeriod overlaps "Measurement Period"
          )
          or exists ( ["Intervention, Performed": "Palliative Care Intervention"] PalliativeIntervention
              where Global."NormalizeInterval"(PalliativeIntervention.relevantDatetime, PalliativeIntervention.relevantPeriod) overlaps "Measurement Period"
          )

      Palliative Care logic after:
      define "Palliative Care in the Measurement Period":
        exists ( ["Assessment, Performed": "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"] PalliativeAssessment
            where Global."NormalizeInterval"(PalliativeAssessment.relevantDatetime, PalliativeAssessment.relevantPeriod) overlaps "Measurement Period"
        )
        or exists (["Diagnosis": "Palliative Care Diagnosis"] PalliativeDiagnosis
        where PalliativeDiagnosis.prevalencePeriod overlaps "Measurement Period")
          or exists ( ["Encounter, Performed": "Palliative Care Encounter"] PalliativeEncounter
              where PalliativeEncounter.relevantPeriod overlaps "Measurement Period"
          )
          or exists ( ["Intervention, Performed": "Palliative Care Intervention"] PalliativeIntervention
              where Global."NormalizeInterval"(PalliativeIntervention.relevantDatetime, PalliativeIntervention.relevantPeriod) overlaps "Measurement Period"
          )


      Value Set/Codes before:
      • value set "Palliative Care Intervention" (2.16.840.1.113883.3.464.1003.198.12.1135)

      Value Set/Codes after:
      • value set "Palliative Care Intervention" (2.16.840.1.113883.3.464.1003.198.12.1135)
      ///Remove codes 305686008 Seen by palliative care physician (finding), 305824005 Seen by palliative care medicine service (finding), 441874000 Seen by palliative care service (finding)

      • value set "Palliative Care Diagnosis" (2.16.840.1.113883.3.464.1003.1167)
      ///Add codes 305686008 Seen by palliative care physician (finding), 305824005 Seen by palliative care medicine service (finding), 441874000 Seen by palliative care service (finding), code "Encounter for palliative care" ICD10CM Code (Z51.5)

      Rationale for Change:
      The creation of a new value set containing the SNOMED findings codes and applying the 'Diagnosis' QDM datatype will help capture intended patient population for those receiving palliative care. 
      Show
      Proposed Solution: ​Palliative Care logic before: define "Palliative Care in the Measurement Period":   exists ( ["Assessment, Performed": "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"] PalliativeAssessment       where Global."NormalizeInterval"(PalliativeAssessment.relevantDatetime, PalliativeAssessment.relevantPeriod) overlaps "Measurement Period"   )   or exists (["Diagnosis": "Encounter for palliative care"] PalliativeDiagnosis   where PalliativeDiagnosis.prevalencePeriod overlaps "Measurement Period")     or exists ( ["Encounter, Performed": "Palliative Care Encounter"] PalliativeEncounter         where PalliativeEncounter.relevantPeriod overlaps "Measurement Period"     )     or exists ( ["Intervention, Performed": "Palliative Care Intervention"] PalliativeIntervention         where Global."NormalizeInterval"(PalliativeIntervention.relevantDatetime, PalliativeIntervention.relevantPeriod) overlaps "Measurement Period"     ) Palliative Care logic after: define "Palliative Care in the Measurement Period":   exists ( ["Assessment, Performed": "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"] PalliativeAssessment       where Global."NormalizeInterval"(PalliativeAssessment.relevantDatetime, PalliativeAssessment.relevantPeriod) overlaps "Measurement Period"   )   or exists (["Diagnosis": "Palliative Care Diagnosis"] PalliativeDiagnosis   where PalliativeDiagnosis.prevalencePeriod overlaps "Measurement Period")     or exists ( ["Encounter, Performed": "Palliative Care Encounter"] PalliativeEncounter         where PalliativeEncounter.relevantPeriod overlaps "Measurement Period"     )     or exists ( ["Intervention, Performed": "Palliative Care Intervention"] PalliativeIntervention         where Global."NormalizeInterval"(PalliativeIntervention.relevantDatetime, PalliativeIntervention.relevantPeriod) overlaps "Measurement Period"     ) Value Set/Codes before: • value set "Palliative Care Intervention" (2.16.840.1.113883.3.464.1003.198.12.1135) Value Set/Codes after: • value set "Palliative Care Intervention" (2.16.840.1.113883.3.464.1003.198.12.1135) ///Remove codes 305686008 Seen by palliative care physician (finding), 305824005 Seen by palliative care medicine service (finding), 441874000 Seen by palliative care service (finding) • value set "Palliative Care Diagnosis" (2.16.840.1.113883.3.464.1003.1167) ///Add codes 305686008 Seen by palliative care physician (finding), 305824005 Seen by palliative care medicine service (finding), 441874000 Seen by palliative care service (finding), code "Encounter for palliative care" ICD10CM Code (Z51.5) Rationale for Change: The creation of a new value set containing the SNOMED findings codes and applying the 'Diagnosis' QDM datatype will help capture intended patient population for those receiving palliative care. 

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          edave Mathematica EC eCQM Team
          edave Mathematica EC eCQM Team
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