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  2. CQM-5564

CRP: Require 2 indications of frailty to meet exclusion

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    • Resolution: Resolved
    • Moderate
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      Brief Description of Measure:
      CMS122: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
      CMS125: Breast Cancer Screening
      CMS130: Colorectal Cancer Screening
      CMS131: Diabetes: Eye Exam
      CMS134: Diabetes: Medical Attention for Nephropathy
      CMS165: Controlling High Blood Pressure

      Description of Issue:
      Currently, the advanced illness and frailty library criteria looks for only one indication of frailty to identify patients who are frail. This approach may be over identifying patients, therefore we are proposing to look for two indications of frailty on different dates of service. We would like to understand any implications of making this change.

      Goal of Review:
      Obtain clinical feedback
      Show
      Brief Description of Measure: CMS122: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) CMS125: Breast Cancer Screening CMS130: Colorectal Cancer Screening CMS131: Diabetes: Eye Exam CMS134: Diabetes: Medical Attention for Nephropathy CMS165: Controlling High Blood Pressure Description of Issue: Currently, the advanced illness and frailty library criteria looks for only one indication of frailty to identify patients who are frail. This approach may be over identifying patients, therefore we are proposing to look for two indications of frailty on different dates of service. We would like to understand any implications of making this change. Goal of Review: Obtain clinical feedback
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      Proposed Solution:
      For all flagged measures: 

      Frailty denominator exclusion header language before:
      Exclude patients 66 […] with at least an indications of frailty […]

      Frailty denominator exclusion header language after:
      Exclude patients 66 […] with at least two indications of frailty with different dates of service  […] 

      Additional proposed change applicable to CMS165 only: 

      Frailty denominator exclusion header language before: 
      Exclude patients 81 […] with an indication of frailty […]

      Frailty denominator exclusion header language after: 
      Exclude patients 81 […] with at least two indications of frailty with different dates of service […]


      For all flagged measures: 
      Frailty logic before:
      define "Has Criteria Indicating Frailty":
        exists ( ["Device, Order": "Frailty Device"] FrailtyDeviceOrder
            where FrailtyDeviceOrder.authorDatetime during day of "Measurement Period"  )
          or exists ( ["Assessment, Performed": "Medical equipment used"] EquipmentUsed
              where EquipmentUsed.result in "Frailty Device"
                and Global."NormalizeInterval" ( EquipmentUsed.relevantDatetime, EquipmentUsed.relevantPeriod ) ends during day of "Measurement Period"    )
          or exists ( ["Diagnosis": "Frailty Diagnosis"] FrailtyDiagnosis
              where FrailtyDiagnosis.prevalencePeriod overlaps "Measurement Period"    )
          or exists ( ["Encounter, Performed": "Frailty Encounter"] FrailtyEncounter
              where FrailtyEncounter.relevantPeriod overlaps "Measurement Period"    )
          or exists ( ["Symptom": "Frailty Symptom"] FrailtySymptom
              where FrailtySymptom.prevalencePeriod overlaps "Measurement Period"    )


      Frailty logic after:
      define "Has 2 Criteria Indicating Frailty":
        Count(( ["Device, Order": "Frailty Device"] FrailtyDeviceOrder
          where date from FrailtyDeviceOrder.authorDatetime during day of "Measurement Period"
          return FrailtyDeviceOrder.authorDatetime  )
        union ( ["Assessment, Performed": "Medical equipment used"] EquipmentUsed
            where EquipmentUsed.result in "Frailty Device"
              and Global."NormalizeInterval" ( EquipmentUsed.relevantDatetime, EquipmentUsed.relevantPeriod ) ends during day of "Measurement Period"
              return date from end of Global."NormalizeInterval" ( EquipmentUsed.relevantDatetime, EquipmentUsed.relevantPeriod )  )
        union ( ["Diagnosis": "Frailty Diagnosis"] FrailtyDiagnosis
            where FrailtyDiagnosis.prevalencePeriod overlaps "Measurement Period"
            return date from start of FrailtyDiagnosis.prevalencePeriod  )
        union ( ["Encounter, Performed": "Frailty Encounter"] FrailtyEncounter
            where FrailtyEncounter.relevantPeriod overlaps "Measurement Period"
            return date from start of FrailtyEncounter.relevantPeriod  )
        union ( ["Symptom": "Frailty Symptom"] FrailtySymptom
            where FrailtySymptom.prevalencePeriod overlaps "Measurement Period"
            return date from start of FrailtySymptom.prevalencePeriod
        )) >=2

      For CMS122, CMS125, CMS130, CMS131, CMS134: 
      Logic before:  
      define “Is Age 66 or Older with Advanced Illness and Frailty”:
      ( AgeInYearsAt(date from 
          end of "Measurement Period"
        )>= 66
          and "Has Criteria Indicating Frailty"
          and […])

      Logic after: 
      define "Is Age 66 or Older with Advanced Illness and Frailty":
        ( AgeInYearsAt(date from
            end of "Measurement Period"
          )>= 66
            and "Has 2 Criteria Indicating Frailty"
            and […]  ) 

      For CMS165: 
      Logic before:  
      define “Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty”;
      ( AgeInYearsAt(date from 
          end of "Measurement Period"
        )in Interval[66, 80]
          and "Has Criteria Indicating Frailty"
          and […] )
        or ( AgeInYearsAt(date from 
            end of "Measurement Period"
          )>= 81
            and "Has Criteria Indicating Frailty"  )

      Logic after: 
      define "Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty":
        ( AgeInYearsAt(date from
            end of "Measurement Period"
          )in Interval[66, 80]
            and "Has 2 Criteria Indicating Frailty"
            and […] )
           or ( AgeInYearsAt(date from
              end of "Measurement Period"
            )>= 81
              and "Has 2 Criteria Indicating Frailty"    )

      Rationale for Change:
      ​This proposed change provides a better and more specific approach to identifying patients who are frail by looking for at least two indications of frailty on at least two dates of service. Based on findings from testing and feedback from NCQA Measurement Advisory Panels, this change was made for HEDIS Measurement Year 2023 for HEDIS measures where the frailty exclusion is applied. 
      Show
      Proposed Solution: For all flagged measures:  Frailty denominator exclusion header language before: Exclude patients 66 […] with at least an indications of frailty […] Frailty denominator exclusion header language after: Exclude patients 66 […] with at least two indications of frailty with different dates of service  […]  Additional proposed change applicable to CMS165 only:  Frailty denominator exclusion header language before:  Exclude patients 81 […] with an indication of frailty […] Frailty denominator exclusion header language after:  Exclude patients 81 […] with at least two indications of frailty with different dates of service […] For all flagged measures:  Frailty logic before: define "Has Criteria Indicating Frailty":   exists ( ["Device, Order": "Frailty Device"] FrailtyDeviceOrder       where FrailtyDeviceOrder.authorDatetime during day of "Measurement Period"  )     or exists ( ["Assessment, Performed": "Medical equipment used"] EquipmentUsed         where EquipmentUsed.result in "Frailty Device"           and Global."NormalizeInterval" ( EquipmentUsed.relevantDatetime, EquipmentUsed.relevantPeriod ) ends during day of "Measurement Period"    )     or exists ( ["Diagnosis": "Frailty Diagnosis"] FrailtyDiagnosis         where FrailtyDiagnosis.prevalencePeriod overlaps "Measurement Period"    )     or exists ( ["Encounter, Performed": "Frailty Encounter"] FrailtyEncounter         where FrailtyEncounter.relevantPeriod overlaps "Measurement Period"    )     or exists ( ["Symptom": "Frailty Symptom"] FrailtySymptom         where FrailtySymptom.prevalencePeriod overlaps "Measurement Period"    ) Frailty logic after: define "Has 2 Criteria Indicating Frailty":   Count(( ["Device, Order": "Frailty Device"] FrailtyDeviceOrder     where date from FrailtyDeviceOrder.authorDatetime during day of "Measurement Period"     return FrailtyDeviceOrder.authorDatetime  )   union ( ["Assessment, Performed": "Medical equipment used"] EquipmentUsed       where EquipmentUsed.result in "Frailty Device"         and Global."NormalizeInterval" ( EquipmentUsed.relevantDatetime, EquipmentUsed.relevantPeriod ) ends during day of "Measurement Period"         return date from end of Global."NormalizeInterval" ( EquipmentUsed.relevantDatetime, EquipmentUsed.relevantPeriod )  )   union ( ["Diagnosis": "Frailty Diagnosis"] FrailtyDiagnosis       where FrailtyDiagnosis.prevalencePeriod overlaps "Measurement Period"       return date from start of FrailtyDiagnosis.prevalencePeriod  )   union ( ["Encounter, Performed": "Frailty Encounter"] FrailtyEncounter       where FrailtyEncounter.relevantPeriod overlaps "Measurement Period"       return date from start of FrailtyEncounter.relevantPeriod  )   union ( ["Symptom": "Frailty Symptom"] FrailtySymptom       where FrailtySymptom.prevalencePeriod overlaps "Measurement Period"       return date from start of FrailtySymptom.prevalencePeriod   )) >=2 For CMS122, CMS125, CMS130, CMS131, CMS134:  Logic before:   define “Is Age 66 or Older with Advanced Illness and Frailty”: ( AgeInYearsAt(date from      end of "Measurement Period"   )>= 66     and "Has Criteria Indicating Frailty"     and […]) Logic after:  define "Is Age 66 or Older with Advanced Illness and Frailty":   ( AgeInYearsAt(date from       end of "Measurement Period"     )>= 66       and "Has 2 Criteria Indicating Frailty"       and […]  )  For CMS165:  Logic before:   define “Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty”; ( AgeInYearsAt(date from      end of "Measurement Period"   )in Interval[66, 80]     and "Has Criteria Indicating Frailty"     and […] )   or ( AgeInYearsAt(date from        end of "Measurement Period"     )>= 81       and "Has Criteria Indicating Frailty"  ) Logic after:  define "Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty":   ( AgeInYearsAt(date from       end of "Measurement Period"     )in Interval[66, 80]       and "Has 2 Criteria Indicating Frailty"       and […] )      or ( AgeInYearsAt(date from         end of "Measurement Period"       )>= 81         and "Has 2 Criteria Indicating Frailty"    ) Rationale for Change: ​This proposed change provides a better and more specific approach to identifying patients who are frail by looking for at least two indications of frailty on at least two dates of service. Based on findings from testing and feedback from NCQA Measurement Advisory Panels, this change was made for HEDIS Measurement Year 2023 for HEDIS measures where the frailty exclusion is applied. 

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          edave Mathematica EC eCQM Team
          edave Mathematica EC eCQM Team
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            Updated:
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