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  2. CQM-5700

CRP: Revert first initial population to include patients previously diagnosed with clinical ASCVD

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    • Resolution: Resolved
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      Brief description of measure
      CMS347: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease:
      Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period:
      *All patients with an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD) or ever had an ASCVD procedure; OR
      *Patients aged >= 20 years who have ever had a low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia; OR
      *Patients aged 40-75 years with a diagnosis of diabetes

      Description of issue
      ​During the last maintenance cycle, the first population for this eCQM was changed from patients previously diagnosed with or currently have a diagnosis of clinical ASCVD (including ASCVD procedure) to include patients who have an active diagnosis of clinical ASCVD or ever had an ASCVD procedure. However, the other submission methods for this measure in MIPS (CQM and Web Interface) were not changed for performance year 2023. 

      The measure steward and expert work group re-evaluated this change and wants to align all three submission methods and revert the eCQM's first population to align with the CQM and Web Interface specifications. 

      The proposed language for the first population would read as “all patients who were previously diagnosed with or currently have a diagnosis of clinical ASCVD, including an ASCVD procedure”

      Goal of review
      Obtain clinical and technical feedback
      Show
      Brief description of measure CMS347: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease: Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period: *All patients with an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD) or ever had an ASCVD procedure; OR *Patients aged >= 20 years who have ever had a low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia; OR *Patients aged 40-75 years with a diagnosis of diabetes Description of issue ​During the last maintenance cycle, the first population for this eCQM was changed from patients previously diagnosed with or currently have a diagnosis of clinical ASCVD (including ASCVD procedure) to include patients who have an active diagnosis of clinical ASCVD or ever had an ASCVD procedure. However, the other submission methods for this measure in MIPS (CQM and Web Interface) were not changed for performance year 2023.  The measure steward and expert work group re-evaluated this change and wants to align all three submission methods and revert the eCQM's first population to align with the CQM and Web Interface specifications.  The proposed language for the first population would read as “all patients who were previously diagnosed with or currently have a diagnosis of clinical ASCVD, including an ASCVD procedure” Goal of review Obtain clinical and technical feedback
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      Proposed solution
      DESCRIPTION:
      Before: 
      All patients with an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD) or ever had an ASCVD procedure; [...]

      After: 
      All patients who were previously diagnosed with or currently have a diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD), including an ASCVD procedure; [...]

      RATE AGGREGATION:
      Before: 
      Population 1: All patients who have an active diagnosis of clinical ASCVD or ever had an ASCVD procedure.

      After:  
      Population 1: All patients who were previously diagnosed with or currently have a diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD), including an ASCVD procedure.

      GUIDANCE:
      Before:
      Initial Population 1:  
      All patients who have an active diagnosis of clinical ASCVD anytime during the measurement period or ever had an ASCVD procedure.
      -If YES, meets Initial Population 1 risk category
      -If NO, screen for next risk category

      After:
      Initial Population 1:  
      All patients who were previously diagnosed with or currently have a diagnosis of clinical ASCVD, including an ASCVD procedure before the end of the measurement period
      -If YES, meets Initial Population 1 risk category
      -If NO, screen for next risk category

      INITIAL POPULATION:
      Before: 
      Population 1:All patients who have an active diagnosis of clinical ASCVD or ever had an ASCVD procedure.

      After:
      Population 1:
      All patients who were previously diagnosed with or currently have a diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD), including an ASCVD procedure.

      LOGIC:
      Before:
      Define: "Initial Population"
      exists "Active ASVCD Diagnosis or Any Prior ASCVD Procedure"
        and exists "Qualifying Encounter during Measurement Period"

      Define: "Active ASVCD Diagnosis or Any Prior ASCVD Procedure"
      ( ( ["Diagnosis": "Myocardial Infarction"]
          union ["Diagnosis": "Cerebrovascular Disease Stroke or TIA"]
          union ["Diagnosis": "Atherosclerosis and Peripheral Arterial Disease"]
          union ["Diagnosis": "Ischemic Heart Disease or Other Related Diagnoses"]
          union ["Diagnosis": "Stable and Unstable Angina"] ) ASCVDDiagnosis
          where ASCVDDiagnosis.prevalencePeriod overlaps "Measurement Period")
        union [...]


      After (Note: same logic as CMS347v5):
      Define: "Initial Population"
      exists "ASVCD Diagnosis or Procedure before End of Measurement Period"
        and exists "Qualifying Encounter during Measurement Period

      Define "ASCVD Diagnosis or Procedure before End of Measurement Period"
      ( ( ["Diagnosis": "Myocardial Infarction"]
          union ["Diagnosis": "Cerebrovascular Disease Stroke or TIA"]
          union ["Diagnosis": "Atherosclerosis and Peripheral Arterial Disease"]
          union ["Diagnosis": "Ischemic Heart Disease or Other Related Diagnoses"]
          union ["Diagnosis": "Stable and Unstable Angina"] ) ASCVDDiagnosis
          where ASCVDDiagnosis.prevalencePeriod starts before
          end of "Measurement Period")
        union [...]

      Rationale for change
      ​​This change aligns the representation of the first population of the eCQM with the other 2 submission methods (CQM and WI measures).  
      Show
      Proposed solution DESCRIPTION: Before:  All patients with an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD) or ever had an ASCVD procedure; [...] After:  All patients who were previously diagnosed with or currently have a diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD), including an ASCVD procedure; [...] RATE AGGREGATION: Before:  Population 1: All patients who have an active diagnosis of clinical ASCVD or ever had an ASCVD procedure. After:   Population 1: All patients who were previously diagnosed with or currently have a diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD), including an ASCVD procedure. GUIDANCE: Before: Initial Population 1:   All patients who have an active diagnosis of clinical ASCVD anytime during the measurement period or ever had an ASCVD procedure. -If YES, meets Initial Population 1 risk category -If NO, screen for next risk category After: Initial Population 1:   All patients who were previously diagnosed with or currently have a diagnosis of clinical ASCVD, including an ASCVD procedure before the end of the measurement period -If YES, meets Initial Population 1 risk category -If NO, screen for next risk category INITIAL POPULATION: Before:  Population 1:All patients who have an active diagnosis of clinical ASCVD or ever had an ASCVD procedure. After: Population 1: All patients who were previously diagnosed with or currently have a diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD), including an ASCVD procedure. LOGIC: Before: Define: "Initial Population" exists "Active ASVCD Diagnosis or Any Prior ASCVD Procedure"   and exists "Qualifying Encounter during Measurement Period" Define: "Active ASVCD Diagnosis or Any Prior ASCVD Procedure" ( ( ["Diagnosis": "Myocardial Infarction"]     union ["Diagnosis": "Cerebrovascular Disease Stroke or TIA"]     union ["Diagnosis": "Atherosclerosis and Peripheral Arterial Disease"]     union ["Diagnosis": "Ischemic Heart Disease or Other Related Diagnoses"]     union ["Diagnosis": "Stable and Unstable Angina"] ) ASCVDDiagnosis     where ASCVDDiagnosis.prevalencePeriod overlaps "Measurement Period")   union [...] After (Note: same logic as CMS347v5): Define: "Initial Population" exists "ASVCD Diagnosis or Procedure before End of Measurement Period"   and exists "Qualifying Encounter during Measurement Period Define "ASCVD Diagnosis or Procedure before End of Measurement Period" ( ( ["Diagnosis": "Myocardial Infarction"]     union ["Diagnosis": "Cerebrovascular Disease Stroke or TIA"]     union ["Diagnosis": "Atherosclerosis and Peripheral Arterial Disease"]     union ["Diagnosis": "Ischemic Heart Disease or Other Related Diagnoses"]     union ["Diagnosis": "Stable and Unstable Angina"] ) ASCVDDiagnosis     where ASCVDDiagnosis.prevalencePeriod starts before     end of "Measurement Period")   union [...] Rationale for change ​​This change aligns the representation of the first population of the eCQM with the other 2 submission methods (CQM and WI measures).  

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          edave Mathematica EC eCQM Team
          edave Mathematica EC eCQM Team
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