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  2. CQM-5702

CRP: Remove system reason denominator exception

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    • Resolution: Resolved
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      Brief description of measure
      CMS145: Coronary Artery Disease (CAD): Beta-Blocker Therapy-- Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <=40%):
      Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have a prior MI or a current or prior LVEF <=40% who were prescribed beta-blocker therapy

      Description of issue
      ​There is nationwide access to beta-blocker medications and all health systems can provide for these therapies. Because of the wide availability of beta-blocker therapy, there is not an applicable system-based reason that a US health system could not provide a beta-blocker. 

      Therefore, the system reason exception is no longer a valid denominator exception, and is being proposed for removal from both the measure header and logic.  This removal will also align with the AHA's other Beta-Blocker Measure, CMS144. 

      Goal of review
      Obtain clinical feedback
      Show
      Brief description of measure CMS145: Coronary Artery Disease (CAD): Beta-Blocker Therapy-- Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <=40%): Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have a prior MI or a current or prior LVEF <=40% who were prescribed beta-blocker therapy Description of issue ​There is nationwide access to beta-blocker medications and all health systems can provide for these therapies. Because of the wide availability of beta-blocker therapy, there is not an applicable system-based reason that a US health system could not provide a beta-blocker.  Therefore, the system reason exception is no longer a valid denominator exception, and is being proposed for removal from both the measure header and logic.  This removal will also align with the AHA's other Beta-Blocker Measure, CMS144.  Goal of review Obtain clinical feedback
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      Proposed solution
      ​REMOVE THE FOLLOWING DENOMINATOR EXCEPTION LANGUAGE:
      Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons attributable to the health care system).
       
      CURRENT LOGIC:
      define "Denominator Exceptions 1"
      "Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
        or [...]
        or "Has Medical Patient or System Reason for Not Ordering Beta Blocker for LVSD"
        or "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer" 
       
      define "Denominator Exceptions 2"
       "Has Arrhythmia with Qualifying CAD Encounter and Prior MI"
        or [...]
        or "Has Medical Patient or System Reason for Not Ordering Beta Blocker Therapy"
        or "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer"

      define "Has Medical Patient or System Reason for Not Ordering Beta Blocker for LVSD"
      exists ["Medication, Not Ordered": "Beta Blocker Therapy for LVSD"] NoBetaBlockerForLVSDOrdered
        with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
          such that NoBetaBlockerForLVSDOrdered.authorDatetime during CADEncounterModerateOrSevereLVSD.relevantPeriod
        where ( NoBetaBlockerForLVSDOrdered.negationRationale in "Medical Reason"
            or NoBetaBlockerForLVSDOrdered.negationRationale in "Patient Reason"
            or NoBetaBlockerForLVSDOrdered.negationRationale in "System Reason" )
       
      define "Has Medical Patient or System Reason for Not Ordering Beta Blocker Therapy"
      exists ["Medication, Not Ordered": "Beta Blocker Therapy"] NoBetaBlockerOrdered
        with "Qualifying CAD Encounter and Prior MI" CADEncounterMI
          such that NoBetaBlockerOrdered.authorDatetime during CADEncounterMI.relevantPeriod
        where ( NoBetaBlockerOrdered.negationRationale in "Medical Reason"
            or NoBetaBlockerOrdered.negationRationale in "Patient Reason"
            or NoBetaBlockerOrdered.negationRationale in "System Reason" )
       
      PROPOSED LOGIC:
      define "Denominator Exceptions 1"
       "Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
        or [...]
        or "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
        or "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer"
       
      define "Denominator Exceptions 2"
       "Has Arrhythmia with Qualifying CAD Encounter and Prior MI"
        or [...]
        or "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"
        or "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer"

      define "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
      exists ["Medication, Not Ordered": "Beta Blocker Therapy for LVSD"] NoBetaBlockerForLVSDOrdered
        with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
          such that NoBetaBlockerForLVSDOrdered.authorDatetime during CADEncounterModerateOrSevereLVSD.relevantPeriod
        where ( NoBetaBlockerForLVSDOrdered.negationRationale in "Medical Reason"
            or NoBetaBlockerForLVSDOrdered.negationRationale in "Patient Reason" )
       
      define "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"
      exists ["Medication, Not Ordered": "Beta Blocker Therapy"] NoBetaBlockerOrdered
        with "Qualifying CAD Encounter and Prior MI" CADEncounterMI
          such that NoBetaBlockerOrdered.authorDatetime during CADEncounterMI.relevantPeriod
        where ( NoBetaBlockerOrdered.negationRationale in "Medical Reason"
            or NoBetaBlockerOrdered.negationRationale in "Patient Reason")

      REMOVE VALUE SET:
      System Reason (OID: 2.16.840.1.113883.3.526.3.1009)

      Rationale for change
      ​Due to the wide availability of beta-blocker therapy, the system reason exception is no longer relevant. 
      Show
      Proposed solution ​REMOVE THE FOLLOWING DENOMINATOR EXCEPTION LANGUAGE: Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons attributable to the health care system).   CURRENT LOGIC: define "Denominator Exceptions 1" "Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"   or [...]   or "Has Medical Patient or System Reason for Not Ordering Beta Blocker for LVSD"   or "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer"    define "Denominator Exceptions 2"  "Has Arrhythmia with Qualifying CAD Encounter and Prior MI"   or [...]   or "Has Medical Patient or System Reason for Not Ordering Beta Blocker Therapy"   or "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer" define "Has Medical Patient or System Reason for Not Ordering Beta Blocker for LVSD" exists ["Medication, Not Ordered": "Beta Blocker Therapy for LVSD"] NoBetaBlockerForLVSDOrdered   with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD     such that NoBetaBlockerForLVSDOrdered.authorDatetime during CADEncounterModerateOrSevereLVSD.relevantPeriod   where ( NoBetaBlockerForLVSDOrdered.negationRationale in "Medical Reason"       or NoBetaBlockerForLVSDOrdered.negationRationale in "Patient Reason"       or NoBetaBlockerForLVSDOrdered.negationRationale in "System Reason" )   define "Has Medical Patient or System Reason for Not Ordering Beta Blocker Therapy" exists ["Medication, Not Ordered": "Beta Blocker Therapy"] NoBetaBlockerOrdered   with "Qualifying CAD Encounter and Prior MI" CADEncounterMI     such that NoBetaBlockerOrdered.authorDatetime during CADEncounterMI.relevantPeriod   where ( NoBetaBlockerOrdered.negationRationale in "Medical Reason"       or NoBetaBlockerOrdered.negationRationale in "Patient Reason"       or NoBetaBlockerOrdered.negationRationale in "System Reason" )   PROPOSED LOGIC: define "Denominator Exceptions 1"  "Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"   or [...]   or "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"   or "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer"   define "Denominator Exceptions 2"  "Has Arrhythmia with Qualifying CAD Encounter and Prior MI"   or [...]   or "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"   or "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer" define "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD" exists ["Medication, Not Ordered": "Beta Blocker Therapy for LVSD"] NoBetaBlockerForLVSDOrdered   with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD     such that NoBetaBlockerForLVSDOrdered.authorDatetime during CADEncounterModerateOrSevereLVSD.relevantPeriod   where ( NoBetaBlockerForLVSDOrdered.negationRationale in "Medical Reason"       or NoBetaBlockerForLVSDOrdered.negationRationale in "Patient Reason" )   define "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy" exists ["Medication, Not Ordered": "Beta Blocker Therapy"] NoBetaBlockerOrdered   with "Qualifying CAD Encounter and Prior MI" CADEncounterMI     such that NoBetaBlockerOrdered.authorDatetime during CADEncounterMI.relevantPeriod   where ( NoBetaBlockerOrdered.negationRationale in "Medical Reason"       or NoBetaBlockerOrdered.negationRationale in "Patient Reason") REMOVE VALUE SET: System Reason (OID: 2.16.840.1.113883.3.526.3.1009) Rationale for change ​Due to the wide availability of beta-blocker therapy, the system reason exception is no longer relevant. 

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          edave Mathematica EC eCQM Team
          edave Mathematica EC eCQM Team
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