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  2. CQM-5711

CRP: Add denominator exclusions to identify patients with an elective total hip/knee arthroplasty

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    • Other
    • Resolution: Resolved
    • Moderate
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    • Hide
      Brief description of measure
      CMS56: Functional Status Assessment for Total Hip Replacement:
      Percentage of patients 19 years of age and older who received an elective primary total hip arthroplasty (THA) and completed a functional status assessment within 90 days prior to the surgery and in the 270 - 365 days after the surgery.

      CMS66: Functional Status Assessment for Total Knee Replacement:
      Percentage of patients 19 years of age and older who received an elective primary total knee arthroplasty (TKA) and completed a functional status assessment within 90 days prior to the surgery and in the 270-365 days after the surgery.

      Description of issue
      ​​In an effort to align with a related measure in development, recent feedback from interested parties indicated that there are additional conditions, diagnoses, and situations that warrant denominator exclusion to adequately identify patients receiving elective total hip arthroplasty (THA) and total knee arthroplasty (TKA).

      Goal of review
      Obtain clinical and technical feedback
      Show
      Brief description of measure CMS56: Functional Status Assessment for Total Hip Replacement: Percentage of patients 19 years of age and older who received an elective primary total hip arthroplasty (THA) and completed a functional status assessment within 90 days prior to the surgery and in the 270 - 365 days after the surgery. CMS66: Functional Status Assessment for Total Knee Replacement: Percentage of patients 19 years of age and older who received an elective primary total knee arthroplasty (TKA) and completed a functional status assessment within 90 days prior to the surgery and in the 270-365 days after the surgery. Description of issue ​​In an effort to align with a related measure in development, recent feedback from interested parties indicated that there are additional conditions, diagnoses, and situations that warrant denominator exclusion to adequately identify patients receiving elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). Goal of review Obtain clinical and technical feedback
    • Hide
      Proposed solution
      ​Add the following conditions, diagnoses, and procedures as denominator exclusions to the measures:

      1. Partial hip/knee arthroplasty procedure
      2. Revision procedure, removal of implanted device, and resurfacing procedure
      3. Malignant neoplasm
      4. Mechanical complications
      5. Patients with a second total hip/knee arthroplasty procedure
      6. Patients who die within 300 days of the procedure

      ​The change below will also apply to CMS66, but reflect 'knee arthroplasty'.

      CMS56

      //Header: Denominator Exclusions – add
      Exclude patients with a partial hip arthroplasty procedure at any point in the patient’s history before the start of the total hip arthroplasty.

      Exclude patients with a revision hip arthroplasty procedure, an implanted device/prosthesis removal procedure or a resurfacing/supplement procedure at any point in the patient’s history before the start of the total hip arthroplasty.

      Exclude patients with a malignant neoplasm of the pelvis, sacrum, coccyx, lower limbs, or bone/bone marrow or a disseminated malignant neoplasm on the day of the total hip arthroplasty.

      Exclude patients with a mechanical complication on the day of the total hip arthroplasty.

      Exclude patients with a second total hip arthroplasty procedure 1 year before or after the original total hip arthroplasty procedure.
      Exclude patients who die on the day of the total hip arthroplasty procedure or in the 300 days after.

      //Logic – before
      define "Denominator Exclusions":
          […]

      //Logic – after 
      define "Denominator Exclusions":
          […]
          or "Has Partial Hip Arthroplasty Procedure"
          or "Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure"
          or "Has Malignant Neoplasm of Lower and Unspecified Limbs"
          or "Has Mechanical Complication"
          or "Has More Than One Elective Primary Total Hip Arthroplasty Performed"
          or "Death Within 300 Days of the THA Procedure"


      //CMS56 uses “Partial Arthroplasty of Hip” and CMS66 uses “Partial Arthroplasty of Knee”

      define "Has Partial Hip Arthroplasty Procedure":
        exists ( ["Procedure, Performed": "Partial Arthroplasty of Hip"] PartialTHAProcedure
            with "Total Hip Arthroplasty Procedure" THAProcedure
              such that Global."NormalizeInterval" ( PartialTHAProcedure.relevantDatetime, PartialTHAProcedure.relevantPeriod ) starts on or before start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod )  )

      define "Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure":
        exists ( "Total Hip Arthroplasty Procedure" THAProcedure
            with ["Procedure, Performed": "Removal, Revision and Supplement Procedures of the Lower Body and Spine"] RevisionTHAProcedure
              such that Global."NormalizeInterval" ( RevisionTHAProcedure.relevantDatetime, RevisionTHAProcedure.relevantPeriod ) starts on or before start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod )  )

      define "Has Malignant Neoplasm of Lower and Unspecified Limbs":
        exists ( ["Diagnosis": "Malignant Neoplasms of Lower and Unspecified Limbs"] MalignantNeoplasm
            with "Total Hip Arthroplasty Procedure" THAProcedure
              such that MalignantNeoplasm.prevalencePeriod overlaps Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod )  )

      define "Has Mechanical Complication":
        exists ( ["Diagnosis": "Mechanical Complications Excluding Upper Body"] MechanicalComplications
            with "Total Hip Arthroplasty Procedure" THAProcedure
              such that MechanicalComplications.prevalencePeriod overlaps Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod )  )

      define "Has More Than One Elective Primary Total Hip Arthroplasty Performed":
        exists ( "Total Hip Arthroplasty Procedure" THAProcedure
            with ["Procedure, Performed": "Primary THA Procedure"] ElectiveTHAProcedure
              such that THAProcedure.id !~ ElectiveTHAProcedure.id
                and start of Global."NormalizeInterval" ( ElectiveTHAProcedure.relevantDatetime, ElectiveTHAProcedure.relevantPeriod ) during Interval[( start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) ) - 1 year, ( start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) ) + 1 year]  )

      define "Death Within 300 Days of the THA Procedure":
        exists ( ["Patient Characteristic Expired": "Dead (finding)"] Deceased
            with "Total Hip Arthroplasty Procedure" THAProcedure
              such that date from Deceased.expiredDatetime during Interval[date from start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ), date from start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) + 300 days] )

      //Terminology – add
      valueset "Lower Body Fractures Excluding Ankle and Foot" (OID: 2.16.840.1.113883.3.464.1003.1178)
      valueset "Malignant Neoplasms of Lower and Unspecified Limbs" (OID: 2.16.840.1.113883.3.464.1003.1180)
      valueset "Mechanical Complications Excluding Upper Body" (OID: 2.16.840.1.113883.3.464.1003.1182)
      valueset "Partial Arthroplasty of Hip" (OID: 2.16.840.1.113883.3.464.1003.1184)
      valueset "Partial Arthroplasty of Knee" (OID: 2.16.840.1.113883.3.464.1003.1192)
      valueset "Removal, Revision and Supplement Procedures of the Lower Body and Spine" (OID: 2.16.840.1.113883.3.464.1003.1189)
      code "Dead (finding)": '419099009' from "SNOMEDCT" display 'Dead (finding)'

      Rationale for change
      ​This change aligns with the related measure in development and current evidence. Additionally, stakeholders support adding these exclusions to accurately identify patients receiving THA and TKA.
      Show
      Proposed solution ​Add the following conditions, diagnoses, and procedures as denominator exclusions to the measures: 1. Partial hip/knee arthroplasty procedure 2. Revision procedure, removal of implanted device, and resurfacing procedure 3. Malignant neoplasm 4. Mechanical complications 5. Patients with a second total hip/knee arthroplasty procedure 6. Patients who die within 300 days of the procedure ​The change below will also apply to CMS66, but reflect 'knee arthroplasty'. CMS56 //Header: Denominator Exclusions – add Exclude patients with a partial hip arthroplasty procedure at any point in the patient’s history before the start of the total hip arthroplasty. Exclude patients with a revision hip arthroplasty procedure, an implanted device/prosthesis removal procedure or a resurfacing/supplement procedure at any point in the patient’s history before the start of the total hip arthroplasty. Exclude patients with a malignant neoplasm of the pelvis, sacrum, coccyx, lower limbs, or bone/bone marrow or a disseminated malignant neoplasm on the day of the total hip arthroplasty. Exclude patients with a mechanical complication on the day of the total hip arthroplasty. Exclude patients with a second total hip arthroplasty procedure 1 year before or after the original total hip arthroplasty procedure. Exclude patients who die on the day of the total hip arthroplasty procedure or in the 300 days after. //Logic – before define "Denominator Exclusions":     […] //Logic – after  define "Denominator Exclusions":     […]     or "Has Partial Hip Arthroplasty Procedure"     or "Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure"     or "Has Malignant Neoplasm of Lower and Unspecified Limbs"     or "Has Mechanical Complication"     or "Has More Than One Elective Primary Total Hip Arthroplasty Performed"     or "Death Within 300 Days of the THA Procedure" //CMS56 uses “Partial Arthroplasty of Hip” and CMS66 uses “Partial Arthroplasty of Knee” define "Has Partial Hip Arthroplasty Procedure":   exists ( ["Procedure, Performed": "Partial Arthroplasty of Hip"] PartialTHAProcedure       with "Total Hip Arthroplasty Procedure" THAProcedure         such that Global."NormalizeInterval" ( PartialTHAProcedure.relevantDatetime, PartialTHAProcedure.relevantPeriod ) starts on or before start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod )  ) define "Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure":   exists ( "Total Hip Arthroplasty Procedure" THAProcedure       with ["Procedure, Performed": "Removal, Revision and Supplement Procedures of the Lower Body and Spine"] RevisionTHAProcedure         such that Global."NormalizeInterval" ( RevisionTHAProcedure.relevantDatetime, RevisionTHAProcedure.relevantPeriod ) starts on or before start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod )  ) define "Has Malignant Neoplasm of Lower and Unspecified Limbs":   exists ( ["Diagnosis": "Malignant Neoplasms of Lower and Unspecified Limbs"] MalignantNeoplasm       with "Total Hip Arthroplasty Procedure" THAProcedure         such that MalignantNeoplasm.prevalencePeriod overlaps Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod )  ) define "Has Mechanical Complication":   exists ( ["Diagnosis": "Mechanical Complications Excluding Upper Body"] MechanicalComplications       with "Total Hip Arthroplasty Procedure" THAProcedure         such that MechanicalComplications.prevalencePeriod overlaps Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod )  ) define "Has More Than One Elective Primary Total Hip Arthroplasty Performed":   exists ( "Total Hip Arthroplasty Procedure" THAProcedure       with ["Procedure, Performed": "Primary THA Procedure"] ElectiveTHAProcedure         such that THAProcedure.id !~ ElectiveTHAProcedure.id           and start of Global."NormalizeInterval" ( ElectiveTHAProcedure.relevantDatetime, ElectiveTHAProcedure.relevantPeriod ) during Interval[( start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) ) - 1 year, ( start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) ) + 1 year]  ) define "Death Within 300 Days of the THA Procedure":   exists ( ["Patient Characteristic Expired": "Dead (finding)"] Deceased       with "Total Hip Arthroplasty Procedure" THAProcedure         such that date from Deceased.expiredDatetime during Interval[date from start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ), date from start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) + 300 days] ) //Terminology – add valueset "Lower Body Fractures Excluding Ankle and Foot" (OID: 2.16.840.1.113883.3.464.1003.1178) valueset "Malignant Neoplasms of Lower and Unspecified Limbs" (OID: 2.16.840.1.113883.3.464.1003.1180) valueset "Mechanical Complications Excluding Upper Body" (OID: 2.16.840.1.113883.3.464.1003.1182) valueset "Partial Arthroplasty of Hip" (OID: 2.16.840.1.113883.3.464.1003.1184) valueset "Partial Arthroplasty of Knee" (OID: 2.16.840.1.113883.3.464.1003.1192) valueset "Removal, Revision and Supplement Procedures of the Lower Body and Spine" (OID: 2.16.840.1.113883.3.464.1003.1189) code "Dead (finding)": '419099009' from "SNOMEDCT" display 'Dead (finding)' Rationale for change ​This change aligns with the related measure in development and current evidence. Additionally, stakeholders support adding these exclusions to accurately identify patients receiving THA and TKA.

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          edave Mathematica EC eCQM Team
          edave Mathematica EC eCQM Team
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