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  2. CQM-5712

CRP: Revise fracture exclusion from 2 to 1

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    • Other
    • Resolution: Resolved
    • Moderate
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      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
      ​​The THA and TKA process measures currently exclude patients who have two or more lower-body fractures indicating trauma at the time of the procedure. A related measure in development excludes patients with at least one specific lower body fracture (i.e., does not include foot or ankle fractures). 

      The measure developer reviewed with interested parties who confirmed that one fracture alone would capture patients who should be excluded from the denominator, by indicating an emergent injury.

      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 ​​The THA and TKA process measures currently exclude patients who have two or more lower-body fractures indicating trauma at the time of the procedure. A related measure in development excludes patients with at least one specific lower body fracture (i.e., does not include foot or ankle fractures).  The measure developer reviewed with interested parties who confirmed that one fracture alone would capture patients who should be excluded from the denominator, by indicating an emergent injury. Goal of review Obtain clinical and technical feedback
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      Proposed solution
      ​​Revise the fracture exclusion from two fractures at the time of procedure to one fracture at the time of procedure and revise the value set to target specific lower body fractures that are more closely associated with nonelective THA and TKA.

      Terminology before for both CMS56/66:
         valueset "Lower Body Fracture" (2.16.840.1.113883.3.464.1003.113.12.1037)

      Terminology after for both CMS56/66:
         valueset “Lower Body Fractures Excluding Ankle and Foot” (2.16.840.1.113883.3.464.1003.1178)

      See changes below for CMS56. Similar changes will also apply to CMS66​.

      Denominator Exclusion Header before:
      Exclude patients with two or more fractures indicating trauma in the 24 hours before or at the start of the total hip arthroplasty […]

      Denominator Exclusion Header after:
      Exclude patients with one or more specific lower body fractures indicating trauma in the 24 hours before or at the start of the total hip arthroplasty


      Logic before:
      Denominator Exclusions
         [...]
        or "Has Total Hip Arthroplasty with 2 or More Lower Body Fractures"
        [...]

      Has Total Hip Arthroplasty with 2 or More Lower Body Fractures
         exists ( "Total Hip Arthroplasty Procedure" THAProcedure
          where Count(["Diagnosis": "Lower Body Fracture"] LowerBodyFracture
              where LowerBodyFracture.prevalencePeriod starts 24 hours or less on or before start of Global."NormalizeInterval"(THAProcedure.relevantDatetime, THAProcedure.relevantPeriod)
          )>= 2)


      Logic after:
      Denominator Exclusions
         [...]
        or "Has Total Hip Arthroplasty with 1 or More Lower Body Fractures"
        [...]

      Has Total Hip Arthroplasty with 1 or More Lower Body Fractures
         exists ( "Total Hip Arthroplasty Procedure" THAProcedure
          where Count(["Diagnosis": " Lower Body Fractures Excluding Ankle and Foot "] LowerBodyFracture
              where LowerBodyFracture.prevalencePeriod starts 24 hours or less on or before start of Global."NormalizeInterval"(THAProcedure.relevantDatetime, THAProcedure.relevantPeriod)
          )>= 1)

      Rationale for change
      ​​These changes align with the number of fractures required for exclusion in a related measure in development. Additionally, interested parties agreed that one fracture alone is associated with an emergent injury and can affect function following THA and TKA.
      Show
      Proposed solution ​​Revise the fracture exclusion from two fractures at the time of procedure to one fracture at the time of procedure and revise the value set to target specific lower body fractures that are more closely associated with nonelective THA and TKA. Terminology before for both CMS56/66:    valueset "Lower Body Fracture" (2.16.840.1.113883.3.464.1003.113.12.1037) Terminology after for both CMS56/66:    valueset “Lower Body Fractures Excluding Ankle and Foot” (2.16.840.1.113883.3.464.1003.1178) See changes below for CMS56. Similar changes will also apply to CMS66​. Denominator Exclusion Header before: Exclude patients with two or more fractures indicating trauma in the 24 hours before or at the start of the total hip arthroplasty […] Denominator Exclusion Header after: Exclude patients with one or more specific lower body fractures indicating trauma in the 24 hours before or at the start of the total hip arthroplasty Logic before: Denominator Exclusions    [...]   or "Has Total Hip Arthroplasty with 2 or More Lower Body Fractures"   [...] Has Total Hip Arthroplasty with 2 or More Lower Body Fractures    exists ( "Total Hip Arthroplasty Procedure" THAProcedure     where Count(["Diagnosis": "Lower Body Fracture"] LowerBodyFracture         where LowerBodyFracture.prevalencePeriod starts 24 hours or less on or before start of Global."NormalizeInterval"(THAProcedure.relevantDatetime, THAProcedure.relevantPeriod)     )>= 2) Logic after: Denominator Exclusions    [...]   or "Has Total Hip Arthroplasty with 1 or More Lower Body Fractures"   [...] Has Total Hip Arthroplasty with 1 or More Lower Body Fractures    exists ( "Total Hip Arthroplasty Procedure" THAProcedure     where Count(["Diagnosis": " Lower Body Fractures Excluding Ankle and Foot "] LowerBodyFracture         where LowerBodyFracture.prevalencePeriod starts 24 hours or less on or before start of Global."NormalizeInterval"(THAProcedure.relevantDatetime, THAProcedure.relevantPeriod)     )>= 1) Rationale for change ​​These changes align with the number of fractures required for exclusion in a related measure in development. Additionally, interested parties agreed that one fracture alone is associated with an emergent injury and can affect function following THA and TKA.

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