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  2. CQM-5730

CRP: Evaluate appropriate QDM application to new value set designed to capture a history of atrial ablation procedure

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    • Other
    • Resolution: Resolved
    • Moderate
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      Brief description of measure
      CMS71: Anticoagulation Therapy for Atrial Fibrillation/Flutter:
      Ischemic stroke patients with atrial fibrillation/flutter who are prescribed or continuing to take anticoagulation therapy at hospital discharge.

      Description of issue
      ​​​The measure developer received stakeholder feedback that recommended the denominator include all "history of ablation," not just procedure.

      The stakeholder informed the measure developer of the current use of the following SNOMED-CT codes in their EHR:
      427951003 - History of radiofrequency ablation operation for arrhythmia
      429756009 - History of radiofrequency ablation operation on left atrium for arrhythmia
      The measure developer's preliminary search found another code that would qualify:

      429508000 - History of ablation of atrioventricular node
      To satisfy clinical intent, the measure developer proposes applying these codes, that narrow the ablation procedures down to those aimed at correcting atrial fibrillation/flutter, to the denominator of the measure.

      However, the above SNOMED codes are Situation codes and according to the CMS Blueprint, they might map in QDM to Family History.

      The measure developer is looking for advice on whether a datatype in QDM already exists to map this situation to or instead to consider postponing its addition until the measure is implemented in FHIR.

      Goal of review
      Obtain clinical and technical feedback
      Show
      Brief description of measure CMS71: Anticoagulation Therapy for Atrial Fibrillation/Flutter: Ischemic stroke patients with atrial fibrillation/flutter who are prescribed or continuing to take anticoagulation therapy at hospital discharge. Description of issue ​​​The measure developer received stakeholder feedback that recommended the denominator include all "history of ablation," not just procedure. The stakeholder informed the measure developer of the current use of the following SNOMED-CT codes in their EHR: 427951003 - History of radiofrequency ablation operation for arrhythmia 429756009 - History of radiofrequency ablation operation on left atrium for arrhythmia The measure developer's preliminary search found another code that would qualify: 429508000 - History of ablation of atrioventricular node To satisfy clinical intent, the measure developer proposes applying these codes, that narrow the ablation procedures down to those aimed at correcting atrial fibrillation/flutter, to the denominator of the measure. However, the above SNOMED codes are Situation codes and according to the CMS Blueprint, they might map in QDM to Family History. The measure developer is looking for advice on whether a datatype in QDM already exists to map this situation to or instead to consider postponing its addition until the measure is implemented in FHIR. Goal of review Obtain clinical and technical feedback
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      Proposed solution
      ​CURRENT LOGIC:
      define "Encounter with Atrial Ablation Procedure"
         TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
           with ["Procedure, Performed": "Atrial Ablation"] AtrialAblation
             such that Global."NormalizeInterval" ( AtrialAblation.relevantDatetime, AtrialAblation.relevantPeriod ) starts before start of IschemicStrokeEncounter.relevantPeriod

      PROPOSED LOGIC:
      define "Encounter with Atrial Ablation Procedure"
         TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
           with ( ["Procedure, Performed": "Atrial Ablation"]
                union ["Procedure, Performed": "History of Atrial Ablation Procedure"]) AtrialAblation
             such that Global."NormalizeInterval" ( AtrialAblation.relevantDatetime, AtrialAblation.relevantPeriod ) starts before start of IschemicStrokeEncounter.relevantPeriod

      The measure developer is looking for feedback as to whether the above changes is most appropriate for how to structure the logic, using the SNOMED-CT codes listed below, or if there is an alternate QDM classification that is more appropriate to apply to SNOMED-CT codes of the 'situation' semantic tag.

      Create new value set for "History of Atrial Ablation" including the following SNOMED-CT concepts:
      427951003 - History of radiofrequency ablation operation for arrhythmia
      429756009 - History of radiofrequency ablation operation on left atrium for arrhythmia
      429508000 - History of ablation of atrioventricular node

      Rationale for change
      ​​There are additional codes to capture a history of an ablation procedure that are not currently applied to the measure's denominator. However, these situation SNOMEDCT codes capture the history of an ablation to the AV node or for arrhythmia, not a procedure as is currently specified in the logic. The measure developer is looking for feedback on what is the most appropriate way to capture this within the technical specification using the Quality Data Model.
      Show
      Proposed solution ​CURRENT LOGIC: define "Encounter with Atrial Ablation Procedure"    TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter      with ["Procedure, Performed": "Atrial Ablation"] AtrialAblation        such that Global."NormalizeInterval" ( AtrialAblation.relevantDatetime, AtrialAblation.relevantPeriod ) starts before start of IschemicStrokeEncounter.relevantPeriod PROPOSED LOGIC: define "Encounter with Atrial Ablation Procedure"    TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter      with ( ["Procedure, Performed": "Atrial Ablation"]           union ["Procedure, Performed": "History of Atrial Ablation Procedure"]) AtrialAblation        such that Global."NormalizeInterval" ( AtrialAblation.relevantDatetime, AtrialAblation.relevantPeriod ) starts before start of IschemicStrokeEncounter.relevantPeriod The measure developer is looking for feedback as to whether the above changes is most appropriate for how to structure the logic, using the SNOMED-CT codes listed below, or if there is an alternate QDM classification that is more appropriate to apply to SNOMED-CT codes of the 'situation' semantic tag. Create new value set for "History of Atrial Ablation" including the following SNOMED-CT concepts: 427951003 - History of radiofrequency ablation operation for arrhythmia 429756009 - History of radiofrequency ablation operation on left atrium for arrhythmia 429508000 - History of ablation of atrioventricular node Rationale for change ​​There are additional codes to capture a history of an ablation procedure that are not currently applied to the measure's denominator. However, these situation SNOMEDCT codes capture the history of an ablation to the AV node or for arrhythmia, not a procedure as is currently specified in the logic. The measure developer is looking for feedback on what is the most appropriate way to capture this within the technical specification using the Quality Data Model.

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          sgearhart Mathematica EH eCQM Team
          sgearhart Mathematica EH eCQM Team
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