Thank you for your inquiry regarding CMS156v11 (2023 Performance Period). Guidance pertaining to average daily dose calculation is included in the Guidance section of the eCQM human-readable format (
https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS156v11-v2.html ): "Calculate average daily dose for each prescription event. To calculate average daily dose, multiply the quantity of pills prescribed by the dose of each pill and divide by the days supply. For example, a prescription for the 30-days supply of digoxin containing 15 pills, 0.25 mg each pill, has an average daily dose of 0.125 mg. To calculate average daily dose for elixirs and concentrates, multiply the volume prescribed by daily dose and divide by the days supply. Do not round when calculating average daily dose."
This guidance is expressed in the measure logic via function "Average Daily Dose". The intended result of "Average Daily Dose" is mg per day, or mg/d, because it is used to calculate the average daily dose of each medication order, for assessment against the daily dose criteria, which is further specified in the definition "High Risk Medications with Average Daily Dose Criteria".
To illustrate this guidance, please see examples below.
Example 1:
( Order.supply * MedicationStrength ) / Quantity { value: DaysSupplied, unit: 'd' }
= ( 15 * 0.25 mg ) / 30 d
or ( 15 pills * 0.25 mg per pill ) / 30 d
= 0.125 mg/d
Example 2:
( Order.supply * MedicationStrength ) / Quantity { value: DaysSupplied, unit: 'd' }
= ( 140 ml * 10 mg/ml ) / 14 d
= 100 mg/d
Average Daily Dose(MedicationOrder "Medication, Order")
MedicationOrder Order
let MedicationStrength: "MedicationStrengthPerUnit"(Order.code),
DaysSupplied: Coalesce(Order.daysSupplied, Order.supply.value /(Order.dosage.value * CMD.ToDaily(Order.frequency)))
return if DaysSupplied is not null
and ( MedicationStrength.unit = 'mg'
or ( MedicationStrength.unit = 'mg/mL'
and Order.supply.unit = 'mL'
)
) then ( ( Order.supply * MedicationStrength ) / Quantity { value: DaysSupplied, unit: 'd' } )
else null
High Risk Medications with Average Daily Dose Criteria
exists ( "More Than One Order"(["Medication, Order": "Reserpine"] ReserpineOrdered
where "Average Daily Dose"(ReserpineOrdered)> 0.1 'mg/d'
)
)
or exists ( "More Than One Order"(["Medication, Order": "Digoxin"] DigoxinOrdered
where "Average Daily Dose"(DigoxinOrdered)> 0.125 'mg/d'
)
)
or exists ( "More Than One Order"(["Medication, Order": "Doxepin"] DoxepinOrdered
where "Average Daily Dose"(DoxepinOrdered)> 6 'mg/d'
)
)
None
Moderate