Hi Team,

We have a query regarding denominator exclusion criteria wrt to the CMS871v3 measure :

Consider the below section:

1. Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start :

from

  "Initial Population" InpatientHospitalization,

  ["Laboratory Test, Performed": "Glucose Lab Test Mass Per Volume"] GlucoseTest

  let HospitalizationInterval: Global."HospitalizationWithObservation" ( InpatientHospitalization ),

  GlucoseTestTime: Global."EarliestOf" ( GlucoseTest.relevantDatetime, GlucoseTest.relevantPeriod )

  where GlucoseTest.result >= 1000 'mg/dL'

    and GlucoseTest.result is not null

    and GlucoseTestTime during Interval[( start of HospitalizationInterval - 1 hour ), ( start of HospitalizationInterval + 6 hours )]

  return GlucoseTest

Scenario 1:

Patient A aged 21 years with

Start of InpatientEncounter.relevantPeriod = 5/10/2024 9:00

End of InpatientEncounter.relevantPeriod = 5/16/2024 10:00

Start of EDEncounter.relevenat period= 5/10/2024 8:30:00

End of EDEncounter.relevenat period= 5/10/2024 8:45:00

having first Glucose Lab Test Mass Per Volume documented on 5/10/2024 7:40 with value 1000 mg/dL.

Scenario 2:

Patient B aged 21 years with

Start of InpatientEncounter.relevantPeriod = 11/12/2024 4:00

End of InpatientEncounter.relevantPeriod = 11/12/2024 7:00

Start of Observation.relevenat period= 11/12/2024 3:00

End of Observation.relevenat period= 11/12/2024 3:45

having first Glucose Lab Test Mass Per Volume documented on 11/12/2024 2:30 with value 1200 mg/dL.

#Query1:

From the above two scenarios, please help us understand which of the above 2 patients will be excluded?

#Query2:

In the version 2 of the measure, we had 'first' as written in the definition for the above logic. In version 3 we do not see that, does this mean there is no need to check First value for denominator exclusion. 

2.Glucose Tests Earlier Than Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start :

from

  "Initial Population" InpatientHospitalization,

  "Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start" GlucoseResult1000,

  ["Laboratory Test, Performed": "Glucose Lab Test Mass Per Volume"] EarlierGlucoseTest

  let HospitalizationInterval: Global."HospitalizationWithObservation" ( InpatientHospitalization ),

  GlucoseTest1000Time: Global."EarliestOf" ( GlucoseResult1000.relevantDatetime, GlucoseResult1000.relevantPeriod ),

  EarlierGlucoseTestTime: Global."EarliestOf" ( EarlierGlucoseTest.relevantDatetime, EarlierGlucoseTest.relevantPeriod )

  where GlucoseTest1000Time during Interval[( start of HospitalizationInterval - 1 hour ), ( start of HospitalizationInterval + 6 hour )]

    and EarlierGlucoseTestTime during Interval[( start of HospitalizationInterval - 1 hour ), GlucoseTest1000Time )

    and EarlierGlucoseTest is not null

    and EarlierGlucoseTest.id !~ GlucoseResult1000.id

  return GlucoseResult1000

#Query  :

Clinically the above definition means, you are checking two Glucose Test (During Hospitalization and Earlier Test). So, logic says the ID of both should be different.

logic should not consider the same test as two different tests, each laboratory test has its own lab ID. Kindly confirm if our understanding is correct.

Also, we would like to know the use of 'id' attribute over here and how it is going to be identified in QRDA I.

Request you to provide us with the resolution urgently as our client deliverables are dependent on it.