Brief Description of Measures: CMS1028/PC-07: Severe Obstetric Complications Patients with severe obstetric complications which occur during the inpatient delivery hospitalization CMS334/PC-02: Cesarean Birth Nulliparous women with a term, singleton baby in a vertex position delivered by cesarean birth Description of Issue: Estimated gestational age (EGA) is frequently reported as weeks and days. The logic of the perinatal care measures requires that the EGA be assessed in the 24 hour period prior to delivery to capture the most accurate EGA. Currently, the logic requires the relevant date/time/period for the assessment, not when EGA was documented. As such, the EGA can be documented after delivery and be different than the assessment time. Feedback from hospitals indicates that while gestational age may be assessed prior to delivery, it often is not documented until after delivery, especially in the case of precipitous deliveries. These hospitals report that the patient is not being included in the denominator as the gestational age is required to qualify the patient for the denominator. This feedback indicates that hospitals are using the documentation date/time instead of the assessment date/time intended to be captured by the logic. To decrease hospital burden, adding the ‘same day as’ operator would capture the last assessment of weeks gestation performed after delivery time but on the same day of delivery.

Proposed Solution: Add "same day as" logic to the LastEstimatedGestationalAge function. Last(["Assessment, Performed": "Estimated Gestational Age at Delivery"] EstimatedGestationalAge     where((Global."EarliestOf"(EstimatedGestationalAge.relevantDatetime, EstimatedGestationalAge.relevantPeriod) 24 hours or less before or on "LastTimeOfDelivery"(Encounter))         or(Global."EarliestOf"(EstimatedGestationalAge.relevantDatetime, EstimatedGestationalAge.relevantPeriod) same day as "LastTimeOfDelivery"(Encounter))     )       and EstimatedGestationalAge.result is not null     sort by Global."EarliestOf"(relevantDatetime, relevantPeriod) ).result as Quantity Rationale for Change: Adding the ‘same day as’ to the measure logic will align with current hospital documentation practices with the intent to decrease administrative and reporting burden.