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  1. eCQM Issue Tracker
  2. CQM-6814

Episode based measures and 'FromDayOfStartOfHospitalizationToDayAfterAdmission' or 'CalendarDayOfOrDayAfter' timing function

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      Thank you for your inquiry into CMS108v12 VTE-1, Venous Thromboembolism Prophylaxis. The ‘Numerator’ logic evaluates the 'Encounter with VTE Prophylaxis Received From Day of Start of Hospitalization To Day After Admission or Procedure’. Patients who were given VTE prophylaxis on any day during this time period will satisfy the Numerator criteria.

      The function FromDayOfStartOfHospitalizationToDayAfterAdmission defines the qualifying scheduling conditions for the Emergency Department (ED) or Observation status period. This period must end within 1 hour prior to the inpatient encounter.

      In the scenario that you provided, the patient has outpatient visit (ED or clinic) 3/1/2024 0800 - 3/1/2024 10:00. The Inpatient Encounter starts on 3/1/2024 23:00. Since the inpatient admission time is greater than 1 hour after the ED end time, this ED encounter would not be associated with this Inpatient admission. However, because the patient was given warfarin on 3/1/2024 09:00, on the same day of the inpatient admission date, this patient will meet the numerator criteria.
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      Thank you for your inquiry into CMS108v12 VTE-1, Venous Thromboembolism Prophylaxis. The ‘Numerator’ logic evaluates the 'Encounter with VTE Prophylaxis Received From Day of Start of Hospitalization To Day After Admission or Procedure’. Patients who were given VTE prophylaxis on any day during this time period will satisfy the Numerator criteria. The function FromDayOfStartOfHospitalizationToDayAfterAdmission defines the qualifying scheduling conditions for the Emergency Department (ED) or Observation status period. This period must end within 1 hour prior to the inpatient encounter. In the scenario that you provided, the patient has outpatient visit (ED or clinic) 3/1/2024 0800 - 3/1/2024 10:00. The Inpatient Encounter starts on 3/1/2024 23:00. Since the inpatient admission time is greater than 1 hour after the ED end time, this ED encounter would not be associated with this Inpatient admission. However, because the patient was given warfarin on 3/1/2024 09:00, on the same day of the inpatient admission date, this patient will meet the numerator criteria.
    • CMS0108v12

      eCQM Logic and Implementation Guidance state that Episode-based measures evaluate the care during an encounter with a measured entity and assign. Previous guidance has clarified that actions performed in different facilities (ex., facility under CCN1, EOC1) should not be used when evaluating an encounter in a different facility (CCN2, EOC2)

      https://oncprojectracking.healthit.gov/support/browse/CQM-5644 
      https://oncprojectracking.healthit.gov/support/browse/CQM-3189 

      Can additional guidance/clarification be provided for logics that use timing functions as 'FromDayOfStartOfHospitalizationToDayAfterAdmission(Encounter "Encounter, Performed")'? As the time is truncated, the interval will include the 'day of' and the 'day after'. 

      Scenario for CMS108v12:
      Numerator logic evaluates 'Encounter with VTE Prophylaxis Received From Day of Start of Hospitalization To Day After Admission or Procedure'
      ( VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
          with "Pharmacological or Mechanical VTE Prophylaxis Received" VTEProphylaxis
            such that Global."NormalizeInterval" ( VTEProphylaxis.relevantDatetime, VTEProphylaxis.relevantPeriod ) starts during day of VTE."FromDayOfStartOfHospitalizationToDayAfterAdmission" ( QualifyingEncounter )
      )

      Patient has outpatient visit (ED or clinic) 3/1/2024 0800 - 3/1/2024 10:00
      EHR Documentation of Warfarin 5mg Medication Administered 3/1/2024 09:00
      Patient is admitted as Inpatient on 3/1/2024 23:00
      Shared EHR is used. Based on the timing of the logic, the VTE prophylaxis was administered the day of start of hospitalization (starts during day of). It does not state that it has to be after the start of the hospitalization. We tested the scenario in Bonnie and assigned an outcome of Numerator to the inpatient encounter. Can you please clarify how this scenario is expected to be evaluated?

            JLeflore Mathematica EH eCQM Team
            isbelia Isbelia Briceno
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