Question 1: Abnormal presentation is a denominator exclusion for this measure. In the original version, documentation of abnormal presentation 42 weeks prior to delivery would exclude the case. In the current version of the eCQM, the 42-week look-back period has been removed to align with the chart-based measure. Therefore, patients with abnormal presentation on previous encounters who present in vertex position on the delivery encounter will remain in the denominator. Do you support removing the 42-week look-back period?

Agree with this suggestion to remove the 42 week look back to align with manual abstraction specifications.

Question 2: The current logic evaluates the concepts of multiple gestation, abnormal presentation, stillbirth, and single live birth based on ICD-10 diagnosis codes using the Diagnosis attribute of the Encounter Performed datatype. Multiple gestation is based also on the Diagnosis datatype. Please comment on the feasibility of using the Assessment Performed datatype with SNOMED codes to represent these concepts instead of or in addition to the Diagnosis datatypes as currently specified.

We would support and encourage the use of both Diagnosis Codes as well as the LOINC and SNOMED codes to capture the data. This will allow a more accurate capture of the data elements needed for this measure.

Question 3: The denominator includes logic to determine whether the patient has had previous live births. The patient has not had previous live births when one of the following is true: Parity equals zero
Gravida equals one
Preterm and term births both equal zero

Parity and preterm and term live births may be updated by the electronic health record software or by clinicians during a delivery encounter. The intent is to capture the pre-delivery value. The logic is currently specified to evaluate these concepts 42 weeks or less before or on the delivery start time. Does this logic meet the intent to capture the pre-delivery value?

This may be a difficult and burdensome data element to capture for a few reasons. First, we are going to be analyzing a patient’s chart after discharge and so the chart will not reflect Gravida 1 and Parity 0 may not be able to be captured. We would recommend that the data element be Gravida 1 Parity 1 with Preterm and term births equaling 0 as well.