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  1. QRDA Issue Tracker
  2. QRDA-339

Seeking clarity in cases such as these where multiple encounters exist within a QRDA-I

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    • Multiple Episode of Care within QRDA-I, Evaluation of these EoC, and Occurrences surrounding these
    • Quantros, Inc.
    • BJ Pate
    • 18007118363
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      CLARIFICATION HAS BEEN MADE TO THE SOLUTION FOR NUMBER 2 BELOW:

      Noting that you submitted the same question to the Jira CQM board (CQM-2082), I will only address those components directly related to QRDA. Note that occurrencing found in measure logic refers to the measure itself, and not the QRDA file.

      1) We are seeking clarity in cases such as these where multiple encounters exist within a QRDA-I, particularly within evaluation of EH measures. With the example from above: If those encounters existed and they are being processed for example through Stroke2 CMS104v3: Should both of these episodes of care be evaluated by the stroke algorithm, and produce distinct pass/fail/exclusion/exception results for each of these episodes? If so is there someplace within documentation that clearly specifies this. Or is it by design Stroke2 CMS104v3 would limit which of those encounters (ie. through Occurrences) would be evaluated?

      The QRDA Implementation Guide for 2015 reporting (where CMS104v3 is used), indicates "A QRDA-I document should be submitted for each patient who meets the Initial Patient Population criteria of an eCQM.” The QRDA file submitted must report raw applicable patient data to calculate measure metrics. Using the example provided for Stroke 2, assuming that at a minimum all Initial Patient Population criteria (encounter performed, age, principal diagnosis, etc.) are present for both the January and February encounters, then both would be reported and processed through the CMS measures engine separately to determine the measure outcome for each (e.g., January Encounter= met numerator criteria, February = met denominator, failed numerator). The measures processing engine will use temporal relationships in its calculation to associate visits and their associated elements.

       
      2) Lastly, is there an option for hospitals to build QRDA files as patient based OR episode of care based, or are QRDA files always built as patient-based files?

      Hospitals must submit QRDA files for each patient only. The base QRDA-I standard allows the option to generate combined or separate files for the measures reported, however per the 2015 QRDA Implementation Guide “For Hospital Quality Reporting, there should be one QRDA-I report per patient for the facility CMS Certification Number (CCN).”
      Please refer to the below:

      OPTION for a single CCN:
      Report for Patient X- includes data elements relevant to CMS104v3 and CMS11v3 (all encounters in the reporting period, assuming the initial patient population is met for each)
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      CLARIFICATION HAS BEEN MADE TO THE SOLUTION FOR NUMBER 2 BELOW: Noting that you submitted the same question to the Jira CQM board ( CQM-2082 ), I will only address those components directly related to QRDA. Note that occurrencing found in measure logic refers to the measure itself, and not the QRDA file. 1) We are seeking clarity in cases such as these where multiple encounters exist within a QRDA-I, particularly within evaluation of EH measures. With the example from above: If those encounters existed and they are being processed for example through Stroke2 CMS104v3: Should both of these episodes of care be evaluated by the stroke algorithm, and produce distinct pass/fail/exclusion/exception results for each of these episodes? If so is there someplace within documentation that clearly specifies this. Or is it by design Stroke2 CMS104v3 would limit which of those encounters (ie. through Occurrences) would be evaluated? The QRDA Implementation Guide for 2015 reporting (where CMS104v3 is used), indicates "A QRDA-I document should be submitted for each patient who meets the Initial Patient Population criteria of an eCQM.” The QRDA file submitted must report raw applicable patient data to calculate measure metrics. Using the example provided for Stroke 2, assuming that at a minimum all Initial Patient Population criteria (encounter performed, age, principal diagnosis, etc.) are present for both the January and February encounters, then both would be reported and processed through the CMS measures engine separately to determine the measure outcome for each (e.g., January Encounter= met numerator criteria, February = met denominator, failed numerator). The measures processing engine will use temporal relationships in its calculation to associate visits and their associated elements.   2) Lastly, is there an option for hospitals to build QRDA files as patient based OR episode of care based, or are QRDA files always built as patient-based files? Hospitals must submit QRDA files for each patient only. The base QRDA-I standard allows the option to generate combined or separate files for the measures reported, however per the 2015 QRDA Implementation Guide “For Hospital Quality Reporting, there should be one QRDA-I report per patient for the facility CMS Certification Number (CCN).” Please refer to the below: OPTION for a single CCN: Report for Patient X- includes data elements relevant to CMS104v3 and CMS11v3 (all encounters in the reporting period, assuming the initial patient population is met for each)

      QRDA category I files are generated one per patient, and should cover all of the data elements required to compute the quality measures whose computation is being certified.
      The HL7 QRDA Implementation Guide is essential reading, and describes the data elements that must/may be included.
      A QRDA-I file indeed contains data relating to multiple visits. Unfortunately, at this time, the only way to associate clinical data with an encounter is temporally – the timing of the diagnosis/result/med-order/etc indicates whether it is associated with the visit.

      Here is additional feedback from Lantana:

      A QRDA file may have multiple visits of a single patient. In that case, the clinical data of patient will be linked to an encounter via timestamp.
      For instance, a QRDA may have two inpatient encounters (encounter_1, and encounter_2), a patient has lab tests in both encounter.

      encounter_1: from 2011-01-01 to 2011-01-10
      encounter_2: from 2011-02-05 to 2011-02-11
      lab_1 exam: occurred 2011-01-05 09:30 AM
      lab_2 exam: occurred 2011-02-07 12:30 PM

      As lab_1 exam's timestamp falls into the encounter_1's date range, thus the lab_1 exam is linked to encounter_1. Same as lab_2 exam, it is linked to the encounter_2 by comparing the date range.

      The above was taken from QRDA-76 Jira cases link: https://jira.oncprojectracking.org/browse/QRDA-76?jql=text%20~%20%22multiple%20encounters%20per%20measure%22

      We are seeking clarity in cases such as these where multiple encounters exist within a QRDA-I, particularly within evaluation of EH measures. With the example from above: If those encounters existed and they are being processed for example through Stroke2 CMS104v3: Should both of these episodes of care be evaluated by the stroke algorithm, and produce distinct pass/fail/exclusion/exception results for each of these episodes? If so is there someplace within documentation that clearly specifies this. Or is it by design Stroke2 CMS104v3 would limit which of those encounters (ie. through Occurrences) would be evaluated?

      We are also looking for clarification on how to interpret the Occurrence clauses in the STK algorithms as they apply to Non-Elective Inpatient Encounters. Do these occurrences apply to the contents of a QRDA files (as a whole), or do they apply to the contents of one or more episodes of care contained within the QRDA file?

      If the occurrences apply to the contents of an episode of care, then the terminology of “Occurrence A of $EncounterInpatientNonElective” seems to be misleading, as there can only be one Inpatient Encounter per episode of care for Inpatient measures.

      Lastly, is there an option for hospitals to build QRDA files as patient based OR episode of care based, or are QRDA files always built as patient-based files?

            chanadenise Chana West
            bpate BJ Pate (Inactive)
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