CMS165v13 - Controlling High Blood Pressure

  ( ["Encounter, Performed": "Office Visit"]
    union ["Encounter, Performed": "Annual Wellness Visit"]
    union ["Encounter, Performed": "Preventive Care Services Established Office Visit, 18 and Up"]
    union ["Encounter, Performed": "Preventive Care Services Initial Office Visit, 18 and Up"]
    union ["Encounter, Performed": "Home Healthcare Services"]
    union ["Encounter, Performed": "Virtual Encounter"]
    union ["Encounter, Performed": "Telephone Visits"] ) ValidEncounter
    where ValidEncounter.relevantPeriod during day of "Measurement Period"

  exists ( ["Diagnosis": "Advanced Illness"] AdvancedIllnessDiagnosis
      where AdvancedIllnessDiagnosis.prevalencePeriod starts during day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"]
  )

  exists ( ["Device, Order": "Frailty Device"] FrailtyDeviceOrder
      where FrailtyDeviceOrder.authorDatetime during day of "Measurement Period"
  )
    or exists ( ["Assessment, Performed": "Medical equipment used"] EquipmentUsed
        where EquipmentUsed.result in "Frailty Device"
          and Global."NormalizeInterval" ( EquipmentUsed.relevantDatetime, EquipmentUsed.relevantPeriod ) ends during day of "Measurement Period"
    )
    or exists ( ["Diagnosis": "Frailty Diagnosis"] FrailtyDiagnosis
        where FrailtyDiagnosis.prevalencePeriod overlaps day of "Measurement Period"
    )
    or exists ( ["Encounter, Performed": "Frailty Encounter"] FrailtyEncounter
        where FrailtyEncounter.relevantPeriod overlaps day of "Measurement Period"
    )
    or exists ( ["Symptom": "Frailty Symptom"] FrailtySymptom
        where FrailtySymptom.prevalencePeriod overlaps day of "Measurement Period"
    )

  exists (["Medication, Active": "Dementia Medications"] DementiaMedication
    where Global."NormalizeInterval" ( DementiaMedication.relevantDatetime, DementiaMedication.relevantPeriod ) overlaps day of Interval[start of "Measurement Period" - 1 year, 
    end of "Measurement Period"])

  ( AgeInYearsAt(date from 
      end of "Measurement Period"
    )>= 66
  )
    and ( ( Last(["Assessment, Performed": "Housing status"] HousingStatus
          where Global."NormalizeInterval"(HousingStatus.relevantDatetime, HousingStatus.relevantPeriod) ends on or before day of 
          end of "Measurement Period"
          sort by 
          end of Global."NormalizeInterval"(relevantDatetime, relevantPeriod)asc
      )) LastHousingStatus
        where LastHousingStatus.result ~ "Lives in nursing home (finding)"
    ) is not null

  ( AgeInYearsAt(date from 
      end of "Measurement Period"
    )in Interval[66, 80]
      and "Has Criteria Indicating Frailty"
      and ( "Has Advanced Illness in Year Before or During Measurement Period"
          or "Has Dementia Medications in Year Before or During Measurement Period"
      )
  )
    or ( AgeInYearsAt(date from 
        end of "Measurement Period"
      )>= 81
        and "Has Criteria Indicating Frailty"
    )

  ( "Qualifying Diastolic Blood Pressure Reading" DBPExam
      return date from Global."LatestOf" ( DBPExam.relevantDatetime, DBPExam.relevantPeriod )
  )
    intersect ( "Qualifying Systolic Blood Pressure Reading" SBPExam
        return date from Global."LatestOf" ( SBPExam.relevantDatetime, SBPExam.relevantPeriod )
    )

  "Initial Population"

  Hospice."Has Hospice Services"
    or exists ( "Pregnancy or Renal Diagnosis" )
    or exists ( "End Stage Renal Disease Procedures" )
    or exists ( "End Stage Renal Disease Encounter" )
    or AIFrailLTCF."Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty"
    or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home"
    or PalliativeCare."Has Palliative Care in the Measurement Period"

  ["Encounter, Performed": "ESRD Monthly Outpatient Services"] ESRDEncounter
    where ESRDEncounter.relevantPeriod starts on or before end of "Measurement Period"

  ( ["Procedure, Performed": "Kidney Transplant"]
    union ["Procedure, Performed": "Dialysis Services"] ) ESRDProcedure
    where end of Global."NormalizeInterval" ( ESRDProcedure.relevantDatetime, ESRDProcedure.relevantPeriod ) on or before end of "Measurement Period"

  ["Diagnosis": "Essential Hypertension"] Hypertension
    where Hypertension.prevalencePeriod overlaps Interval[start of "Measurement Period", start of "Measurement Period" + 6 months )

  "Lowest Diastolic Reading on Most Recent Blood Pressure Day".result < 90 'mm[Hg]'

  "Lowest Systolic Reading on Most Recent Blood Pressure Day".result < 140 'mm[Hg]'

  exists ( ["Encounter, Performed": "Encounter Inpatient"] InpatientEncounter
      where ( InpatientEncounter.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
          or InpatientEncounter.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
      )
        and InpatientEncounter.relevantPeriod ends during day of "Measurement Period"
  )
    or exists ( ["Encounter, Performed": "Hospice Encounter"] HospiceEncounter
        where HospiceEncounter.relevantPeriod overlaps day of "Measurement Period"
    )
    or exists ( ["Assessment, Performed": "Hospice care [Minimum Data Set]"] HospiceAssessment
        where HospiceAssessment.result ~ "Yes (qualifier value)"
          and Global."NormalizeInterval" ( HospiceAssessment.relevantDatetime, HospiceAssessment.relevantPeriod ) overlaps day of "Measurement Period"
    )
    or exists ( ["Intervention, Order": "Hospice Care Ambulatory"] HospiceOrder
        where HospiceOrder.authorDatetime during day of "Measurement Period"
    )
    or exists ( ["Intervention, Performed": "Hospice Care Ambulatory"] HospicePerformed
        where Global."NormalizeInterval" ( HospicePerformed.relevantDatetime, HospicePerformed.relevantPeriod ) overlaps day of "Measurement Period"
    )
  or exists ( ["Diagnosis": "Hospice Diagnosis"] HospiceCareDiagnosis
        where HospiceCareDiagnosis.prevalencePeriod overlaps day of "Measurement Period"
    )

  AgeInYearsAt(date from 
    end of "Measurement Period"
  ) in Interval[18, 85]
    and exists "Essential Hypertension Diagnosis"
    and exists AdultOutpatientEncounters."Qualifying Encounters"

  First("Qualifying Diastolic Blood Pressure Reading" DBPReading
      where Global."LatestOf"(DBPReading.relevantDatetime, DBPReading.relevantPeriod) same day as "Most Recent Blood Pressure Day"
      sort by(result as Quantity)
  )

  First("Qualifying Systolic Blood Pressure Reading" SBPReading
      where Global."LatestOf"(SBPReading.relevantDatetime, SBPReading.relevantPeriod) same day as "Most Recent Blood Pressure Day"
      sort by(result as Quantity)
  )

  Last("Blood Pressure Days" BPDays
      sort asc
  )

  "Has Systolic Blood Pressure Less Than 140"
    and "Has Diastolic Blood Pressure Less Than 90"

  exists ( ["Assessment, Performed": "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"] PalliativeAssessment
      where Global."NormalizeInterval" ( PalliativeAssessment.relevantDatetime, PalliativeAssessment.relevantPeriod ) overlaps day of "Measurement Period"
  )
    or exists ( ["Diagnosis": "Palliative Care Diagnosis"] PalliativeDiagnosis
        where PalliativeDiagnosis.prevalencePeriod overlaps day of "Measurement Period"
    )
    or exists ( ["Encounter, Performed": "Palliative Care Encounter"] PalliativeEncounter
        where PalliativeEncounter.relevantPeriod overlaps day of "Measurement Period"
    )
    or exists ( ["Intervention, Performed": "Palliative Care Intervention"] PalliativeIntervention
        where Global."NormalizeInterval" ( PalliativeIntervention.relevantDatetime, PalliativeIntervention.relevantPeriod ) overlaps day of "Measurement Period"
    )

  ( ["Diagnosis": "Pregnancy"]
    union ["Diagnosis": "End Stage Renal Disease"]
    union ["Diagnosis": "Kidney Transplant Recipient"]
    union ["Diagnosis": "Chronic Kidney Disease, Stage 5"] ) PregnancyESRDDiagnosis
    where PregnancyESRDDiagnosis.prevalencePeriod overlaps "Measurement Period"

  ["Physical Exam, Performed": "Diastolic blood pressure"] DiastolicBP
    without ( ["Encounter, Performed": "Encounter Inpatient"]
      union ["Encounter, Performed": "Emergency Department Evaluation and Management Visit"] ) DisqualifyingEncounter
      such that Global."LatestOf" ( DiastolicBP.relevantDatetime, DiastolicBP.relevantPeriod ) during day of DisqualifyingEncounter.relevantPeriod
    where DiastolicBP.result.unit = 'mm[Hg]'
      and Global."LatestOf" ( DiastolicBP.relevantDatetime, DiastolicBP.relevantPeriod ) during day of "Measurement Period"

  ["Physical Exam, Performed": "Systolic blood pressure"] SystolicBP
    without ( ["Encounter, Performed": "Encounter Inpatient"]
      union ["Encounter, Performed": "Emergency Department Evaluation and Management Visit"] ) DisqualifyingEncounter
      such that Global."LatestOf" ( SystolicBP.relevantDatetime, SystolicBP.relevantPeriod ) during day of DisqualifyingEncounter.relevantPeriod
    where SystolicBP.result.unit = 'mm[Hg]'
      and Global."LatestOf" ( SystolicBP.relevantDatetime, SystolicBP.relevantPeriod ) during day of "Measurement Period"

  ["Patient Characteristic Ethnicity": "Ethnicity"]

  ["Patient Characteristic Payer": "Payer Type"]

  ["Patient Characteristic Race": "Race"]

  ["Patient Characteristic Sex": "ONC Administrative Sex"]

  not ( 
    end of period is null
      or 
      end of period = maximum DateTime
  )

  if ( HasEnd(period)) then 
  end of period 
    else start of period

  Latest(NormalizeInterval(pointInTime, period))

  if pointInTime is not null then Interval[pointInTime, pointInTime]
    else if period is not null then period 
    else null as Interval<DateTime>