[CQM-1090] Insufficiently restricted timing for Comfort Measures in CMS100v3 Created: 04/03/14 Updated: 03/27/19 Resolved: 03/27/19 |
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Status: | Closed |
Project: | eCQM Issue Tracker |
Component/s: | Measure |
Type: | Annual Update | Priority: | Minor |
Reporter: | Jon Salmon (Inactive) | Assignee: | Joelencia Leflore |
Resolution: | Resolved | Votes: | 0 |
Labels: | None |
Issue Links: |
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Solution: | Thank you for your feedback on the AMI-2 measure. With harmonization efforts, the solution for this ticket will also be reflected in the AMI-10 measure logic. While this ticket recommends that “occurrence” is not meaningful in the logic and recommends its removal, • AND: “Occurrence A of Encounter, Performed: Emergency Department Visit” <= 1 hour(s) ends before start of “Occurrence A of Encounter, Performed: Encounter Inpatient” • AND: “Occurrence A of Intervention, Performed: Comfort Measures” starts after start of “Occurrence A of Encounter, Performed: Emergency Department Visit” • AND: “Occurrence A of Intervention, Performed: Comfort Measures” starts before or during “Occurrence A of Encounter, Performed: Encounter Inpatient” This logic change compliments the fix proposed in ticket The second OR clause in the denominator exclusion contains logic statements that capture Comfort Measures documentation starting during an inpatient encounter that does not include an ED encounter leading to an inpatient encounter. The patient’s encounter begins in the inpatient setting. The current logic using the “Occurrence A” qualifier to specify the Comfort Measures instance will be removed in the 2015 EH eCQM update. This solution should satisfy questions raised in |
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Description |
Consider the following excerpt from the Denominator Exclusions criteria of CMS100v3 (AMI-2):
In the second criterion, due to the use of "starts after start", comfort measures provided any time after the start of the ED encounter, even months later, unrelated to this episode of care, will exclude this inpatient encounter from the Denominator. This surely is not the desired behavior. Proposed fix: The comparison could simply be changed from "starts after start" to "starts during". That would yield consistency with a similar pair of criteria in the population which look for comfort measures provided during the inpatient encounter. But presumably, when the inpatient encounter is preceded by an ED encounter, the exclusion should be satisfied by comfort measures initiated any time during the episode of care, not just during the ED encounter. Thus this issue could be resolved by leaving "starts after start" intact and adding another criterion to cover the other boundary:
Impact on other issues: |
Comments |
Comment by Cindy Cullen [ 03/27/19 ] |
eCQM CMS100 is no longer included in the IQR program. The use of occurrencing has been sunsetted as a result of the introduction of CQL-based logic for eCQMs. |
Comment by Howard Bregman (Inactive) [ 04/04/14 ] |
Adding an end bound to the time range as proposed would be a reasonable solution. However, it should be the order for comfort measures that should be the criterion, not the occurrence of the intervention. |