[CQM-1296] Difference in logic for Comfort Measures Only in AMI-2 and AMI-10 Created: 08/27/14  Updated: 03/27/19  Resolved: 03/27/19

Status: Closed
Project: eCQM Issue Tracker
Component/s: Measure

Type: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals Priority: Minor
Reporter: Carla McCorkle (Inactive) Assignee: Cindy Cullen
Resolution: Resolved Votes: 0
Labels: None

Attachments: PNG File AMI10_CMO_Logic.png     PNG File AMI2_CMO_Logic.png    
Issue Links:
Relates
relates to CQM-1090 Insufficiently restricted timing for ... Closed
Supports
Supports CQM-1089 Extraneous "Occurrence A" for Interve... Closed
Contact Name: Carla McCorkle
Contact Email: carla.mccorkle@xerox.com
Contact Phone: 520-750-4177
Institution/Name: Midas+
Guidance required: Yes
Solution: "Soution noted in CQM-1090 The logic will be modified to add an additional logic statement: 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 CQM-1090 and satisfies the scenarios for patients with an ED encounter. This leads to an inpatient encounter where Comfort Measure documentation may occur in the ED and inpatient setting, and patients with only an inpatient encounter where Comfort Measure documentation occurs during the inpatient encounter. This solution satisfies the questions raised in CQM-1089 and CQM-1090.
Solution Posted On:
2015 Reporting Period EH eCQMs:
CMS100v3/NQF142, CMS30v4/NQF0639
Impact: Cases with Comfort Measures Only documented during Inpatient Stay will not be excluded.

 Description   

We appreciate the update to the Comfort Measure Only(CMO) logic to include CMO documented during the ED visit. However, there is a discrepancy in how the logic is written for AMI-2 and how it is written for AMI-10.

As written for AMI-2, the logic makes sense and will calculate correctly. However, for AMI-10, we believe there are conflicting statements in the ED Visit logic (additional AND statement for Encounter Inpatient). Below is how the statements appear in each:

AMI-2
 OR:
 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"

AMI-10
 OR:
 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"

Is the intent that CMO is documented in both the ED and during the IP encounter as written in AMI-10? We suspect that the intent is to capture only CMO which starts after the start of the ED visit, as written in AMI-2. The additional logic statements will capture CMO documented during the IP encounter.

Screenshots attached for further clarification.

 Comments   
Comment by Cindy Cullen [ 03/27/19 ]

eCQMs for AMI-2 and AMI-10 are no longer in the IQR program.

Comment by Jon Salmon (Inactive) [ 09/02/14 ]

I thought this issue felt awfully familiar when I posted the previous comment: I submitted it as CQM-1090 shortly after the annual update was released in April. See that issue for the solution from CMS.

Comment by Jon Salmon (Inactive) [ 08/29/14 ]

The criteria in CMS30v4 (NQF 0639, AMI-10) don't require that the comfort measures intervention is documented in both the ED and the IP encounters, only that it starts sometime after the start of the ED and before the end of the IP. Unfortunately, since that additional constraint is missing from CMS100v3 (NQF 0142, AMI-2), its Denominator Exclusions can be satisfied by a comfort measures intervention that starts any time after the start of the ED visit, including months later, for a completely unrelated episode. That's surely not the intent. The criterion in AMI-10 should be added to AMI-2 for the next annual update. (That's up to the measure developer, of course.) Good catch!

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