ecqm.measure

CMS108v7 - Venous Thromboembolism Prophylaxis (VTE-1)

Rationale:

Venous Thromboembolism Prophylaxis (VTE-1). Hospitalized patients at high-risk for VTE may develop an asymptomatic deep vein thrombosis (DVT), and die from pulmonary embolism (PE) even before the diagnosis is suspected. The majority of fatal events occur as sudden or abrupt death, underscoring the importance of prevention as the most critical action step for reducing death from PE (Geerts, et al, 2008). The estimated annual incidence of deep-vein thrombosis (DVT) and pulmonary embolism (PE), known collectively as venous thromboembolism (VTE), is approximately 900,000 (Geerts, et al, 2008). Approximately two-thirds of cases of DVT or PE are associated with recent hospitalization. This is consistent with the 2001 report by The Agency for Healthcare Research and Quality (AHRQ). AHRQ indicates that 'the appropriate application of effective preventive measures in hospitals has major potential for improving patient safety by reducing the incidence of venous thromboembolism' (Shojania, 2001). Despite its proven effectiveness, rates of appropriate thromboprophylaxis remain low in both medical and surgical patients. A recent analysis from the ENDORSE survey, which evaluated prophylaxis rates in 17,084 major surgery patients, found that more than one third of patients at risk for VTE (38%) did not receive prophylaxis and that rates varied by surgery type (Cohen, et al., 2008). In a review of evidence-based patient safety practices, the Agency for Healthcare Research and Quality defined thromboprophylaxis against VTE as the 'number one patient safety practice' for hospitalized patients (Shojania, 2001). Updated 'safe practices' published by the National Quality Forum (NQF) recommend routine evaluation of hospitalized patients for risk of VTE and use of appropriate prophylaxis (National Quality Forum. National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism, 2006). As noted by the ACCP, a vast number of randomized clinical trials provide irrefutable evidence that thromboprophylaxis reduces VTE events, and there are studies that have also shown that fatal PE is prevented by thromboprophylaxis (Geerts, et al. 2008). Some select surgeries have previously been monitored in the Surgical Care Improvement Project; since performance on these surgeries has achieved very high levels, they are not included in this measure.

Data Elements

RiskForVenousThromboembolismPerformed

AssessmentPerformed: Data elements that meet criteria using this datatype should document completion of the assessment indicated by the QDM category and its corresponding value set. Timing: The time the assessment is completed; Author dateTime.

DataType

Cardinality

RiskForVenousThromboembolismPerformed

0..*

IntermittentPneumaticCompressionDevicesIpcApplied

Clinical Focus: This set of values represents the different types of intermittent pneumatic compression devices used for VTE prophylaxis.

Data Element Scope: The intent of this data element is to represent the application of certain intermittent pneumatic compression devices. Using the Quality Data Model, this data element will map to the Device category.

Inclusion Criteria: Only include codes which represent different types of intermittent pneumatic compression devices.

Exclusion Criteria: None

Subject constrained to the Intermittent pneumatic compression devices (IPC)

DeviceApplied: Data elements that meet criteria using this datatype should document that the device indicated by the QDM category and its corresponding value set is in use, or impacts or alters the treatment, care plan, or encounter (e.g., an antithrombotic device has been placed on the patient's legs to prevent thromboembolism, or a cardiac pacemaker is in place). Timing: The Relevant Period addresses: startTime – When the device is inserted or first used stopTime – when the device is removed or last used

DataType

Cardinality

IntermittentPneumaticCompressionDevicesIpcApplied

0..*

IntermittentPneumaticCompressionDevicesIpcOrder

Clinical Focus: This set of values represents the different types of intermittent pneumatic compression devices used for VTE prophylaxis.

Data Element Scope: The intent of this data element is to represent the application of certain intermittent pneumatic compression devices. Using the Quality Data Model, this data element will map to the Device category.

Inclusion Criteria: Only include codes which represent different types of intermittent pneumatic compression devices.

Exclusion Criteria: None

Subject constrained to the Intermittent pneumatic compression devices (IPC)

DeviceOrder: Data elements that meet criteria using this datatype should document an order for the device indicated by the QDM category and its corresponding value set. Timing: The time the order is signed; Author dateTime.

DataType

Cardinality

IntermittentPneumaticCompressionDevicesIpcOrder

0..*

VenousFootPumpsVfpApplied

Clinical Focus: This set of values identifies patients who have a venous foot pump device applied for VTE prophylaxis.

Data Element Scope: The intent of this data element is to identify patients who have a venous foot pump device applied for VTE prophylaxis. Using the Quality Data Model, this particular element will map to the Device category.

Inclusion Criteria: Only use codes which represent venous foot pump devices which are used for VTE prophylaxis.

Exclusion Criteria: None

Subject constrained to the Venous foot pumps (VFP)

DeviceApplied: Data elements that meet criteria using this datatype should document that the device indicated by the QDM category and its corresponding value set is in use, or impacts or alters the treatment, care plan, or encounter (e.g., an antithrombotic device has been placed on the patient's legs to prevent thromboembolism, or a cardiac pacemaker is in place). Timing: The Relevant Period addresses: startTime – When the device is inserted or first used stopTime – when the device is removed or last used

DataType

Cardinality

VenousFootPumpsVfpApplied

0..*

VenousFootPumpsVfpOrder

Clinical Focus: This set of values identifies patients who have a venous foot pump device applied for VTE prophylaxis.

Data Element Scope: The intent of this data element is to identify patients who have a venous foot pump device applied for VTE prophylaxis. Using the Quality Data Model, this particular element will map to the Device category.

Inclusion Criteria: Only use codes which represent venous foot pump devices which are used for VTE prophylaxis.

Exclusion Criteria: None

Subject constrained to the Venous foot pumps (VFP)

DeviceOrder: Data elements that meet criteria using this datatype should document an order for the device indicated by the QDM category and its corresponding value set. Timing: The time the order is signed; Author dateTime.

DataType

Cardinality

VenousFootPumpsVfpOrder

0..*

GraduatedCompressionStockingsGcsApplied

Clinical Focus: This set of values contains codes and concepts for graduated compression stocking devices which are used to prevent VTEs in patients.

Data Element Scope: The intent of this data element is to identify patients who have a graduated compression stocking device applied. It may also be used to identify patients who did not have a graduated compression stocking device applied for VTE prophylaxis for an allowable reason when used with a negation rationale attribute. Using the Quality Data Model, this data element maps to the Device category.

Inclusion Criteria: Only include codes which represent graduated compression stockings.

Exclusion Criteria: None

Subject constrained to the Graduated compression stockings (GCS)

DeviceApplied: Data elements that meet criteria using this datatype should document that the device indicated by the QDM category and its corresponding value set is in use, or impacts or alters the treatment, care plan, or encounter (e.g., an antithrombotic device has been placed on the patient's legs to prevent thromboembolism, or a cardiac pacemaker is in place). Timing: The Relevant Period addresses: startTime – When the device is inserted or first used stopTime – when the device is removed or last used

DataType

Cardinality

GraduatedCompressionStockingsGcsApplied

0..*

GraduatedCompressionStockingsGcsOrder

Clinical Focus: This set of values contains codes and concepts for graduated compression stocking devices which are used to prevent VTEs in patients.

Data Element Scope: The intent of this data element is to identify patients who have a graduated compression stocking device applied. It may also be used to identify patients who did not have a graduated compression stocking device applied for VTE prophylaxis for an allowable reason when used with a negation rationale attribute. Using the Quality Data Model, this data element maps to the Device category.

Inclusion Criteria: Only include codes which represent graduated compression stockings.

Exclusion Criteria: None

Subject constrained to the Graduated compression stockings (GCS)

DeviceOrder: Data elements that meet criteria using this datatype should document an order for the device indicated by the QDM category and its corresponding value set. Timing: The time the order is signed; Author dateTime.

DataType

Cardinality

GraduatedCompressionStockingsGcsOrder

0..*

ObstetricsDiagnosis

Clinical Focus: This grouping of value sets identifies patients who have a condition related to pregnancy or obstetrics.

Data Element Scope: The intent of this data element is to identify patients who have a condition, problem or diagnosis related to pregnancy or obstetrics. Using the Quality Data Model, this particular element will map to either the Diagnosis category.

Inclusion Criteria: Only use codes which represent a condition, problem or diagnosis related to pregnancy or obstetrics.

Exclusion Criteria: None.

ResultValue constrained to codes in the Obstetrics valueset (2.16.840.1.113883.3.117.1.7.1.263)

Diagnosis: Condition/Diagnosis/Problem represents a practitioner’s identification of a patient’s disease, illness, injury, or condition. This category contains a single datatype to represent all of these concepts: Diagnosis. A practitioner determines the diagnosis by means of examination, diagnostic test results, patient history, and/or family history. Diagnoses are usually considered unfavorable, but may also represent neutral or favorable conditions that affect a patient’s plan of care (e.g., pregnancy). The QDM does not prescribe the source of diagnosis data in the EHR. Diagnoses may be found in a patient’s problem list, encounter diagnosis list, claims data, or other sources within the EHR. The preferred terminology for diagnoses is SNOMED-CT, but diagnoses may also be encoded using ICD-9/10. The Diagnosis datatype should not be used for differential diagnoses or rule-out diagnoses (neither of which are currently supported by the QDM).

DataType

Cardinality

ObstetricsDiagnosis

0..*

ObstetricsVteDiagnosis

Clinical Focus: This grouping of value sets identifies patients who have a venous thromboembolism related to pregnancy or obstetrics.

Data Element Scope: The intent of this data element is to identify patients who have a venous thromboembolism related to pregnancy or obstetrics. Using the Quality Data Model, this particular element would map to the Diagnosis category or the Diagnosis attribute for the Encounter category.

Inclusion Criteria: Only use codes which represent a venous thromboembolism related to pregnancy or obstetrics.

Exclusion Criteria: None.

ResultValue constrained to codes in the Obstetrics VTE valueset (2.16.840.1.113883.3.117.1.7.1.264)

Diagnosis: Condition/Diagnosis/Problem represents a practitioner’s identification of a patient’s disease, illness, injury, or condition. This category contains a single datatype to represent all of these concepts: Diagnosis. A practitioner determines the diagnosis by means of examination, diagnostic test results, patient history, and/or family history. Diagnoses are usually considered unfavorable, but may also represent neutral or favorable conditions that affect a patient’s plan of care (e.g., pregnancy). The QDM does not prescribe the source of diagnosis data in the EHR. Diagnoses may be found in a patient’s problem list, encounter diagnosis list, claims data, or other sources within the EHR. The preferred terminology for diagnoses is SNOMED-CT, but diagnoses may also be encoded using ICD-9/10. The Diagnosis datatype should not be used for differential diagnoses or rule-out diagnoses (neither of which are currently supported by the QDM).

DataType

Cardinality

ObstetricsVteDiagnosis

0..*

AtrialFibrillationFlutterDiagnosis

Clinical Focus: This grouping value set contains diagnoses used to identify patients with a history of atrial fibrillation/flutter or a current finding of atrial fibrillation/flutter.

Data Element Scope: The intent of this data element is to identify patients with a diagnosis of atrial fibrillation or flutter. Using the Quality Data Model, this particular element would map to the Diagnosis category or the Diagnosis attribute for the Encounter category.

Inclusion Criteria: Include codes that identify patients with a history of atrial fibrillation/flutter or a current finding of atrial fibrillation/flutter. This is a grouping of ICD10CM, ICD9CM and SNOMEDCT codes.

Exclusion Criteria: None.

ResultValue constrained to codes in the Atrial Fibrillation/Flutter valueset (2.16.840.1.113883.3.117.1.7.1.202)

Diagnosis: Condition/Diagnosis/Problem represents a practitioner’s identification of a patient’s disease, illness, injury, or condition. This category contains a single datatype to represent all of these concepts: Diagnosis. A practitioner determines the diagnosis by means of examination, diagnostic test results, patient history, and/or family history. Diagnoses are usually considered unfavorable, but may also represent neutral or favorable conditions that affect a patient’s plan of care (e.g., pregnancy). The QDM does not prescribe the source of diagnosis data in the EHR. Diagnoses may be found in a patient’s problem list, encounter diagnosis list, claims data, or other sources within the EHR. The preferred terminology for diagnoses is SNOMED-CT, but diagnoses may also be encoded using ICD-9/10. The Diagnosis datatype should not be used for differential diagnoses or rule-out diagnoses (neither of which are currently supported by the QDM).

DataType

Cardinality

AtrialFibrillationFlutterDiagnosis

0..*

VenousThromboembolismDiagnosis

Clinical Focus: This grouping of value sets identifies patients who have a venous thromboembolism, including those who have a pulmonary embolism.

Data Element Scope: The intent of this data element is to identify patients who have a venous thromboembolism, including those who have a pulmonary embolism. Using the Quality Data Model, this particular element will map to the Diagnosis category, or the Diagnosis or Principal Diagnosis attribute for the Encounter category.

Inclusion Criteria: Only use codes representing pulmonary embolism and proximal venous thromboembolisms, including specific proximal veins: popliteal vein, femoral/superficial femoral vein, deep femoral vein, ileofemoral vein, iliac vein and inferior vena cava.

Exclusion Criteria: None.

ResultValue constrained to codes in the Venous Thromboembolism valueset (2.16.840.1.113883.3.117.1.7.1.279)

Diagnosis: Condition/Diagnosis/Problem represents a practitioner’s identification of a patient’s disease, illness, injury, or condition. This category contains a single datatype to represent all of these concepts: Diagnosis. A practitioner determines the diagnosis by means of examination, diagnostic test results, patient history, and/or family history. Diagnoses are usually considered unfavorable, but may also represent neutral or favorable conditions that affect a patient’s plan of care (e.g., pregnancy). The QDM does not prescribe the source of diagnosis data in the EHR. Diagnoses may be found in a patient’s problem list, encounter diagnosis list, claims data, or other sources within the EHR. The preferred terminology for diagnoses is SNOMED-CT, but diagnoses may also be encoded using ICD-9/10. The Diagnosis datatype should not be used for differential diagnoses or rule-out diagnoses (neither of which are currently supported by the QDM).

DataType

Cardinality

VenousThromboembolismDiagnosis

0..*

EmergencyDepartmentVisitPerformed

Clinical Focus: This set of values identifies procedures representing an emergency department encounter.

Data Element Scope: The intent of this data element is to identify patients who have had an emergency department encounter. Using the Quality Data Model, this particular element will map to the 'Encounter' category.

Inclusion Criteria: Include codes representing an emergency department visit encounter utilizing the SNOMED CT code system.

Exclusion Criteria: None

Subject constrained to the Emergency Department Visit

EncounterPerformed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

EmergencyDepartmentVisitPerformed

0..*

EncounterInpatientPerformed

Clinical Focus: This set of values identify the most common inpatient encounter types.

Data Element Scope: The intent of this data element is to identify patients who have had an inpatient encounter. Using the Quality Data Model, this particular element will map to the 'encounter' category.

Inclusion Criteria: Only SNOMED CT codes representing inpatient encounter should be included.

Exclusion Criteria: None.

Subject constrained to the Encounter Inpatient

EncounterPerformed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

EncounterInpatientPerformed

0..*

ComfortMeasuresOrder

Clinical Focus: This set of values contains care regimes used to define comfort measure care.

Data Element Scope: The intent of this data element is to identify patients receiving comfort measures care. Using the Quality Data Model, this particular element would map to the Intervention category.

Inclusion Criteria: Include SNOMEDCT regime and therapy codes for comfort measures, terminal care, dying care, and hospice care.

Exclusion Criteria: None.

Subject constrained to the Comfort Measures

InterventionOrder: Data elements that meet criteria using this datatype should document a request to perform the intervention indicated by the QDM category and its corresponding value set. Timing: The time the order is signed; Author dateTime

DataType

Cardinality

ComfortMeasuresOrder

0..*

ComfortMeasuresPerformed

Clinical Focus: This set of values contains care regimes used to define comfort measure care.

Data Element Scope: The intent of this data element is to identify patients receiving comfort measures care. Using the Quality Data Model, this particular element would map to the Intervention category.

Inclusion Criteria: Include SNOMEDCT regime and therapy codes for comfort measures, terminal care, dying care, and hospice care.

Exclusion Criteria: None.

Subject constrained to the Comfort Measures

InterventionPerformed: Data elements that meet criteria using this datatype should document the completion of the intervention indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: startTime – The time the intervention begins stopTime – The time the intervention ends NOTE - timing refers to a single instance of an intervention. If a measure seeks to evaluate multiple interventions over a period of time, the measure developer should use CQL logic to represent the query request.

DataType

Cardinality

ComfortMeasuresPerformed

0..*

InrPerformed

Clinical Focus: This set of values contains codes for laboratory test for INR, or International Normalized Ratio.

Data Element Scope: The intent of this data element is to identify INR laboratory tests. Using the Quality Data Model, this data element maps to the Laboratory Test category.

Inclusion Criteria: Only include codes which represent a laboratory test of INR (International Normalized Ratio). These are LOINC codes.

Exclusion Criteria: None

Subject constrained to the INR

LaboratoryTestPerformed: Data elements that meet criteria using this datatype should document the laboratory test indicated by the QDM category and its corresponding value set was performed. Timing: The Relevant Period addresses: startTime – When the laboratory test is initiated (i.e., the time the specimen collection begins). stopTime – when the laboratory test is completed (i.e., the time the specimen collection ends). Examples: 1) Initiation of a venipuncture for a fasting blood glucose to the time venipuncture for the fasting blood glucose is completed – basically a single point in time for many specimen collections. 2) Initiation of a 24-hour urine collection for measured creatinine clearance until completion of the 24-hour urine collection Note – the time that the result report is available is a separate attribute than the time of the study (specimen collection)

DataType

Cardinality

InrPerformed

0..*

LowDoseUnfractionatedHeparinForVteProphylaxisAdministered

Clinical Focus: This set of values contains unfractionated heparin medications with strengths that could reasonably be used for VTE prophylaxis.

Data Element Scope: The intent of this data element is to identify patients who are on low-dose unfractionated heparin as VTE prophylaxis. Using the Quality Data Model, this data element maps to the Medication category.

Inclusion Criteria: Injectable products that could reasonably be used to achieve a dose of at least 5000 units when administered subcutaneously.

Exclusion Criteria: Concentrations less than 250 UNT/ML.

Subject constrained to the Low Dose Unfractionated Heparin for VTE Prophylaxis

MedicationAdministered: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient. Timing: The Relevant Period addresses: startTime = when a single medication administration event starts (e.g., the initiation of an intravenous infusion, or administering a pill or IM injection to a patient); stopTime = when a single medication administration event ends (e.g., the end time of the intravenous infusion, or the administration of a pill or IM injection is completed - for pills and IM injections, the start and stop times are the same) NOTE – Measure developers should address multiple administrations over a period of time using CQL logic. Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

LowDoseUnfractionatedHeparinForVteProphylaxisAdministered

0..*

LowDoseUnfractionatedHeparinForVteProphylaxisOrder

Clinical Focus: This set of values contains unfractionated heparin medications with strengths that could reasonably be used for VTE prophylaxis.

Data Element Scope: The intent of this data element is to identify patients who are on low-dose unfractionated heparin as VTE prophylaxis. Using the Quality Data Model, this data element maps to the Medication category.

Inclusion Criteria: Injectable products that could reasonably be used to achieve a dose of at least 5000 units when administered subcutaneously.

Exclusion Criteria: Concentrations less than 250 UNT/ML.

Subject constrained to the Low Dose Unfractionated Heparin for VTE Prophylaxis

MedicationOrder: Data elements that meet criteria using this datatype should document a request to a pharmacy to provide the medication indicated by the QDM category and its corresponding value set. Timing: The Author dateTime is the time the order is signed. Timing: The Relevant Period addresses: startTime = when the first administration of the medication is expected. The first administration may be expected at the time of the order or at a specified future date (i.e., the active time for the order); such information should be identified in the medication order. If the startTime is not specified in the order, the startTime defaults to the Author dateTime (the time the order is signed). stopTime = when the medication supply provided by the medication order is expected to be completed, including all fulfillments covered by the number of refills. Note that when calculating cumulative medication duration, the stopTime may be present directly in the medication order. If the stopTime is not available, the duration in days is the difference between the Relevant Period start and stop times multiplied by (1 + the number of refills). Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

LowDoseUnfractionatedHeparinForVteProphylaxisOrder

0..*

InjectableFactorXaInhibitorForVteProphylaxisAdministered

Clinical Focus: This set of values contains codes which identify a select medication-an injectable Factor Xa inhibitor-which is used for VTE prophylaxis.

Data Element Scope: The intent of this data element is to identify patients who are on a select Injectable Factor Xa Inhibitor as prophylaxis for VTE. Using the Quality Data Model, this data element maps to the Medication category.

Inclusion Criteria: Only include codes which represent injectable Factor Xa inhibitor medications. These are RxNorm codes.

Exclusion Criteria: None.

Subject constrained to the Injectable Factor Xa Inhibitor for VTE Prophylaxis

MedicationAdministered: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient. Timing: The Relevant Period addresses: startTime = when a single medication administration event starts (e.g., the initiation of an intravenous infusion, or administering a pill or IM injection to a patient); stopTime = when a single medication administration event ends (e.g., the end time of the intravenous infusion, or the administration of a pill or IM injection is completed - for pills and IM injections, the start and stop times are the same) NOTE – Measure developers should address multiple administrations over a period of time using CQL logic. Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

InjectableFactorXaInhibitorForVteProphylaxisAdministered

0..*

InjectableFactorXaInhibitorForVteProphylaxisOrder

Clinical Focus: This set of values contains codes which identify a select medication-an injectable Factor Xa inhibitor-which is used for VTE prophylaxis.

Data Element Scope: The intent of this data element is to identify patients who are on a select Injectable Factor Xa Inhibitor as prophylaxis for VTE. Using the Quality Data Model, this data element maps to the Medication category.

Inclusion Criteria: Only include codes which represent injectable Factor Xa inhibitor medications. These are RxNorm codes.

Exclusion Criteria: None.

Subject constrained to the Injectable Factor Xa Inhibitor for VTE Prophylaxis

MedicationOrder: Data elements that meet criteria using this datatype should document a request to a pharmacy to provide the medication indicated by the QDM category and its corresponding value set. Timing: The Author dateTime is the time the order is signed. Timing: The Relevant Period addresses: startTime = when the first administration of the medication is expected. The first administration may be expected at the time of the order or at a specified future date (i.e., the active time for the order); such information should be identified in the medication order. If the startTime is not specified in the order, the startTime defaults to the Author dateTime (the time the order is signed). stopTime = when the medication supply provided by the medication order is expected to be completed, including all fulfillments covered by the number of refills. Note that when calculating cumulative medication duration, the stopTime may be present directly in the medication order. If the stopTime is not available, the duration in days is the difference between the Relevant Period start and stop times multiplied by (1 + the number of refills). Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

InjectableFactorXaInhibitorForVteProphylaxisOrder

0..*

LowMolecularWeightHeparinForVteProphylaxisAdministered

Clinical Focus: This set of values represents medications used for VTE prophylaxis. The medications are low molecular weight heparins. The medications included in this value set are administered parenterally.

Data Element Scope: The intent of this data element is to identify patients who are on low molecular weight heparin therapy as VTE prophylaxis. Using the Quality Data Model, this data element maps to the Medication category.

Inclusion Criteria: Only include RxNorm codes which specifically represent low molecular weight heparins which are administered parenterally.

Exclusion Criteria: None.

Subject constrained to the Low Molecular Weight Heparin for VTE Prophylaxis

MedicationAdministered: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient. Timing: The Relevant Period addresses: startTime = when a single medication administration event starts (e.g., the initiation of an intravenous infusion, or administering a pill or IM injection to a patient); stopTime = when a single medication administration event ends (e.g., the end time of the intravenous infusion, or the administration of a pill or IM injection is completed - for pills and IM injections, the start and stop times are the same) NOTE – Measure developers should address multiple administrations over a period of time using CQL logic. Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

LowMolecularWeightHeparinForVteProphylaxisAdministered

0..*

LowMolecularWeightHeparinForVteProphylaxisOrder

Clinical Focus: This set of values represents medications used for VTE prophylaxis. The medications are low molecular weight heparins. The medications included in this value set are administered parenterally.

Data Element Scope: The intent of this data element is to identify patients who are on low molecular weight heparin therapy as VTE prophylaxis. Using the Quality Data Model, this data element maps to the Medication category.

Inclusion Criteria: Only include RxNorm codes which specifically represent low molecular weight heparins which are administered parenterally.

Exclusion Criteria: None.

Subject constrained to the Low Molecular Weight Heparin for VTE Prophylaxis

MedicationOrder: Data elements that meet criteria using this datatype should document a request to a pharmacy to provide the medication indicated by the QDM category and its corresponding value set. Timing: The Author dateTime is the time the order is signed. Timing: The Relevant Period addresses: startTime = when the first administration of the medication is expected. The first administration may be expected at the time of the order or at a specified future date (i.e., the active time for the order); such information should be identified in the medication order. If the startTime is not specified in the order, the startTime defaults to the Author dateTime (the time the order is signed). stopTime = when the medication supply provided by the medication order is expected to be completed, including all fulfillments covered by the number of refills. Note that when calculating cumulative medication duration, the stopTime may be present directly in the medication order. If the stopTime is not available, the duration in days is the difference between the Relevant Period start and stop times multiplied by (1 + the number of refills). Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

LowMolecularWeightHeparinForVteProphylaxisOrder

0..*

WarfarinAdministered

Clinical Focus: This set of values contains Warfarin medications that are administered to patients to reduce the risk of blood clot formation.

Data Element Scope: The intent of this data element is to identify patients who are prescribed warfarin therapy at discharge following acute myocardial infarction. Using the Quality Data Model, this particular element would map to the Medication category.

Inclusion Criteria: Drug forms that are consistent with oral administration should be included: tablets. Only single ingredient.

Exclusion Criteria: None.

Subject constrained to the Warfarin

MedicationAdministered: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient. Timing: The Relevant Period addresses: startTime = when a single medication administration event starts (e.g., the initiation of an intravenous infusion, or administering a pill or IM injection to a patient); stopTime = when a single medication administration event ends (e.g., the end time of the intravenous infusion, or the administration of a pill or IM injection is completed - for pills and IM injections, the start and stop times are the same) NOTE – Measure developers should address multiple administrations over a period of time using CQL logic. Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

WarfarinAdministered

0..*

WarfarinOrder

Clinical Focus: This set of values contains Warfarin medications that are administered to patients to reduce the risk of blood clot formation.

Data Element Scope: The intent of this data element is to identify patients who are prescribed warfarin therapy at discharge following acute myocardial infarction. Using the Quality Data Model, this particular element would map to the Medication category.

Inclusion Criteria: Drug forms that are consistent with oral administration should be included: tablets. Only single ingredient.

Exclusion Criteria: None.

Subject constrained to the Warfarin

MedicationOrder: Data elements that meet criteria using this datatype should document a request to a pharmacy to provide the medication indicated by the QDM category and its corresponding value set. Timing: The Author dateTime is the time the order is signed. Timing: The Relevant Period addresses: startTime = when the first administration of the medication is expected. The first administration may be expected at the time of the order or at a specified future date (i.e., the active time for the order); such information should be identified in the medication order. If the startTime is not specified in the order, the startTime defaults to the Author dateTime (the time the order is signed). stopTime = when the medication supply provided by the medication order is expected to be completed, including all fulfillments covered by the number of refills. Note that when calculating cumulative medication duration, the stopTime may be present directly in the medication order. If the stopTime is not available, the duration in days is the difference between the Relevant Period start and stop times multiplied by (1 + the number of refills). Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

WarfarinOrder

0..*

GlycoproteinIIbIiIaInhibitorsAdministered

Clinical Focus: This set of values contains codes which identify a select medication-a Glycoprotein Iib/IIIa inhibitor.

Data Element Scope: The intent of this data element is to identify patients who are on a Glycoprotein Iib/IIIa inhibitor. Using the Quality Data Model, this data element maps to the Medication category.

Inclusion Criteria: Only include codes which represent a Glycoprotein Iib/IIIa inhibitor. These are RxNorm codes.

Exclusion Criteria: None

Subject constrained to the Glycoprotein IIb/IIIa Inhibitors

MedicationAdministered: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient. Timing: The Relevant Period addresses: startTime = when a single medication administration event starts (e.g., the initiation of an intravenous infusion, or administering a pill or IM injection to a patient); stopTime = when a single medication administration event ends (e.g., the end time of the intravenous infusion, or the administration of a pill or IM injection is completed - for pills and IM injections, the start and stop times are the same) NOTE – Measure developers should address multiple administrations over a period of time using CQL logic. Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

GlycoproteinIIbIiIaInhibitorsAdministered

0..*

DirectThrombinInhibitorAdministered

Clinical Focus: This set of values contains codes which identify a select medication-a direct thrombin inhibitor.

Data Element Scope: The intent of this data element is to identify patients who are on a direct thrombin inhibitor. Using the Quality Data Model, this data element maps to the Medication category.

Inclusion Criteria: Only include codes which represent direct thrombin inhibitors. These are RxNorm codes.

Exclusion Criteria: None

Subject constrained to the Direct Thrombin Inhibitor

MedicationAdministered: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient. Timing: The Relevant Period addresses: startTime = when a single medication administration event starts (e.g., the initiation of an intravenous infusion, or administering a pill or IM injection to a patient); stopTime = when a single medication administration event ends (e.g., the end time of the intravenous infusion, or the administration of a pill or IM injection is completed - for pills and IM injections, the start and stop times are the same) NOTE – Measure developers should address multiple administrations over a period of time using CQL logic. Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

DirectThrombinInhibitorAdministered

0..*

UnfractionatedHeparinAdministered

Clinical Focus: This value set identifies heparin formulations that could reasonably be used to treat venous thromboembolism as a continuous infusion.

Data Element Scope: The intent of this data element is to identify patients who receive unfractionated heparin as an intravenous infusion. Using the Quality Data Model, this particular element will map to the Medication category.

Inclusion Criteria: Injectable products that could reasonably be used for continuous infusion of heparin and achieve therapeutic levels.

Exclusion Criteria: Concentrations < 250 UNT/ML (except those representing premixed heparin infusion bags, per inclusion criteria

Subject constrained to the Unfractionated Heparin

MedicationAdministered: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient. Timing: The Relevant Period addresses: startTime = when a single medication administration event starts (e.g., the initiation of an intravenous infusion, or administering a pill or IM injection to a patient); stopTime = when a single medication administration event ends (e.g., the end time of the intravenous infusion, or the administration of a pill or IM injection is completed - for pills and IM injections, the start and stop times are the same) NOTE – Measure developers should address multiple administrations over a period of time using CQL logic. Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

UnfractionatedHeparinAdministered

0..*

OralFactorXaInhibitorForVteProphylaxisOrVteTreatmentAdministered

Clinical Focus: This set of values identifies oral Factor Xa inhibitors indicated for VTE prophylaxis and treatment.

Data Element Scope: The intent of this data element is to identify patients who receive oral factor Xa inhibitors for VTE prophylaxis. Using the Quality Data Model, this particular element will map to the Medication category.

Inclusion Criteria: Oral forms of factor Xa inhibitors.

Exclusion Criteria: Other dose forms of factor Xa inhibitors.

Subject constrained to the Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment

MedicationAdministered: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient. Timing: The Relevant Period addresses: startTime = when a single medication administration event starts (e.g., the initiation of an intravenous infusion, or administering a pill or IM injection to a patient); stopTime = when a single medication administration event ends (e.g., the end time of the intravenous infusion, or the administration of a pill or IM injection is completed - for pills and IM injections, the start and stop times are the same) NOTE – Measure developers should address multiple administrations over a period of time using CQL logic. Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

OralFactorXaInhibitorForVteProphylaxisOrVteTreatmentAdministered

0..*

IntravenousRouteRoute

Clinical Focus: This set of values identifies the route by which a medication is administered, in this case an intravenous route.

Data Element Scope: The intent of this data element is to identify the route by which a medication is administered, in this case an intravenous route. Using the Quality Data Model, this particular element is an attribute.

Inclusion Criteria: Only use codes which identify an intravenous route for giving a medication. Codes used are to be SNOMED-CT codes only.

Exclusion Criteria: None

Route: Refers to the path by which the medication or substance should be taken into the body systems, such as intradermally, intrathecally, intramuscularly, intranasally, intravenously, orally, rectally, subcutaneously, sublingually, topically, or vaginally.

DataType

Cardinality

IntravenousRouteRoute

0..*

SubcutaneousRouteRoute

Clinical Focus: This set of values identifies the route by which a medication is administered, in this case a subcutaneous route.

Data Element Scope: The intent of this data element is to identify the route by which a medication is administered, in this case a subcutaneous route. Using the Quality Data Model, this particular element is an attribute.

Inclusion Criteria: Only use codes which identify a subcutaneous route for giving a medication. These are SNOMED-CT codes.

Exclusion Criteria: None

Route: Refers to the path by which the medication or substance should be taken into the body systems, such as intradermally, intrathecally, intramuscularly, intranasally, intravenously, orally, rectally, subcutaneously, sublingually, topically, or vaginally.

DataType

Cardinality

SubcutaneousRouteRoute

0..*

EthnicityPatientCharacteristicEthnicity

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

ResultValue constrained to codes in the Ethnicity valueset (2.16.840.1.114222.4.11.837)

PatientCharacteristicEthnicity: Data elements that meet criteria using this datatype should document that the patient has one or more of the ethnicities indicated by the QDM category and its corresponding value set. Timing: Ethnicity does not have a specific timing. Measures using Patient Characteristic, Ethnicity should address the most recent entry in the clinical record.

DataType

Cardinality

EthnicityPatientCharacteristicEthnicity

0..*

OncAdministrativeSexPatientCharacteristicGender

Clinical Focus: Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.

Data Element Scope: Gender

Inclusion Criteria: Male and Female only.

Exclusion Criteria: Any gender identity that is not male or female.

ResultValue constrained to codes in the ONC Administrative Sex valueset (2.16.840.1.113762.1.4.1)

PatientCharacteristicGender: Data elements that meet criteria using this datatype should document that the patient's sex matches the QDM category and its corresponding value set. Timing: Birth (administrative) sex does not have a specific timing.

DataType

Cardinality

OncAdministrativeSexPatientCharacteristicGender

0..*

PayerPatientCharacteristicPayer

Clinical Focus: Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system

Data Element Scope: @code in CCDA r2.1 template Planned Coverage [act: identifier urn:oid:2.16.840.1.113883.10.20.22.4.129 (open)] DYNAMIC

Inclusion Criteria: All codes in the code system

Exclusion Criteria: none

ResultValue constrained to codes in the Payer valueset (2.16.840.1.114222.4.11.3591)

PatientCharacteristicPayer: Data elements that meet criteria using this datatype should document that the patient has one or more of the payers indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: startTime – The first day of insurance coverage with the referenced payer stopTime – The last day of insurance coverage with the referenced payer

DataType

Cardinality

PayerPatientCharacteristicPayer

0..*

RacePatientCharacteristicRace

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

ResultValue constrained to codes in the Race valueset (2.16.840.1.114222.4.11.836)

PatientCharacteristicRace: Data elements that meet criteria using this datatype should document the patient’s race. Timing: Race does not have a specific timing. Measures using Patient Characteristic, Race should address the most recent entry in the clinical record.

DataType

Cardinality

RacePatientCharacteristicRace

0..*

GeneralSurgeryPerformed

Clinical Focus: This grouping of value sets contains value sets which identify patients who have a general surgery procedure. These surgical procedures are thoracic and abdominal procedures, except for cardiac procedures.

Data Element Scope: The intent of this data element is to identify patients who have general surgery procedures. Using the Quality Data Model, this data element maps to the Procedure category.

Inclusion Criteria: Only include codes which represent general surgery. These surgical procedures are thoracic and abdominal procedures, except for cardiac procedures.

Exclusion Criteria: None.

Subject constrained to the General Surgery

ProcedurePerformed: Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

GeneralSurgeryPerformed

0..*

PrincipalOrdinality

Clinical Focus: This set of values contains the qualifier value used to identify the term principal.

Data Element Scope: The intent of this data element is to identify and define the qualifier value principal. Using the Quality Data Model, this particular element would map to the ordinality attribute.

Inclusion Criteria: Include SNOMEDCT codes that define the principal qualifier value.

Exclusion Criteria: Exclude codes that do not meet the inclusion criteria.

Ordinality: The scale in which different procedures are ordered in terms of the qualitative value, as opposed to a ranking performed strictly numerically or quantitatively.

DataType

Cardinality

PrincipalOrdinality

0..*

GynecologicalSurgeryPerformed

Clinical Focus: This grouping of value sets identifies patients who have procedures of gynecologic surgery.

Data Element Scope: The intent of this data element is to identify patients who have a gynecologic surgery procedure. Using the Quality Data Model, this particular element will map to the Procedure category.

Inclusion Criteria: Only use codes which represent gynecologic surgery procedures.

Exclusion Criteria: None.

Subject constrained to the Gynecological Surgery

ProcedurePerformed: Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

GynecologicalSurgeryPerformed

0..*

HipFractureSurgeryPerformed

Clinical Focus: This grouping of value sets identifies patients who have procedures of hip fracture surgery.

Data Element Scope: The intent of this data element is to identify patients who have a hip fracture surgery procedure. Using the Quality Data Model, this particular element will map to the Procedure category.

Inclusion Criteria: Only use codes which represent hip fracture surgery.

Exclusion Criteria: None.

Subject constrained to the Hip Fracture Surgery

ProcedurePerformed: Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

HipFractureSurgeryPerformed

0..*

HipReplacementSurgeryPerformed

Clinical Focus: This grouping of value sets identifies patients who have total hip replacement procedures.

Data Element Scope: The intent of this data element is to identify patients who have a total hip replacement procedure. Using the Quality Data Model, this particular element will map to the Procedure category.

Inclusion Criteria: Only use codes which represent the surgical procedure of a total hip replacement.

Exclusion Criteria: None.

Subject constrained to the Hip Replacement Surgery

ProcedurePerformed: Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

HipReplacementSurgeryPerformed

0..*

IntracranialNeurosurgeryPerformed

Clinical Focus: This grouping of value sets identifies patients who have procedures of intracranial neurosurgery.

Data Element Scope: The intent of this data element is to identify patients who have an intracranial neurosurgery procedure. Using the Quality Data Model, this particular element will map to the Procedure category.

Inclusion Criteria: Only use codes which represent intracranial neurosurgery.

Exclusion Criteria: None.

Subject constrained to the Intracranial Neurosurgery

ProcedurePerformed: Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

IntracranialNeurosurgeryPerformed

0..*

KneeReplacementSurgeryPerformed

Clinical Focus: This grouping of value sets identifies patients who have total knee replacement procedures.

Data Element Scope: The intent of this data element is to identify patients who have a total knee replacement procedure. Using the Quality Data Model, this particular element will map to the Procedure category.

Inclusion Criteria: Only use codes which represent the surgical procedure of a total knee replacement.

Exclusion Criteria: None.

Subject constrained to the Knee Replacement Surgery

ProcedurePerformed: Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

KneeReplacementSurgeryPerformed

0..*

UrologicalSurgeryPerformed

Clinical Focus: This grouping of value sets identifies patients who have urologic surgery procedures.

Data Element Scope: The intent of this data element is to identify patients who have a urologic surgery procedure. Using the Quality Data Model, this particular element will map to the Procedure category.

Inclusion Criteria: Only use codes which represent urologic surgery procedures.

Exclusion Criteria: None.

Subject constrained to the Urological Surgery

ProcedurePerformed: Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

UrologicalSurgeryPerformed

0..*

GeneralOrNeuraxialAnesthesiaPerformed

Clinical Focus: This group of value sets identifies patients who have a surgical procedure where a general and/or neuraxial anesthesia is used.

Data Element Scope: The intent of this data element is to identify patients who have a surgical procedure where general and/or neuraxial anesthesia is used. Using the Quality Data Model, this particular element will map to the Procedure category.

Inclusion Criteria: Only use codes which represent general and/or neuraxial anesthesia. Codes used are to be ICD10PCS, ICD9 or SNOMED-CT codes only.

Exclusion Criteria: None.

Subject constrained to the General or Neuraxial Anesthesia

ProcedurePerformed: Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

GeneralOrNeuraxialAnesthesiaPerformed

0..*