ecqm.measure

CMS158v7 - Pregnant women that had HBsAg testing

Rationale:

Pregnant women that had HBsAg testing. The U.S. Preventive Services Task Force (USPSTF) found good evidence that universal prenatal screening for hepatitis B virus (HBV) infection using hepatitis B surface antigen (HBsAg) substantially reduces prenatal transmission of HBV and the subsequent development of chronic HBV infection (USPSTF 2009). The current practice of vaccinating all infants against HBV infection and post-exposure prophylaxis with hepatitis B immune globulin administered at birth to infants of HBV-infected mothers substantially reduces the risk for acquiring HBV infection.

Data Elements

HepatitisB1Diagnosis

Clinical Focus: This set of values contain codes commonly used to identify patients with acute or chronic Hepatitis B infection.

Data Element Scope: The intent of this data element is identify patients with acute or chronic Hepatitis B infection. Using the Quality Data Model, this particular element would map to the 'Diagnosis, Active'.

Inclusion Criteria: The codes used in this value set can be reasonably used to identify patients with acute or chronic Hepatitis B infection.

Exclusion Criteria: Patients with evidence of current or past acute or chronic Hepatitis B infection.

ResultValue constrained to codes in the Hepatitis B1 valueset (2.16.840.1.113883.3.67.1.101.1.269)

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

HepatitisB1Diagnosis

0..*

DeliveryDiagnosisDiagnosis

Clinical Focus: This set of values contain codes commonly used in the outpatient setting to identify patients who had a live birth or delivery.

Data Element Scope: The intent of this data element is identify patients who had a live birth or delivery. Using the Quality Data Model, this particular element would map to the 'Procedure, Performed' element.

Inclusion Criteria: The codes used in this value set can be reasonably used to identify patients who had a live birth or delivery.

Exclusion Criteria: None

ResultValue constrained to codes in the Delivery - Diagnosis valueset (2.16.840.1.113883.3.67.1.101.1.278)

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

DeliveryDiagnosisDiagnosis

0..*

HBsAgPerformed

Clinical Focus: Under development

Data Element Scope: Under development

Inclusion Criteria: Under development

Exclusion Criteria: Under development

Subject constrained to the HBsAg

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

HBsAgPerformed

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..*

FemalePatientCharacteristicGender

Clinical Focus: Concepts that represent Female when assessing quality measures

Data Element Scope: Gender

Inclusion Criteria: Appropriate female gender concepts

Exclusion Criteria: Concepts representing Male gender

ResultValue constrained to codes in the Female valueset (2.16.840.1.113883.3.560.100.2)

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

FemalePatientCharacteristicGender

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..*

DeliveryProcedurePerformed

Clinical Focus: This set of values contain codes commonly used in the outpatient setting to identify patients who had a live birth or delivery.

Data Element Scope: The intent of this data element is identify patients who had a live birth or delivery. Using the Quality Data Model, this particular element would map to the 'Procedure, Performed' element.

Inclusion Criteria: The codes used in this value set can be reasonably used to identify patients who had a live birth or delivery.

Exclusion Criteria: None

Subject constrained to the Delivery - Procedure

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

DeliveryProcedurePerformed

0..*