ecqm.measure

CMS347v2 - Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

Rationale:

Statin Therapy for the Prevention and Treatment of Cardiovascular Disease. 'Cardiovascular disease (CVD) is the leading cause of death in the United States, causing approximately 1 of every 7 deaths in the United States in 2011. In 2011, stroke caused approximately 1 of every 20 deaths in the United States and the estimated annual costs for CVD and stroke were $320.1 billion, including $195.6 billion in direct costs (hospital services, physicians and other professionals, prescribed medications, home health care, and other medical durables) and $124.5 billion in indirect costs from lost future productivity (cardiovascular and stroke premature deaths). CVD costs more than any other diagnostic group' (Mozaffarian et al., 2015). Data collected between 2009 and 2012 indicates that more than 100 million U.S. adults, 20 years or older, had total cholesterol levels equal to 200 mg/dL or more, while almost 31 million had levels 240 mg/dL or more (Mozaffarian et al., 2015). Elevated blood cholesterol is a major risk factor for CVD and statin therapy has been associated with a reduced risk of CVD. Numerous randomized trials have demonstrated that treatment with a statin reduces LDL-C, and reduces the risk of major cardiovascular events by approximately 20 percent (Ference, 2015). In 2013, guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults were published (see Stone et al., 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: a Report of the American College of Cardiology [ACC]/American Heart Association [AHA] Task Force on Practice Guidelines). This guideline was published by an Expert Panel, which synthesized evidence from randomized controlled trials to identify people most likely to benefit from cholesterol-lowering therapy. The ACC/AHA Guideline recommendations are intended to provide a strong evidence-based foundation for the treatment of blood cholesterol for the primary and secondary prevention and treatment of Atherosclerotic Cardiovascular Disease (ASCVD) in adult men and women (21 years of age or older). The document concludes the addition of statin therapy reduces the risk of ASCVD among high-risk individuals, defined as follows: individuals with clinical ASCVD, with LDL-C >= 190 mg/dL, or with diabetes and LDL-C 70-189 mg/dL (Stone et al., 2013). However, one study that surveyed U.S. cardiovascular practices participating in the PINNACLE registry, found that 32.4 percent of patients with an indication for statins under the 2013 ACC/AHA cholesterol guidelines were not currently receiving them (Maddox et al., 2014). Although, systematic evidence review found that statins are safe drugs with low incidence of conditions or diseases attributable to statin use (Law et al., 2006). Overall, the Statin Safety Expert Panel that participated in an NLA Statin Safety Task Force meeting in October 2013 reaffirms the general safety of statin therapy. The panel members concluded that for most patients requiring statin therapy, the potential benefits of statin therapy outweigh the potential risks. In general terms, the benefits of statins to prevent non-fatal myocardial infarction, revascularization, stroke, and CVD mortality, far outweighs any potential harm related to the drug (Jacobson, 2014).

Data Elements

StatinAllergenAdverseEvent

Clinical Focus: Identifies patients with an allergy to statin medications.

Data Element Scope: Statin Allergens as structured in RXNORM

Inclusion Criteria: Only includes codes that use the IN term type for statins.

Exclusion Criteria: Does not include non-statin medications.

ResultValue constrained to codes in the Statin Allergen valueset (2.16.840.1.113883.3.117.1.7.1.423)

AdverseEvent: Adverse Event is used to define any untoward medical occurrence associated with the clinical care delivery, whether or not considered drug related.

DataType

Cardinality

StatinAllergenAdverseEvent

0..*

StatinAllergenAllergyIntolerance

Clinical Focus: Identifies patients with an allergy to statin medications.

Data Element Scope: Statin Allergens as structured in RXNORM

Inclusion Criteria: Only includes codes that use the IN term type for statins.

Exclusion Criteria: Does not include non-statin medications.

ResultValue constrained to codes in the Statin Allergen valueset (2.16.840.1.113883.3.117.1.7.1.423)

AllergyIntolerance: Allergy is used to address immune-mediated reactions to a substance such as type 1 hypersensitivity reactions, other allergy-like reactions, including pseudo-allergy. Intolerance is a record of a clinical assessment of a propensity, or a potential risk to an individual, to have a non-immune mediated adverse reaction on future exposure to the specified substance, or class of substance.

DataType

Cardinality

StatinAllergenAllergyIntolerance

0..*

HypercholesterolemiaDiagnosis

Clinical Focus: This value set is designed to capture that the patient has a diagnosis, past or present, of hypercholesterolemia.

Data Element Scope: Appropriate for use with data elements in QDM Categories or Attributes represented by diagnosis codes.

Inclusion Criteria: Included are diagnoses of hypercholesterolemia.

Exclusion Criteria: Other diagnoses not related or used to identify patients with hypercholesterolemia are excluded.

ResultValue constrained to codes in the Hypercholesterolemia valueset (2.16.840.1.113762.1.4.1047.100)

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

HypercholesterolemiaDiagnosis

0..*

RhabdomyolysisDiagnosis

Clinical Focus: The set of values is intended to capture the diagnosis or condition of Rhabdomyolysis.

Data Element Scope: Appropriate for use with data elements in QDM Categories or Attributes represented by diagnosis codes.

Inclusion Criteria: Only the diagnosis of Rhabdomyolysis is included.

Exclusion Criteria: Excludes any other diagnoses not related to Rhabdomyolysis.

ResultValue constrained to codes in the Rhabdomyolysis valueset (2.16.840.1.113762.1.4.1047.102)

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

RhabdomyolysisDiagnosis

0..*

AtherosclerosisAndPeripheralArterialDiseaseDiagnosis

Clinical Focus: This set of values is intended to capture that a patient has a diagnosis, condition, or disorder of Atherosclerosis or Peripheral Arterial Disease (PAD).

Data Element Scope: Appropriate for use with data elements in QDM Categories or Attributes represented by diagnosis codes.

Inclusion Criteria: Conditions that indicate arterial blood flow is restricted putting patients at higher risk for heart disease are included.

Exclusion Criteria: Other vascular conditions that are not diagnosed as part of Atherosclerosis and Peripheral Artery Disease are excluded.

ResultValue constrained to codes in the Atherosclerosis and Peripheral Arterial Disease valueset (2.16.840.1.113762.1.4.1047.21)

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

AtherosclerosisAndPeripheralArterialDiseaseDiagnosis

0..*

LiverDiseaseDiagnosis

Clinical Focus: The focus of this value set is to capture a diagnosis of liver disease. The original intent of this value set is to capture liver disease that would indicate that a statin medication may not be appropriate.

Data Element Scope: Appropriate for use with data elements in QDM Categories or Attributes represented by diagnosis codes.

Inclusion Criteria: This value set includes chronic and acute liver conditions that may represent the liver is failing. Examples of conditions include, but are not limited to the following: alcoholic liver damage, cirrhosis, hepatitis C and E, and liver necrosis.

Exclusion Criteria: This value set does not contain Hepatitis A and Hepatitis B.

ResultValue constrained to codes in the Liver Disease valueset (2.16.840.1.113762.1.4.1047.42)

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

LiverDiseaseDiagnosis

0..*

CerebrovascularDiseaseStrokeTiaDiagnosis

Clinical Focus: This value set includes stroke and high risk diagnoses associated with stroke, including TIA and generalized ischemic cerebrovascular disease, which would indicate a patient has Atherosclerotic Cardiovascular Disease (ASCVD) in relation to a cerebrovascular event.

Data Element Scope: Appropriate for use with data elements in QDM Categories or Attributes represented by diagnosis codes.

Inclusion Criteria: Includes ASCVD diagnoses of cerebrovascular origin.

Exclusion Criteria: Excludes any other ASCVD diagnoses not related to cerebrovascular disease, stroke, or TIA.

ResultValue constrained to codes in the Cerebrovascular disease, Stroke, TIA valueset (2.16.840.1.113762.1.4.1047.44)

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

CerebrovascularDiseaseStrokeTiaDiagnosis

0..*

IschemicHeartDiseaseOrCoronaryOcclusionRuptureOrThrombosisDiagnosis

Clinical Focus: The intent of this set of values is to capture ischemic heart disease and associated diagnoses as related to Atherosclerotic Cardiovascular Disease (ASCVD).

Data Element Scope: Appropriate for use with data elements in QDM Categories or Attributes represented by diagnosis codes.

Inclusion Criteria: Included are acute and chronic forms of ischemic heart disease as well as coronary occlusion, thrombosis, or rupture that can be related to ASCVD.

Exclusion Criteria: Excluded are acute coronary occlusion related directly to myocardial infarction and myocardial ischemia.

ResultValue constrained to codes in the Ischemic heart disease or coronary occlusion, rupture, or thrombosis valueset (2.16.840.1.113762.1.4.1047.46)

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

IschemicHeartDiseaseOrCoronaryOcclusionRuptureOrThrombosisDiagnosis

0..*

StableAndUnstableAnginaDiagnosis

Clinical Focus: The intent of this set of values is to capture the diagnosis of angina.

Data Element Scope: Appropriate for use with data elements in QDM Categories or Attributes represented by diagnosis codes.

Inclusion Criteria: Included are stable and unstable angina, pre and post infarction angina, angina decubitus, intermediate coronary syndrome, other unspecified angina or sequelae of myocardial infarction, and other forms of angina pectoris.

Exclusion Criteria: Excluded is any form of angina that does not define Atherosclerotic Cardiovascular Disease (ASCVD

ResultValue constrained to codes in the Stable and Unstable Angina valueset (2.16.840.1.113762.1.4.1047.47)

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

StableAndUnstableAnginaDiagnosis

0..*

BreastfeedingDiagnosis

Clinical Focus: The intent of this value set is to capture that a patient is planning to or actively breastfeeding.

Data Element Scope: Appropriate for use with data elements in QDM Categories or Attributes represented by diagnosis codes.

Inclusion Criteria: Included are codes to indicate lactation and the actual finding or intention of breastfeeding or nursing.

Exclusion Criteria: Excluded are codes that would not indicate the possibility of breastfeeding.

ResultValue constrained to codes in the Breastfeeding valueset (2.16.840.1.113762.1.4.1047.73)

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

BreastfeedingDiagnosis

0..*

DiabetesDiagnosis

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

ResultValue constrained to codes in the Diabetes valueset (2.16.840.1.113883.3.464.1003.103.12.1001)

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

DiabetesDiagnosis

0..*

HepatitisADiagnosis

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

ResultValue constrained to codes in the Hepatitis A valueset (2.16.840.1.113883.3.464.1003.110.12.1024)

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

HepatitisADiagnosis

0..*

EndStageRenalDiseaseDiagnosis

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

ResultValue constrained to codes in the End Stage Renal Disease valueset (2.16.840.1.113883.3.526.3.353)

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

EndStageRenalDiseaseDiagnosis

0..*

MyocardialInfarctionDiagnosis

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

ResultValue constrained to codes in the Myocardial Infarction valueset (2.16.840.1.113883.3.526.3.403)

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

MyocardialInfarctionDiagnosis

0..*

PregnancyDxDiagnosis

Clinical Focus: The purpose of this value set it to incorporate all possible pregnancy findings that would indicate a positive pregnancy test.

Data Element Scope: Appropriate for use with data elements in QDM Categories or Attributes represented by diagnosis codes.

Inclusion Criteria: This set of values includes abdominal and normal pregnancy as well as abortion, tubal, ectopic pregnancy and various other diagnoses that could indicate a patient is pregnant.

Exclusion Criteria: Previously conceived and past delivered pregnancies are not included.

ResultValue constrained to codes in the Pregnancy Dx valueset (2.16.840.1.113883.3.600.1.1623)

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

PregnancyDxDiagnosis

0..*

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..*

OutpatientEncountersForPreventiveCarePerformed

Clinical Focus: The intent of this value set is to capture outpatient encounters.

Data Element Scope: Appropriate for use with data elements in QDM Categories or Attributes represented by encounter codes.

Inclusion Criteria: Included are evaluation and management of a new or established patient through an encounter for annual visit, preventative evaluation, follow-up, or periodic re-evaluations that would occur in the outpatient setting.

Exclusion Criteria: Any encounters that do not meet the inclusion criteria are excluded.

Subject constrained to the Outpatient Encounters for Preventive Care

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

OutpatientEncountersForPreventiveCarePerformed

0..*

OfficeVisitPerformed

Clinical Focus: This value set indentifies patients who have had an office or other outpatient visit.

Data Element Scope: This value set was intended to map to the QDM data type of encounter.

Inclusion Criteria: Includes comprehensive history, evaluation, and management of a patient in an office or outpatient facility. Patient can be presenting with problems that are minor to high severity.

Exclusion Criteria: Excludes non-office visits, including telehealth services.

Subject constrained to the Office 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

OfficeVisitPerformed

0..*

OutpatientConsultation1Performed

Clinical Focus: This value set indentifies patients who have had an outpatient interaction at an office with a member of their medical care team.

Data Element Scope: This value set was intended to map to the QDM data type of encounter.

Inclusion Criteria: Includes comprehensive history, evaluation, and management of a patient in an office or outpatient facility. Patient can be presenting with problems that are minor to high severity.

Exclusion Criteria: Excludes non-office visits, including telehealth services.

Subject constrained to the Outpatient Consultation1

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

OutpatientConsultation1Performed

0..*

PreventiveCareServicesInitialOfficeVisit18AndUpPerformed

Clinical Focus: This value set indentifies patients over the age of 18 who have had an initial preventive care office visit.

Data Element Scope: This value set was intended to map to the QDM data type of encounter.

Inclusion Criteria: Includes comprehensive preventive medicine reevaluation and management of an individual over the age of 18.

Exclusion Criteria: Excludes non-office visits, including telehealth services.

Subject constrained to the Preventive Care Services-Initial Office Visit, 18 and Up

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

PreventiveCareServicesInitialOfficeVisit18AndUpPerformed

0..*

PreventiveCareServicesEstablishedOfficeVisit18AndUpPerformed

Clinical Focus: This value set indentifies patients over the age of 18 who have had an established preventive care office visit.

Data Element Scope: This value set was intended to map to the QDM data type of encounter.

Inclusion Criteria: Includes comprehensive preventive medicine reevaluation and management of an individual over the age of 18.

Exclusion Criteria: Excludes non-office visits, including telehealth services.

Subject constrained to the Preventive Care Services - Established Office Visit, 18 and Up

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

PreventiveCareServicesEstablishedOfficeVisit18AndUpPerformed

0..*

PreventiveCareServicesIndividualCounselingPerformed

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

Subject constrained to the Preventive Care Services-Individual Counseling

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

PreventiveCareServicesIndividualCounselingPerformed

0..*

PreventiveCareServicesOtherPerformed

Clinical Focus: This value set identifies patients who patients who had an unlisted preventive medicine service. Inclusion: Includes unlisted preventive medicine services

Data Element Scope: This value set was intended to map to the QDM data type of encounter.

Inclusion Criteria: Includes unlisted preventive medicine services.

Exclusion Criteria: Excludes visits that are not performed in-person, including telehealth services.

Subject constrained to the Preventive Care Services - Other

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

PreventiveCareServicesOtherPerformed

0..*

AnnualWellnessVisitPerformed

Clinical Focus: This value set contains concepts related to annual wellness visits.

Data Element Scope: The intent of this data element is to identify patients who have had an annual wellness visit. Using the Quality Data Model, this particular data element would be classified under the 'Encounter' category.

Inclusion Criteria: Includes encounters specific to annual wellness visits.

Exclusion Criteria: None

Subject constrained to the Annual Wellness 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

AnnualWellnessVisitPerformed

0..*

PalliativeCareEncounterPerformed

Clinical Focus: This value set is intended to capture an encounter for palliative care.

Data Element Scope: Appropriate for use with data elements in QDM Categories or Attributes represented by procedure codes.

Inclusion Criteria: Includes palliative care encounter.

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

Subject constrained to the Palliative care encounter

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

PalliativeCareEncounterPerformed

0..*

PalliativeCareOrder

Clinical Focus: This set of values is intended to capture that a patient is ordered, admitted to, or referred to palliative care, comfort measures, or Hospice care.

Data Element Scope: Appropriate for use with data elements in QDM Categories or Attributes represented by procedure codes.

Inclusion Criteria: This includes a referral or admission for palliative care or the health care provider is seeing this patient for palliative care.

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

Subject constrained to the Palliative Care

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

PalliativeCareOrder

0..*

LdlTestPerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the LDL Test

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

LdlTestPerformed

0..*

LowIntensityStatinTherapyActive

Clinical Focus: The intent of this value set is to incorporate low intensity statin medications as defined by the 2013 ACC/AHA guideline.

Data Element Scope: Appropriate for use with data elements in QDM Categories or Attributes represented by medication codes.

Inclusion Criteria: Low intensity statin therapy is included in this set of values.

Exclusion Criteria: Any other intensity of statin therapy is excluded.

Subject constrained to the Low intensity statin therapy

MedicationActive: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set is being taken by the patient. Keep in mind that when this datatype is used with timing relationships, the criterion is looking for a medication being taken for the time frame indicated by the timing relationships. Timing: The Relevant Period addresses: StartTime = when the medication is first known to be used (generally the time of entry on the medication list); StopTime = when the medication is discontinued (generally, the time discontinuation is recorded on the medication list)

DataType

Cardinality

LowIntensityStatinTherapyActive

0..*

LowIntensityStatinTherapyOrder

Clinical Focus: The intent of this value set is to incorporate low intensity statin medications as defined by the 2013 ACC/AHA guideline.

Data Element Scope: Appropriate for use with data elements in QDM Categories or Attributes represented by medication codes.

Inclusion Criteria: Low intensity statin therapy is included in this set of values.

Exclusion Criteria: Any other intensity of statin therapy is excluded.

Subject constrained to the Low intensity statin therapy

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

LowIntensityStatinTherapyOrder

0..*

HighIntensityStatinTherapyActive

Clinical Focus: The intent of this value set is to incorporate high intensity statin medications as defined by the 2013 ACC/AHA guideline.

Data Element Scope: Appropriate for use with data elements in QDM Categories or Attributes represented by medication codes.

Inclusion Criteria: High intensity statin therapy is included in this set of values.

Exclusion Criteria: Any other intensity of statin therapy is excluded.

Subject constrained to the High intensity statin therapy

MedicationActive: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set is being taken by the patient. Keep in mind that when this datatype is used with timing relationships, the criterion is looking for a medication being taken for the time frame indicated by the timing relationships. Timing: The Relevant Period addresses: StartTime = when the medication is first known to be used (generally the time of entry on the medication list); StopTime = when the medication is discontinued (generally, the time discontinuation is recorded on the medication list)

DataType

Cardinality

HighIntensityStatinTherapyActive

0..*

HighIntensityStatinTherapyOrder

Clinical Focus: The intent of this value set is to incorporate high intensity statin medications as defined by the 2013 ACC/AHA guideline.

Data Element Scope: Appropriate for use with data elements in QDM Categories or Attributes represented by medication codes.

Inclusion Criteria: High intensity statin therapy is included in this set of values.

Exclusion Criteria: Any other intensity of statin therapy is excluded.

Subject constrained to the High intensity statin therapy

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

HighIntensityStatinTherapyOrder

0..*

ModerateIntensityStatinTherapyActive

Clinical Focus: The intent of this value set is to incorporate moderate intensity statin medications as defined by the 2013 ACC/AHA guideline.

Data Element Scope: Appropriate for use with data elements in QDM Categories or Attributes represented by medication codes.

Inclusion Criteria: Moderate intensity statin therapy is included in this set of values.

Exclusion Criteria: Any other intensity of statin therapy is excluded.

Subject constrained to the Moderate intensity statin therapy

MedicationActive: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set is being taken by the patient. Keep in mind that when this datatype is used with timing relationships, the criterion is looking for a medication being taken for the time frame indicated by the timing relationships. Timing: The Relevant Period addresses: StartTime = when the medication is first known to be used (generally the time of entry on the medication list); StopTime = when the medication is discontinued (generally, the time discontinuation is recorded on the medication list)

DataType

Cardinality

ModerateIntensityStatinTherapyActive

0..*

ModerateIntensityStatinTherapyOrder

Clinical Focus: The intent of this value set is to incorporate moderate intensity statin medications as defined by the 2013 ACC/AHA guideline.

Data Element Scope: Appropriate for use with data elements in QDM Categories or Attributes represented by medication codes.

Inclusion Criteria: Moderate intensity statin therapy is included in this set of values.

Exclusion Criteria: Any other intensity of statin therapy is excluded.

Subject constrained to the Moderate intensity statin therapy

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

ModerateIntensityStatinTherapyOrder

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..*

PciPerformed

Clinical Focus: This grouping value set contains procedures used to define percutaneous coronary intervention (PCI).

Data Element Scope: The intent of this data element is to identify patients who had percutaneous coronary intervention (PCI) during an episode of acute myocardial infarction. Using the Quality Data Model, this particular element would map to the Procedure, Performed datatype.

Inclusion Criteria: Include codes that identify patients receiving percutaneous coronary intervention (PCI). This is a grouping of ICD10PCS and SNOMEDCT codes.

Exclusion Criteria: None

Subject constrained to the PCI

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

PciPerformed

0..*

CarotidInterventionPerformed

Clinical Focus: This set of values identifies patients who have undergone a carotid artery surgical procedure.

Data Element Scope: Appropriate for use with data elements in QDM Categories or Attributes represented by procedure codes.

Inclusion Criteria: Included are codes that represent carotid intervention surgical procedures.

Exclusion Criteria: Excluded are codes that would not indicate a carotid intervention has been surgically performed.

Subject constrained to the Carotid Intervention

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

CarotidInterventionPerformed

0..*

CabgSurgeriesPerformed

Clinical Focus: This grouping of value sets identifies patients who have a CABG surgical procedure.

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

Inclusion Criteria: Only use codes which represent CABG surgical procedures. Codes used are to be ICD10PCS, ICD9 or SNOMED-CT codes only.

Exclusion Criteria: Exclude codes that represent a CABG performed using a scope.

Subject constrained to the CABG Surgeries

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

CabgSurgeriesPerformed

0..*