ecqm.measure

CMS645v2 - Bone density evaluation for patients with prostate cancer and receiving androgen deprivation therapy

Rationale:

Bone density evaluation for patients with prostate cancer and receiving androgen deprivation therapy. Androgen suppression as a treatment for prostate cancer can cause osteoporosis(Qaseem, 2008). Men undergoing prolonged androgen deprivation therapy (ADT) incur bone loss at a rate higher than menopausal women (Guise, 2007). In preserving bone health, the goal is to prevent or treat osteopenia/osteoporosis for the patient on ADT and to prevent or delay skeletal related events. The National Osteoporosis Foundation recommendations including a baseline assessment of bone density with a DEXA scan and daily calcium and Vitamin D supplementation (Watts, 2012). The DEXA scan is the gold standard for bone density screening. Men at risk for adverse bone consequences from chronic ADT do not always receive care according to evidence based guidelines. These findings call for improved processes that standardize evidence based practice including baseline and follow up bone density assessment (Watts, 2012).

Data Elements

ProstateCancerDiagnosis

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

ResultValue constrained to codes in the Prostate Cancer valueset (2.16.840.1.113883.3.526.3.319)

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

ProstateCancerDiagnosis

0..*

DexaDualEnergyXrayAbsorptiometryBoneDensityForUrologyCareOrder

Clinical Focus: Xray studies to determine bone density.

Data Element Scope: The intent of this data element is to identify patients with low bone mineral density

Inclusion Criteria: 1 or more axial sites, axial skeleton (hips, pelvis, spine) or 1 or more appendicular skeleton sites (radius, wrist, heel)

Exclusion Criteria: Study other than DEXA

Subject constrained to the DEXA Dual Energy Xray Absorptiometry, Bone Density for Urology Care

DiagnosticStudyOrder: Data elements that meet criteria using this datatype should document a request by a clinician or appropriately licensed care provider to an appropriate provider or organization to perform the diagnostic study indicated by the QDM category and its corresponding value set. The request may be in the form of a consultation or a direct order to the organization that performs the diagnostic study. Diagnostic studies are those that are not performed in the clinical laboratory. Such studies include but are not limited to imaging studies, cardiology studies (electrocardiogram, treadmill stress testing), pulmonary function testing, vascular laboratory testing, and others. Timing: The time the order is signed; Author dateTime.

DataType

Cardinality

DexaDualEnergyXrayAbsorptiometryBoneDensityForUrologyCareOrder

0..*

DexaDualEnergyXrayAbsorptiometryBoneDensityForUrologyCarePerformed

Clinical Focus: Xray studies to determine bone density.

Data Element Scope: The intent of this data element is to identify patients with low bone mineral density

Inclusion Criteria: 1 or more axial sites, axial skeleton (hips, pelvis, spine) or 1 or more appendicular skeleton sites (radius, wrist, heel)

Exclusion Criteria: Study other than DEXA

Subject constrained to the DEXA Dual Energy Xray Absorptiometry, Bone Density for Urology Care

DiagnosticStudyPerformed: Data elements that meet criteria using this datatype should document the completion of the diagnostic study indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: startTime – when the diagnostic study is initiated stopTime – when the diagnostic study is completed Examples: 1) Initiation of a treadmill stress test to the time the treadmill stress test has completed. 2) Initiation of the ultrasound study until completion of the ultrasound study

DataType

Cardinality

DexaDualEnergyXrayAbsorptiometryBoneDensityForUrologyCarePerformed

0..*

OfficeVisit1Performed

Clinical Focus: This value set identifies 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 Visit1

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

OfficeVisit1Performed

0..*

AndrogenDeprivationTherapyForUrologyCareActive

Clinical Focus: Androgen deprivation therapy as identified for UrologyCare

Data Element Scope: This data element is to list androgen deprivation therapy for urology care for prostate cancer.

Inclusion Criteria: Androgen deprivation therapy medications

Exclusion Criteria: Medications that are not androgen deprivation therapy

Subject constrained to the Androgen deprivation therapy for Urology Care

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

AndrogenDeprivationTherapyForUrologyCareActive

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..*

MalePatientCharacteristicGender

Clinical Focus: Concepts that represent Male when assessing quality measures

Data Element Scope: Gender

Inclusion Criteria: Appropriate male gender concepts

Exclusion Criteria: concepts representing Female gender

ResultValue constrained to codes in the Male valueset (2.16.840.1.113883.3.560.100.1)

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

MalePatientCharacteristicGender

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..*

InjectionLeuprolideAcetateOrder

Clinical Focus: HCPCS code fo injection of leuprolide acetate for intended twelve month period.

Data Element Scope: The intent of this data element is to include androgen deprivation therapy for equal to or greater than 12 months. This is accomplished by indicating the CPT code and then a modifier such as J1950,cont which is non-billable but allows for reporting the intent.

Inclusion Criteria: Injection of leuprolide acetate intended for 12 months or greater.

Exclusion Criteria: Injection of leuprolude acetate intended for a period of less than 12 months.

Subject constrained to the Injection Leuprolide Acetate

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

DataType

Cardinality

InjectionLeuprolideAcetateOrder

0..*