ecqm.measure

CMS90v8 - Functional Status Assessments for Congestive Heart Failure

Rationale:

Functional Status Assessments for Congestive Heart Failure. Patients living with congestive heart failure (CHF) often have poor functional status and health-related quality of life, which declines as the disease progresses (Allen et al. 2012). In addition, their care is often complicated by multiple comorbidities. To assist in managing these complex patients, the American College of Cardiology Foundation and American Heart Association recommend collecting initial and repeat assessments of a patient's function and ability to complete desired activities of daily living (Hunt et al. 2009). The American Heart Association has also released scientific statements emphasizing the collection of patient-reported health status (for example, functional limitations, symptom burden, quality of life) from CHF patients as an important means of establishing a dynamic conversation between patient and provider regarding care goals and the patient's priorities (Allen et al. 2012; Rumsfeld et al. 2013).

Data Elements

ClinicalSummaryScoreKccqPerformed

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

ClinicalSummaryScoreKccqPerformed

0..*

QualityOfLifeScoreKccqPerformed

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

QualityOfLifeScoreKccqPerformed

0..*

Promis10GlobalMentalHealthScorePerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the PROMIS 10 Global Mental Health Score

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

Promis10GlobalMentalHealthScorePerformed

0..*

Promis10GlobalPhysicalHealthScorePerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the PROMIS 10 Global Physical Health Score

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

Promis10GlobalPhysicalHealthScorePerformed

0..*

Vr12PhysicalComponentTScorePerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the VR12 Physical Component T Score

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

Vr12PhysicalComponentTScorePerformed

0..*

Vr12MentalComponentTScorePerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the VR12 Mental Component T Score

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

Vr12MentalComponentTScorePerformed

0..*

Promis29SleepDisturbanceScorePerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the PROMIS 29 Sleep Disturbance Score

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

Promis29SleepDisturbanceScorePerformed

0..*

Promis29PhysicalFunctionScorePerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the PROMIS 29 Physical Function Score

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

Promis29PhysicalFunctionScorePerformed

0..*

Promis29PainInterferenceScorePerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the PROMIS 29 Pain Interference Score

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

Promis29PainInterferenceScorePerformed

0..*

Promis29FatigueScorePerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the PROMIS 29 Fatigue Score

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

Promis29FatigueScorePerformed

0..*

Promis29DepressionScorePerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the PROMIS 29 Depression Score

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

Promis29DepressionScorePerformed

0..*

Promis29AnxietyScorePerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the PROMIS 29 Anxiety Score

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

Promis29AnxietyScorePerformed

0..*

Promis29SocialRolesScorePerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the PROMIS 29 Social Roles Score

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

Promis29SocialRolesScorePerformed

0..*

KccqPhysicalLimitationScorePerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the KCCQ Physical Limitation Score

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

KccqPhysicalLimitationScorePerformed

0..*

KccqSelfEfficacyScorePerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the KCCQ Self Efficacy Score

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

KccqSelfEfficacyScorePerformed

0..*

KccqSocialLimitationScorePerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the KCCQ Social Limitation Score

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

KccqSocialLimitationScorePerformed

0..*

KccqTotalSymptomScorePerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the KCCQ Total Symptom Score

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

KccqTotalSymptomScorePerformed

0..*

Vr36MentalComponentSummaryMcsScorePerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the VR 36 Mental Component Summary (MCS) Score

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

Vr36MentalComponentSummaryMcsScorePerformed

0..*

Vr36PhysicalComponentSummaryPcsScorePerformed

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

Subject constrained to the VR 36 Physical Component Summary (PCS) Score

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

Vr36PhysicalComponentSummaryPcsScorePerformed

0..*

SevereDementiaDiagnosis

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

ResultValue constrained to codes in the Severe Dementia valueset (2.16.840.1.113883.3.526.3.1025)

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

SevereDementiaDiagnosis

0..*

HeartFailureDiagnosis

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

ResultValue constrained to codes in the Heart Failure valueset (2.16.840.1.113883.3.526.3.376)

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

HeartFailureDiagnosis

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..*

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..*

HospiceCareAmbulatoryOrder

Clinical Focus: Patients receiving hospice care outside of hospital or long term care facility.

Data Element Scope: The intent of this value set is to identify all patients receiving hospice care outside of hospital or long term care facility . Using the quality data model this maps to 'Intervention, Order' and 'Procedure, Order'.

Inclusion Criteria: All hospice care concepts should be included.

Exclusion Criteria: Do not include concepts for palliative care or comfort measures.

Subject constrained to the Hospice care ambulatory

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

HospiceCareAmbulatoryOrder

0..*

HospiceCareAmbulatoryPerformed

Clinical Focus: Patients receiving hospice care outside of hospital or long term care facility.

Data Element Scope: The intent of this value set is to identify all patients receiving hospice care outside of hospital or long term care facility . Using the quality data model this maps to 'Intervention, Order' and 'Procedure, Order'.

Inclusion Criteria: All hospice care concepts should be included.

Exclusion Criteria: Do not include concepts for palliative care or comfort measures.

Subject constrained to the Hospice care ambulatory

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

HospiceCareAmbulatoryPerformed

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..*