ecqm.measure

CMS9v7 - Exclusive Breast Milk Feeding (PC-05)

Rationale:

Exclusive Breast Milk Feeding (PC-05). Exclusive breast milk feeding for the first 6 months of neonatal life has long been the expressed goal of World Health Organization (WHO), Department of Health and Human Services (DHHS), American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG). ACOG has recently reiterated its position (ACOG, 2007). A recent Cochrane review substantiates the benefits (Kramer et al., 2002). Much evidence has now focused on the prenatal and intrapartum period as critical for the success of exclusive (or any) BF (Centers for Disease Control and Prevention [CDC], 2007; Petrova et al., 2007; Shealy et al., 2005; Taveras et al., 2004). Exclusive breast milk feeding rate during birth hospital stay has been calculated by the California Department of Public Health for the last several years using newborn genetic disease testing data. Healthy People 2010 and the CDC have also been active in promoting this goal.

Data Elements

EstimatedGestationalAgeAtBirthPerformed

Clinical Focus: This value set represents the concept of estimated gestational age at birth.

Data Element Scope: The intent of this data element is to identify estimated gestational age at birth. Using the Quality Data Model, this particular element will map to the Assessment category.

Inclusion Criteria: Include SNOMED CT codes that identify estimated gestational age at birth.

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

Subject constrained to the Estimated Gestational Age at Birth

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

EstimatedGestationalAgeAtBirthPerformed

0..*

SingleLiveBornNewbornBornInHospitalDiagnosis

Clinical Focus: This set of values contains types of delivery that represent the single live birth.

Data Element Scope: The intent of this data element is to identify single live born newborn. Using the Quality Data Model, this particular element will map to the 'Diagnosis' category or the attribute of 'Diagnoses' for Encounter category.

Inclusion Criteria: Include codes that identify single live born newborn.

Exclusion Criteria: Exclude codes indicating the birth took place outside of the hospital.

ResultValue constrained to codes in the Single Live Born Newborn Born in Hospital valueset (2.16.840.1.113883.3.117.1.7.1.26)

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

SingleLiveBornNewbornBornInHospitalDiagnosis

0..*

SingleLiveBornNewbornBornInHospitalDiagnoses

Clinical Focus: This set of values contains types of delivery that represent the single live birth.

Data Element Scope: The intent of this data element is to identify single live born newborn. Using the Quality Data Model, this particular element will map to the 'Diagnosis' category or the attribute of 'Diagnoses' for Encounter category.

Inclusion Criteria: Include codes that identify single live born newborn.

Exclusion Criteria: Exclude codes indicating the birth took place outside of the hospital.

Diagnoses: Coded diagnoses/problems addressed during the encounter. The diagnoses attribute is intended to capture ALL diagnoses, including principal diagnosis. Use of the Encounter, Performed: diagnoses attribute and the Diagnosis datatype is redundant for relating the diagnosis to the Encounter, Performed. The Encounter, Performed: diagnoses syntax is preferred. Referencing the same diagnosis using Encounter, Performed (diagnoses attribute) and Diagnosis (datatype) should only occur if the measure must define a specified length of a prevalence period, e.g., The measure must assure that the diagnoseis have been present for at least some defined time period before the encounter, and were addressed during the Encounter

DataType

Cardinality

SingleLiveBornNewbornBornInHospitalDiagnoses

0..*

GalactosemiaDiagnosis

Clinical Focus: This grouping value set include diagnoses that represent galactosemia.

Data Element Scope: The intent of this data element is to identify galactosemia. Using the Quality Data Model, this particular element will map to the 'Diagnosis' categories.

Inclusion Criteria: Include ICD 10 CM and SNOMED CT codes that identify galactosemia.

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

ResultValue constrained to codes in the Galactosemia valueset (2.16.840.1.113883.3.117.1.7.1.35)

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

GalactosemiaDiagnosis

0..*

GalactosemiaDiagnoses

Clinical Focus: This grouping value set include diagnoses that represent galactosemia.

Data Element Scope: The intent of this data element is to identify galactosemia. Using the Quality Data Model, this particular element will map to the 'Diagnosis' categories.

Inclusion Criteria: Include ICD 10 CM and SNOMED CT codes that identify galactosemia.

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

Diagnoses: Coded diagnoses/problems addressed during the encounter. The diagnoses attribute is intended to capture ALL diagnoses, including principal diagnosis. Use of the Encounter, Performed: diagnoses attribute and the Diagnosis datatype is redundant for relating the diagnosis to the Encounter, Performed. The Encounter, Performed: diagnoses syntax is preferred. Referencing the same diagnosis using Encounter, Performed (diagnoses attribute) and Diagnosis (datatype) should only occur if the measure must define a specified length of a prevalence period, e.g., The measure must assure that the diagnoseis have been present for at least some defined time period before the encounter, and were addressed during the Encounter

DataType

Cardinality

GalactosemiaDiagnoses

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..*

PatientExpiredDischargeDisposition

Clinical Focus: This value set identifies a patient who has died in the hospital.

Data Element Scope: The intent of this data element is to identify the discharge status of patient expired as an attribute of the inpatient encounter. Using the Quality Data Model, this value set is used for this attribute.

Inclusion Criteria: Only include codes for a patient who had died in the hospital. Codes used are to be SNOMED-CT codes only.

Exclusion Criteria: None

DischargeDisposition: The disposition, or location to which the patient is transferred at the time of hospital discharge.

DataType

Cardinality

PatientExpiredDischargeDisposition

0..*

DischargeToAcuteCareFacilityDischargeDisposition

Clinical Focus: This set of values contains procedures used to represent the discharge of a patient to an acute care facility.

Data Element Scope: The intent of this data element is to identify the final place or setting to which the patient was discharged on the day of discharge from a particular inpatient encounter. This particular value set intends to identify patients who where discharged to an acute care facility. Using the Quality Data Model, this particular value set is used with the Attribute of 'Discharge Disposition' used with the Encounter category.

Inclusion Criteria: Only SNOMED CT codes representing short-term acute care hospitals, including specialty hospitals, should be included.

Exclusion Criteria: None

DischargeDisposition: The disposition, or location to which the patient is transferred at the time of hospital discharge.

DataType

Cardinality

DischargeToAcuteCareFacilityDischargeDisposition

0..*

NeonatalIntensiveCareUnitNicuFacilityLocations

Clinical Focus: This set of values represent a neonatal intensive care unit (NICU) location.

Data Element Scope: The intent of this data element is to identify the NICU. Using the Quality Data Model, this particular element will map as an attribute to an encounter.

Inclusion Criteria: Include SNOMED CT codes that identify the NICU.

Exclusion Criteria: None

FacilityLocations: The particular locations in a facility in which the diagnostic study or encounter occurs or occurred. Examples include, but are not limited to, intensive care units (ICUs), non- ICUs, burn critical-care unit, neonatal ICU, and respiratory-care unit. Each Encounter, Performed may have 1 or more locations. For example, a patient treated in multiple locations during an individual encounter might be expressed as: Encounter, Performed: Inpatient Admission, ICU (location period), Non-ICU Admission (location period), Rehab (location period)

DataType

Cardinality

NeonatalIntensiveCareUnitNicuFacilityLocations

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..*

ParenteralNutritionPerformed

Clinical Focus: This grouping value set contains procedures that represent parenteral infusion.

Data Element Scope: The intent of this data element is to identify parenteral infusion procedures. Using the Quality Data Model, this particular element will map to the 'Procedure' category.

Inclusion Criteria: Include ICD 10 PCS, and SNOMED CT codes that identify parenteral infusion.

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

Subject constrained to the Parenteral Nutrition

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

ParenteralNutritionPerformed

0..*

DietaryIntakeOtherThanBreastMilkAdministered

Clinical Focus: This set of values represent dietary intake other than breast milk.

Data Element Scope: The intent of this data element is to identify dietary intake other than breast milk. Using the Quality Data Model, this particular element will map to the 'substance' category.

Inclusion Criteria: Include SNOMED CT codes that identify dietary intake other than breast milk.

Exclusion Criteria: Exclude codes that represent breast milk.

Subject constrained to the Dietary Intake Other than Breast Milk

SubstanceAdministered: SubstaData elements that meet criteria using this datatype should document that the substance indicated by the QDM category and its corresponding value set was actually given to the patient. Timing: The Relevant Period addresses: StartTime = when a single substance administration event starts (e.g., the initiation of an intravenous infusion, or administering the substance orally or topically to a patient); StopTime = when a single substance administration event ends (e.g., the end time of the intravenous infusion, or the administration of a substance orally or topically is completed - for oral or topical administration, the start and stop times are the same)nceAdministered

DataType

Cardinality

DietaryIntakeOtherThanBreastMilkAdministered

0..*

BreastMilkAdministered

Clinical Focus: This set of values represent the concept of breast milk.

Data Element Scope: The intent of this data element is to identify breast milk. Using the Quality Data Model, this particular element will map to the 'substance' category.

Inclusion Criteria: Include SNOMED CT codes that identify breast milk.

Exclusion Criteria: None

Subject constrained to the Breast Milk

SubstanceAdministered: SubstaData elements that meet criteria using this datatype should document that the substance indicated by the QDM category and its corresponding value set was actually given to the patient. Timing: The Relevant Period addresses: StartTime = when a single substance administration event starts (e.g., the initiation of an intravenous infusion, or administering the substance orally or topically to a patient); StopTime = when a single substance administration event ends (e.g., the end time of the intravenous infusion, or the administration of a substance orally or topically is completed - for oral or topical administration, the start and stop times are the same)nceAdministered

DataType

Cardinality

BreastMilkAdministered

0..*