ecqm.unions

Numerator1 Union

Description:

Based On: Union95

Used By:

• CMS108v7

QDM Attributes

InrPerformed

Clinical Focus: This set of values contains codes for laboratory test for INR, or International Normalized Ratio.

Data Element Scope: The intent of this data element is to identify INR laboratory tests. Using the Quality Data Model, this data element maps to the Laboratory Test category.

Inclusion Criteria: Only include codes which represent a laboratory test of INR (International Normalized Ratio). These are LOINC codes.

Exclusion Criteria: None

Subject constrained to the INR

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

InrPerformed

0..*

UnfractionatedHeparinAdministered

Clinical Focus: This value set identifies heparin formulations that could reasonably be used to treat venous thromboembolism as a continuous infusion.

Data Element Scope: The intent of this data element is to identify patients who receive unfractionated heparin as an intravenous infusion. Using the Quality Data Model, this particular element will map to the Medication category.

Inclusion Criteria: Injectable products that could reasonably be used for continuous infusion of heparin and achieve therapeutic levels.

Exclusion Criteria: Concentrations < 250 UNT/ML (except those representing premixed heparin infusion bags, per inclusion criteria

Subject constrained to the Unfractionated Heparin

MedicationAdministered: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient. Timing: The Relevant Period addresses: startTime = when a single medication administration event starts (e.g., the initiation of an intravenous infusion, or administering a pill or IM injection to a patient); stopTime = when a single medication administration event ends (e.g., the end time of the intravenous infusion, or the administration of a pill or IM injection is completed - for pills and IM injections, the start and stop times are the same) NOTE – Measure developers should address multiple administrations over a period of time using CQL logic. Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

UnfractionatedHeparinAdministered

0..*

DirectThrombinInhibitorAdministered

Clinical Focus: This set of values contains codes which identify a select medication-a direct thrombin inhibitor.

Data Element Scope: The intent of this data element is to identify patients who are on a direct thrombin inhibitor. Using the Quality Data Model, this data element maps to the Medication category.

Inclusion Criteria: Only include codes which represent direct thrombin inhibitors. These are RxNorm codes.

Exclusion Criteria: None

Subject constrained to the Direct Thrombin Inhibitor

MedicationAdministered: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient. Timing: The Relevant Period addresses: startTime = when a single medication administration event starts (e.g., the initiation of an intravenous infusion, or administering a pill or IM injection to a patient); stopTime = when a single medication administration event ends (e.g., the end time of the intravenous infusion, or the administration of a pill or IM injection is completed - for pills and IM injections, the start and stop times are the same) NOTE – Measure developers should address multiple administrations over a period of time using CQL logic. Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

DirectThrombinInhibitorAdministered

0..*

GlycoproteinIIbIiIaInhibitorsAdministered

Clinical Focus: This set of values contains codes which identify a select medication-a Glycoprotein Iib/IIIa inhibitor.

Data Element Scope: The intent of this data element is to identify patients who are on a Glycoprotein Iib/IIIa inhibitor. Using the Quality Data Model, this data element maps to the Medication category.

Inclusion Criteria: Only include codes which represent a Glycoprotein Iib/IIIa inhibitor. These are RxNorm codes.

Exclusion Criteria: None

Subject constrained to the Glycoprotein IIb/IIIa Inhibitors

MedicationAdministered: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient. Timing: The Relevant Period addresses: startTime = when a single medication administration event starts (e.g., the initiation of an intravenous infusion, or administering a pill or IM injection to a patient); stopTime = when a single medication administration event ends (e.g., the end time of the intravenous infusion, or the administration of a pill or IM injection is completed - for pills and IM injections, the start and stop times are the same) NOTE – Measure developers should address multiple administrations over a period of time using CQL logic. Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

GlycoproteinIIbIiIaInhibitorsAdministered

0..*

LowDoseUnfractionatedHeparinForVteProphylaxisAdministered

Clinical Focus: This set of values contains unfractionated heparin medications with strengths that could reasonably be used for VTE prophylaxis.

Data Element Scope: The intent of this data element is to identify patients who are on low-dose unfractionated heparin as VTE prophylaxis. Using the Quality Data Model, this data element maps to the Medication category.

Inclusion Criteria: Injectable products that could reasonably be used to achieve a dose of at least 5000 units when administered subcutaneously.

Exclusion Criteria: Concentrations less than 250 UNT/ML.

Subject constrained to the Low Dose Unfractionated Heparin for VTE Prophylaxis

MedicationAdministered: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient. Timing: The Relevant Period addresses: startTime = when a single medication administration event starts (e.g., the initiation of an intravenous infusion, or administering a pill or IM injection to a patient); stopTime = when a single medication administration event ends (e.g., the end time of the intravenous infusion, or the administration of a pill or IM injection is completed - for pills and IM injections, the start and stop times are the same) NOTE – Measure developers should address multiple administrations over a period of time using CQL logic. Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

LowDoseUnfractionatedHeparinForVteProphylaxisAdministered

0..*

LowDoseUnfractionatedHeparinForVteProphylaxisOrder

Clinical Focus: This set of values contains unfractionated heparin medications with strengths that could reasonably be used for VTE prophylaxis.

Data Element Scope: The intent of this data element is to identify patients who are on low-dose unfractionated heparin as VTE prophylaxis. Using the Quality Data Model, this data element maps to the Medication category.

Inclusion Criteria: Injectable products that could reasonably be used to achieve a dose of at least 5000 units when administered subcutaneously.

Exclusion Criteria: Concentrations less than 250 UNT/ML.

Subject constrained to the Low Dose Unfractionated Heparin for VTE Prophylaxis

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

LowDoseUnfractionatedHeparinForVteProphylaxisOrder

0..*

LowMolecularWeightHeparinForVteProphylaxisAdministered

Clinical Focus: This set of values represents medications used for VTE prophylaxis. The medications are low molecular weight heparins. The medications included in this value set are administered parenterally.

Data Element Scope: The intent of this data element is to identify patients who are on low molecular weight heparin therapy as VTE prophylaxis. Using the Quality Data Model, this data element maps to the Medication category.

Inclusion Criteria: Only include RxNorm codes which specifically represent low molecular weight heparins which are administered parenterally.

Exclusion Criteria: None.

Subject constrained to the Low Molecular Weight Heparin for VTE Prophylaxis

MedicationAdministered: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient. Timing: The Relevant Period addresses: startTime = when a single medication administration event starts (e.g., the initiation of an intravenous infusion, or administering a pill or IM injection to a patient); stopTime = when a single medication administration event ends (e.g., the end time of the intravenous infusion, or the administration of a pill or IM injection is completed - for pills and IM injections, the start and stop times are the same) NOTE – Measure developers should address multiple administrations over a period of time using CQL logic. Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

LowMolecularWeightHeparinForVteProphylaxisAdministered

0..*

LowMolecularWeightHeparinForVteProphylaxisOrder

Clinical Focus: This set of values represents medications used for VTE prophylaxis. The medications are low molecular weight heparins. The medications included in this value set are administered parenterally.

Data Element Scope: The intent of this data element is to identify patients who are on low molecular weight heparin therapy as VTE prophylaxis. Using the Quality Data Model, this data element maps to the Medication category.

Inclusion Criteria: Only include RxNorm codes which specifically represent low molecular weight heparins which are administered parenterally.

Exclusion Criteria: None.

Subject constrained to the Low Molecular Weight Heparin for VTE Prophylaxis

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

LowMolecularWeightHeparinForVteProphylaxisOrder

0..*

InjectableFactorXaInhibitorForVteProphylaxisAdministered

Clinical Focus: This set of values contains codes which identify a select medication-an injectable Factor Xa inhibitor-which is used for VTE prophylaxis.

Data Element Scope: The intent of this data element is to identify patients who are on a select Injectable Factor Xa Inhibitor as prophylaxis for VTE. Using the Quality Data Model, this data element maps to the Medication category.

Inclusion Criteria: Only include codes which represent injectable Factor Xa inhibitor medications. These are RxNorm codes.

Exclusion Criteria: None.

Subject constrained to the Injectable Factor Xa Inhibitor for VTE Prophylaxis

MedicationAdministered: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient. Timing: The Relevant Period addresses: startTime = when a single medication administration event starts (e.g., the initiation of an intravenous infusion, or administering a pill or IM injection to a patient); stopTime = when a single medication administration event ends (e.g., the end time of the intravenous infusion, or the administration of a pill or IM injection is completed - for pills and IM injections, the start and stop times are the same) NOTE – Measure developers should address multiple administrations over a period of time using CQL logic. Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

InjectableFactorXaInhibitorForVteProphylaxisAdministered

0..*

InjectableFactorXaInhibitorForVteProphylaxisOrder

Clinical Focus: This set of values contains codes which identify a select medication-an injectable Factor Xa inhibitor-which is used for VTE prophylaxis.

Data Element Scope: The intent of this data element is to identify patients who are on a select Injectable Factor Xa Inhibitor as prophylaxis for VTE. Using the Quality Data Model, this data element maps to the Medication category.

Inclusion Criteria: Only include codes which represent injectable Factor Xa inhibitor medications. These are RxNorm codes.

Exclusion Criteria: None.

Subject constrained to the Injectable Factor Xa Inhibitor for VTE Prophylaxis

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

InjectableFactorXaInhibitorForVteProphylaxisOrder

0..*

WarfarinAdministered

Clinical Focus: This set of values contains Warfarin medications that are administered to patients to reduce the risk of blood clot formation.

Data Element Scope: The intent of this data element is to identify patients who are prescribed warfarin therapy at discharge following acute myocardial infarction. Using the Quality Data Model, this particular element would map to the Medication category.

Inclusion Criteria: Drug forms that are consistent with oral administration should be included: tablets. Only single ingredient.

Exclusion Criteria: None.

Subject constrained to the Warfarin

MedicationAdministered: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient. Timing: The Relevant Period addresses: startTime = when a single medication administration event starts (e.g., the initiation of an intravenous infusion, or administering a pill or IM injection to a patient); stopTime = when a single medication administration event ends (e.g., the end time of the intravenous infusion, or the administration of a pill or IM injection is completed - for pills and IM injections, the start and stop times are the same) NOTE – Measure developers should address multiple administrations over a period of time using CQL logic. Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

WarfarinAdministered

0..*

WarfarinOrder

Clinical Focus: This set of values contains Warfarin medications that are administered to patients to reduce the risk of blood clot formation.

Data Element Scope: The intent of this data element is to identify patients who are prescribed warfarin therapy at discharge following acute myocardial infarction. Using the Quality Data Model, this particular element would map to the Medication category.

Inclusion Criteria: Drug forms that are consistent with oral administration should be included: tablets. Only single ingredient.

Exclusion Criteria: None.

Subject constrained to the Warfarin

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

WarfarinOrder

0..*

IntermittentPneumaticCompressionDevicesIpcApplied

Clinical Focus: This set of values represents the different types of intermittent pneumatic compression devices used for VTE prophylaxis.

Data Element Scope: The intent of this data element is to represent the application of certain intermittent pneumatic compression devices. Using the Quality Data Model, this data element will map to the Device category.

Inclusion Criteria: Only include codes which represent different types of intermittent pneumatic compression devices.

Exclusion Criteria: None

Subject constrained to the Intermittent pneumatic compression devices (IPC)

DeviceApplied: Data elements that meet criteria using this datatype should document that the device indicated by the QDM category and its corresponding value set is in use, or impacts or alters the treatment, care plan, or encounter (e.g., an antithrombotic device has been placed on the patient's legs to prevent thromboembolism, or a cardiac pacemaker is in place). Timing: The Relevant Period addresses: startTime – When the device is inserted or first used stopTime – when the device is removed or last used

DataType

Cardinality

IntermittentPneumaticCompressionDevicesIpcApplied

0..*

IntermittentPneumaticCompressionDevicesIpcOrder

Clinical Focus: This set of values represents the different types of intermittent pneumatic compression devices used for VTE prophylaxis.

Data Element Scope: The intent of this data element is to represent the application of certain intermittent pneumatic compression devices. Using the Quality Data Model, this data element will map to the Device category.

Inclusion Criteria: Only include codes which represent different types of intermittent pneumatic compression devices.

Exclusion Criteria: None

Subject constrained to the Intermittent pneumatic compression devices (IPC)

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

DataType

Cardinality

IntermittentPneumaticCompressionDevicesIpcOrder

0..*

VenousFootPumpsVfpApplied

Clinical Focus: This set of values identifies patients who have a venous foot pump device applied for VTE prophylaxis.

Data Element Scope: The intent of this data element is to identify patients who have a venous foot pump device applied for VTE prophylaxis. Using the Quality Data Model, this particular element will map to the Device category.

Inclusion Criteria: Only use codes which represent venous foot pump devices which are used for VTE prophylaxis.

Exclusion Criteria: None

Subject constrained to the Venous foot pumps (VFP)

DeviceApplied: Data elements that meet criteria using this datatype should document that the device indicated by the QDM category and its corresponding value set is in use, or impacts or alters the treatment, care plan, or encounter (e.g., an antithrombotic device has been placed on the patient's legs to prevent thromboembolism, or a cardiac pacemaker is in place). Timing: The Relevant Period addresses: startTime – When the device is inserted or first used stopTime – when the device is removed or last used

DataType

Cardinality

VenousFootPumpsVfpApplied

0..*

VenousFootPumpsVfpOrder

Clinical Focus: This set of values identifies patients who have a venous foot pump device applied for VTE prophylaxis.

Data Element Scope: The intent of this data element is to identify patients who have a venous foot pump device applied for VTE prophylaxis. Using the Quality Data Model, this particular element will map to the Device category.

Inclusion Criteria: Only use codes which represent venous foot pump devices which are used for VTE prophylaxis.

Exclusion Criteria: None

Subject constrained to the Venous foot pumps (VFP)

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

DataType

Cardinality

VenousFootPumpsVfpOrder

0..*

GraduatedCompressionStockingsGcsApplied

Clinical Focus: This set of values contains codes and concepts for graduated compression stocking devices which are used to prevent VTEs in patients.

Data Element Scope: The intent of this data element is to identify patients who have a graduated compression stocking device applied. It may also be used to identify patients who did not have a graduated compression stocking device applied for VTE prophylaxis for an allowable reason when used with a negation rationale attribute. Using the Quality Data Model, this data element maps to the Device category.

Inclusion Criteria: Only include codes which represent graduated compression stockings.

Exclusion Criteria: None

Subject constrained to the Graduated compression stockings (GCS)

DeviceApplied: Data elements that meet criteria using this datatype should document that the device indicated by the QDM category and its corresponding value set is in use, or impacts or alters the treatment, care plan, or encounter (e.g., an antithrombotic device has been placed on the patient's legs to prevent thromboembolism, or a cardiac pacemaker is in place). Timing: The Relevant Period addresses: startTime – When the device is inserted or first used stopTime – when the device is removed or last used

DataType

Cardinality

GraduatedCompressionStockingsGcsApplied

0..*

GraduatedCompressionStockingsGcsOrder

Clinical Focus: This set of values contains codes and concepts for graduated compression stocking devices which are used to prevent VTEs in patients.

Data Element Scope: The intent of this data element is to identify patients who have a graduated compression stocking device applied. It may also be used to identify patients who did not have a graduated compression stocking device applied for VTE prophylaxis for an allowable reason when used with a negation rationale attribute. Using the Quality Data Model, this data element maps to the Device category.

Inclusion Criteria: Only include codes which represent graduated compression stockings.

Exclusion Criteria: None

Subject constrained to the Graduated compression stockings (GCS)

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

DataType

Cardinality

GraduatedCompressionStockingsGcsOrder

0..*