Elective Delivery

Last updated: May 17, 2016

CMS Measure ID: CMS113v4
Version: 4
NQF Number: 0469
Measure Description:

Patients with elective vaginal deliveries or elective cesarean births at >= 37 and < 39 weeks of gestation completed

Initial Patient Population:

Patients age >= 8 years and < 65 admitted to the hospital for inpatient acute care and had a length of stay < 120 days who undergo a delivery procedure

Denominator Statement:

Patients delivering newborns with >= 37 and < 39 weeks of gestation completed

Denominator Exclusions:

Patients with conditions possibly justifying elective delivery prior to 39 weeks gestation

Numerator Statement:

Patients with elective deliveries by either:

  • Medical induction of labor while not in labor prior to the procedure
  • Cesarean birth while not in labor and with no history of a prior uterine surgery
Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: The Joint Commission
Domain: Effective Clinical Care
Short Name: PC01
Next Version: Elective Delivery
Previous Version: Elective Delivery
Measure Score: Proportion
Improvement Notation:

Improvement noted as a decrease in the rate

Guidance:

The unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization.

Wherever the gestational age is mentioned with relative timing to delivery, the intent is to capture the estimated gestational age on the day of delivery.

Gestational age should be rounded off to the nearest completed week, not the following week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks.

Specifications

Release Notes

Header

  • Changed all references to 'Cesarean Section' to 'Cesarean Birth' to reflect preferred obstetric data definition.
  • Copyright updated.
  • eMeasure version number incremented.
  • Updated the Initial Population and Numerator header statements to better align with measure logic.

Logic

  • Added timing constraint of <=24 hours to constrain induction of labor to inductions occurring in relation to the delivery.
  • Changed data type of 'Result' or 'Finding' to 'Performed'.
  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Introduced occurrencing on variables to enforce that the same instance of a clinical event is used throughout the measure when the logic within the variable does not limit the event to a single instance, e.g., FIRST or MOST RECENT.
  • Introduced the new timing operator overlaps to replace two lines of logic (AND/AND NOT) or to enforce when an event or set of events occur to meet the measure intent.
  • Introduced variable $EncounterInpatient to allow re-use of logical expressions and reduce redundancy/complexity.
  • Revised logic to exclude¬†patients with a gestational age at delivery of 39 or 40 weeks.
  • Replaced 'ORs' with 'Union of' operator to provide a mechanism for specifying that qualifying event(s) must be a member of at least one of the data elements being unioned (if appropriate for measure intent).
  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.
  • Replaced timing relationship 'during' with 'starts during' where both a start datetime and an end datetime associated with a particular QDM element are not critical to fulfill the measure intent.
  • Revised timing operator to constrain logic to Labor findings occurring immediately prior to the cesarean birth.
  • The top level logical operator for the Numerator Exclusions, Denominator Exclusions, Denominator Exceptions, and Measure Population Exclusions defaults to 'OR'.

Value Sets

  • Value set Cesarean Birth (OID 2.16.840.1.113883.3.117.1.7.1.282): Updated value set name from Cesarean Section to Cesarean Birth.
  • Value set Classical Cesarean Birth (OID 2.16.840.1.113883.3.117.1.7.1.421): Updated value set name from Classical Cesarean Section to Classical Cesarean Birth.
  • Value set Conditions Possibly Justifying Elective Delivery Prior to 39 Weeks Gestation (OID 2.16.840.1.113883.3.117.1.7.1.286): Added 1 SNOMED code and 83 ICD10CM codes and deleted 4 ICD10CM codes.
  • Value set Delivery Procedures (OID 2.16.840.1.113762.1.4.1045.59): Replaced OID 2.16.840.1.113883.3.117.1.7.1.401 and added 10 ICDPCS codes (10D00Z0, 10D00Z1, 10D00Z2, 10D07Z3, 10D07Z4, 10D07Z5, 10D07Z6, 10D07Z7, 10D07Z8, 10E0XZZ).
  • Value set Medical Induction of Labor (OID 2.16.840.1.113883.3.117.1.7.1.288 ): Added 8 ICDPCS codes (0U7C7DZ, 0U7C7ZZ, 10900ZC, 10903ZC, 10904ZC, 10907ZC, 10908ZC, 3E033VJ).

External Resources