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CMS Measure ID:
Version:
9
NQF Number:
0
Performance/Reporting Period
2021
Description:

Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2

Data Elements contained within the eCQM + Expand all

Value Set Description from VSAC
Clinical Focus: This value set grouping contains concepts that represent patients who have had a hemorrhagic stroke, or stroke caused by hemorrhage.
Data Element Scope: This value set may use the Quality Data Model (QDM) attribute related to Principal Diagnosis. The intent of this data element is to identify patients who have a diagnosis of hemorrhagic stroke, or stroke caused by a hemorrhage.
Inclusion Criteria: Includes only relevant concepts associated with a diagnosis of hemorrhagic stroke, or stroke caused by hemorrhage. This is a grouping of ICD-10-CM and SNOMED CT codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnoses: Hemorrhagic Stroke value set (2.16.840.1.113883.3.117.1.7.1.212)

QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

Diagnoses

Coded diagnoses/problems addressed during the encounter. The diagnoses attribute has three components:

  • diagnosis (code)
  • presentOnAdmissionIndicator (code)
  • rank (positive integer)

To reference an encounter diagnosis, the expression must include the diagnosis code component. The other components are optional. The expression should only include the presentOnAdmissionIndicator if it is necessary to reference present on admission and should only include the rank if it is necessary to reference principal diagnosis.

The "Encounter, Performed" diagnosis attribute is intended to capture ALL diagnoses, including the principal diagnosis, i.e., all diagnoses addressed during the encounter represented by the diagnosis (code) used in the expression.The presentOnAdmissionIndicator (code) allows the eCQM developer to include criteria about whether each specific "Encounter, Performed" diagnosis was present at the time of admission (an indicator used to evaluate patient safety and adverse events). See presentOnAdmissionIndicator attribute definition for information about using the "Encounter, Performed" diagnosis attribute.

The "Encounter, Performed" diagnosis (rank) replaces the principal diagnosis attribute. To reference a principal diagnosis, eCQM developers should express the "Encounter, Performed" diagnosis with a diagnosis (code) and a rank of 1. See definition of rank attribute.

With an "Encounter, Performed" diagnosis, there is no dependency on the timing of the diagnosis in relation to the encounter.

  • Use of the "Encounter, Performed": diagnoses attribute component and the "Diagnosis" datatype is redundant for relating the diagnosis to the "Encounter, Performed". The "Encounter, Performed": diagnoses component 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 prevalencePeriod, e.g.,
    • The measure must assure that the diagnoses
      • have been present for at least some defined time period before the encounter, and
      • were addressed during the "Encounter, Performed"
    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts that represent diagnosis codes for intravenous or intra-arterial thrombolytic (t-PA) therapy administered within 24 hours prior to admission.
    Data Element Scope: This value set may use Quality Data Model (QDM) category related to Diagnosis. The intent of this data element is to identify administration intravenous or intra-arterial thrombolytic (t-PA) therapy within 24 hours prior to admission.
    Inclusion Criteria: Includes only relevant concepts associated with administration of intravenous or intra-arterial thrombolytic (t-PA) therapy of within 24 hours prior to admission.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Diagnoses: Intravenous Or Intra Arterial Thrombolytic (TPA) Therapy Prior To Arrival value set (2.16.840.1.113762.1.4.1110.21)

    QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

    Diagnoses

    Coded diagnoses/problems addressed during the encounter. The diagnoses attribute has three components:

    • diagnosis (code)
    • presentOnAdmissionIndicator (code)
    • rank (positive integer)

    To reference an encounter diagnosis, the expression must include the diagnosis code component. The other components are optional. The expression should only include the presentOnAdmissionIndicator if it is necessary to reference present on admission and should only include the rank if it is necessary to reference principal diagnosis.

    The "Encounter, Performed" diagnosis attribute is intended to capture ALL diagnoses, including the principal diagnosis, i.e., all diagnoses addressed during the encounter represented by the diagnosis (code) used in the expression.The presentOnAdmissionIndicator (code) allows the eCQM developer to include criteria about whether each specific "Encounter, Performed" diagnosis was present at the time of admission (an indicator used to evaluate patient safety and adverse events). See presentOnAdmissionIndicator attribute definition for information about using the "Encounter, Performed" diagnosis attribute.

    The "Encounter, Performed" diagnosis (rank) replaces the principal diagnosis attribute. To reference a principal diagnosis, eCQM developers should express the "Encounter, Performed" diagnosis with a diagnosis (code) and a rank of 1. See definition of rank attribute.

    With an "Encounter, Performed" diagnosis, there is no dependency on the timing of the diagnosis in relation to the encounter.

    • Use of the "Encounter, Performed": diagnoses attribute component and the "Diagnosis" datatype is redundant for relating the diagnosis to the "Encounter, Performed". The "Encounter, Performed": diagnoses component 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 prevalencePeriod, e.g.,
      • The measure must assure that the diagnoses
        • have been present for at least some defined time period before the encounter, and
        • were addressed during the "Encounter, Performed"
      Value Set Description from VSAC
      Clinical Focus: This value set grouping contains concepts that represent patients who have had a stroke caused by ischemia, where the blood supply is restricted to an area of the brain by something like thrombosis or an embolism.
      Data Element Scope: This value set may use the Quality Data Model (QDM) category or attribute related to Diagnosis. The intent of this data element is to identify patients who have a diagnosis of ischemic stroke, or stroke caused by ischemia.
      Inclusion Criteria: Includes only relevant concepts associated with a diagnosis of ischemic stroke, or stroke caused by ischemia. This is a grouping of ICD-10-CM and SNOMED CT codes and concepts.
      Exclusion Criteria: No exclusions.

      Constrained to codes in the Diagnoses: Ischemic Stroke value set (2.16.840.1.113883.3.117.1.7.1.247)

      QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

      Diagnoses

      Coded diagnoses/problems addressed during the encounter. The diagnoses attribute has three components:

      • diagnosis (code)
      • presentOnAdmissionIndicator (code)
      • rank (positive integer)

      To reference an encounter diagnosis, the expression must include the diagnosis code component. The other components are optional. The expression should only include the presentOnAdmissionIndicator if it is necessary to reference present on admission and should only include the rank if it is necessary to reference principal diagnosis.

      The "Encounter, Performed" diagnosis attribute is intended to capture ALL diagnoses, including the principal diagnosis, i.e., all diagnoses addressed during the encounter represented by the diagnosis (code) used in the expression.The presentOnAdmissionIndicator (code) allows the eCQM developer to include criteria about whether each specific "Encounter, Performed" diagnosis was present at the time of admission (an indicator used to evaluate patient safety and adverse events). See presentOnAdmissionIndicator attribute definition for information about using the "Encounter, Performed" diagnosis attribute.

      The "Encounter, Performed" diagnosis (rank) replaces the principal diagnosis attribute. To reference a principal diagnosis, eCQM developers should express the "Encounter, Performed" diagnosis with a diagnosis (code) and a rank of 1. See definition of rank attribute.

      With an "Encounter, Performed" diagnosis, there is no dependency on the timing of the diagnosis in relation to the encounter.

      • Use of the "Encounter, Performed": diagnoses attribute component and the "Diagnosis" datatype is redundant for relating the diagnosis to the "Encounter, Performed". The "Encounter, Performed": diagnoses component 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 prevalencePeriod, e.g.,
        • The measure must assure that the diagnoses
          • have been present for at least some defined time period before the encounter, and
          • were addressed during the "Encounter, Performed"
        Value Set Description from VSAC
        Clinical Focus: This value set contains concepts that represent diagnosis codes for intravenous or intra-arterial thrombolytic (t-PA) therapy administered within 24 hours prior to admission.
        Data Element Scope: This value set may use Quality Data Model (QDM) category related to Diagnosis. The intent of this data element is to identify administration intravenous or intra-arterial thrombolytic (t-PA) therapy within 24 hours prior to admission.
        Inclusion Criteria: Includes only relevant concepts associated with administration of intravenous or intra-arterial thrombolytic (t-PA) therapy of within 24 hours prior to admission.
        Exclusion Criteria: No exclusions.

        Constrained to codes in the Diagnosis: Intravenous or Intra arterial Thrombolytic (tPA) Therapy Prior to Arrival value set (2.16.840.1.113762.1.4.1110.21)

        QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

        Diagnosis

        Data elements that meet criteria using this datatype should document the Condition/Diagnosis/Problem and its corresponding value set. The onset dateTime corresponds to the implicit start dateTime of the datatype and the abatement dateTime corresponds to the implicit stop dateTime of the datatype. If the abatement dateTime is not present, then the diagnosis is considered to still be active. When this datatype is used with timing relationships, the criterion is looking for an active diagnosis for the time frame indicated by the timing relationships.

        Timing: The prevalencePeriod references the time from the onset date to the abatement date.

        Value Set Description from VSAC
        Clinical Focus: This value set contains concepts that represent procedures representing an emergency department encounter.
        Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Encounter. The intent of this data element is to identify patients who have had an emergency department encounter.
        Inclusion Criteria: Includes only relevant concepts associated with an emergency department visit encounter using the SNOMED CT code system.
        Exclusion Criteria: No exclusions.

        Constrained to codes in the Encounter, Performed: Emergency Department Visit value set (2.16.840.1.113883.3.117.1.7.1.292)

        QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

        Encounter, Performed

        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.

        The "Encounter, Performed" participant references the primary participant.

        Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

        A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here

        Timing:

        • The relevantPeriod addresses:
          • startTime - The time the encounter began (admission time).
          • stopTime - The time the encounter ended (discharge time).
        • author dateTime references the time the action was recorded.
        • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

        Notes:

        • negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.
        • The locationPeriod is an attribute of the attribute facility location that addresses:
          • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
          • stopTime - the time the patient departed from the location.
        Value Set Description from VSAC
        Clinical Focus: This value set contains concepts that represent procedures for non-elective inpatient encounters.
        Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Encounter. The intent of this data element is to identify non-elective inpatient encounters.
        Inclusion Criteria: Includes only relevant concepts associated with SNOMED CT codes representing non-elective inpatient encounters.
        Exclusion Criteria: No exclusions.

        Constrained to codes in the Encounter, Performed: Non-Elective Inpatient Encounter value set (2.16.840.1.113883.3.117.1.7.1.424)

        QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

        Encounter, Performed

        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.

        The "Encounter, Performed" participant references the primary participant.

        Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

        A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here

        Timing:

        • The relevantPeriod addresses:
          • startTime - The time the encounter began (admission time).
          • stopTime - The time the encounter ended (discharge time).
        • author dateTime references the time the action was recorded.
        • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

        Notes:

        • negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.
        • The locationPeriod is an attribute of the attribute facility location that addresses:
          • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
          • stopTime - the time the patient departed from the location.
        Value Set Description from VSAC
        Clinical Focus: This value set contains concepts that represent observation encounter types.
        Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Encounter. The intent of this data element is to identify patients who have had an observation encounter.
        Inclusion Criteria: Includes only relevant concepts associated with SNOMED CT codes representing inpatient encounter.
        Exclusion Criteria: No exclusions.

        Constrained to codes in the Encounter, Performed: Observation Services value set (2.16.840.1.113762.1.4.1111.143)

        QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

        Encounter, Performed

        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.

        The "Encounter, Performed" participant references the primary participant.

        Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

        A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here

        Timing:

        • The relevantPeriod addresses:
          • startTime - The time the encounter began (admission time).
          • stopTime - The time the encounter ended (discharge time).
        • author dateTime references the time the action was recorded.
        • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

        Notes:

        • negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.
        • The locationPeriod is an attribute of the attribute facility location that addresses:
          • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
          • stopTime - the time the patient departed from the location.
        Value Set Description from VSAC
        Clinical Focus: This value set contains concepts that represent care regimes used to define comfort measure care.
        Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Intervention. The intent of this data element is to identify patients receiving comfort measure care.
        Inclusion Criteria: Includes only relevant concepts associated with SNOMED CT regime and therapy codes for comfort measures, terminal care, dying care and hospice care.
        Exclusion Criteria: Exclude diagnosis codes that identify patients with Palliative Care.

        Constrained to codes in the Intervention, Order: Comfort Measures value set (1.3.6.1.4.1.33895.1.3.0.45)

        QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

        Intervention, Order

        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.

        Note: negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.

        Value Set Description from VSAC
        Clinical Focus: This value set contains concepts that represent care regimes used to define comfort measure care.
        Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Intervention. The intent of this data element is to identify patients receiving comfort measure care.
        Inclusion Criteria: Includes only relevant concepts associated with SNOMED CT regime and therapy codes for comfort measures, terminal care, dying care and hospice care.
        Exclusion Criteria: Exclude diagnosis codes that identify patients with Palliative Care.

        Constrained to codes in the Intervention, Performed: Comfort Measures value set (1.3.6.1.4.1.33895.1.3.0.45)

        QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

        Intervention, Performed

        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:

        • relevant dateTime references the time the intervention is performed when the intervention occurs at a single point in time.
        • relevantPeriod references a start and stop time for an intervention that occurs over a time interval. relevantPeriod addresses:
          • startTime - The time the intervention begins.
          • stopTime - The time the intervention ends.
        • author dateTime references the time the action was recorded.
        • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

        Notes:

        • 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.
        • negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.
           
        Value Set Description from VSAC
        Clinical Focus: This value set contains concepts that represent codes for laboratory test for INR, or international normalized ratio.
        Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Laboratory Test. The intent of this data element is to identify INR laboratory tests.
        Inclusion Criteria: Includes only relevant concepts associated with a laboratory test of INR (International Normalized Ratio). These are LOINC codes.
        Exclusion Criteria: No exclusions.

        Constrained to codes in the Laboratory Test, Performed: INR value set (2.16.840.1.113883.3.117.1.7.1.213)

        QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

        Laboratory Test, Performed

        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.

        A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.    

        Timing:

        • relevant dateTime references the time the laboratory test is performed when the laboratory test occurs at a single point in time.
        • relevantPeriod references a start and stop time for a laboratory test that occurs over a time interval. relevantPeriod addresses:
          • startTime - The time the laboratory test begins.
          • stopTime - The time the laboratory test ends.
        • author dateTime references the time the action was recorded.
        • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

        Examples:

        • Initiation of a venipuncture for a fasting blood glucose to the time venipuncture for the fasting blood glucose is completed – use relevant dateTime to reference this single point in time for many specimen collections
        • Initiation of a 24-hour urine collection for measured creatinine clearance until completion of the 24-hour urine collection – use relevantPeriod to reference the start to stop time for this event.

        Notes:

        • The time that the result report is available is a separate attribute than the time of the study (specimen collection).
        • negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.
        Value Set Description from VSAC
        Clinical Focus: This value set contains concepts that represent anticoagulant and antiplatelet medications used to reduce stroke mortality and morbidity.
        Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Medication. The intent of this data element is to identify patients who receive antithrombotic therapy following stroke.
        Inclusion Criteria: Includes only relevant concepts associated with single and multi-ingredient drugs. Oral, rectal, and injectable dose forms should be included. Antithrombotic medications includes only relevant concepts associated with anticoagulants and antiplatelet drugs.
        Exclusion Criteria: Excludes codes for enoxaparin and heparin generally given for VTE prophylaxis.

        Constrained to codes in the Medication, Administered: Antithrombotic Therapy value set (2.16.840.1.113883.3.117.1.7.1.201)

        QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

        Medication, Administered

        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:

        • relevant dateTime references the time the medication is administered if it was given or taken at a single point in time.
        • relevantPeriod references a start and stop time for medication administration if the administration event occurred over a time interval (e.g., an intravenous infusion). The relevantPeriod addresses:
          • startTime - when a single medication administration event starts (e.g., the initiation of an intravenous infusion).
          • stopTime - when a single medication administration event ends (e.g., the end time of the intravenous infusion).
        • author dateTime references the time the action was recorded.
        • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

        Notes:

        • Measure developers should address multiple administrations over a period of time using CQL logic.
        • negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.

        Refer to Special Cases in Appendix A (Section 5.7) for scenarios to consider in calculating cumulative medication duration.
         

        Value Set Description from VSAC
        Clinical Focus: This value set contains concepts that represents pharmacological contraindications for antithrombotic therapy.
        Data Element Scope: This value set may use Quality Data Model (QDM) category related to represents pharmacological contraindications for antithrombotic therapy.
        Inclusion Criteria: This is a grouping value set of RXNORM codes.
        Exclusion Criteria: n/a

        Constrained to codes in the Medication, Administered: Pharmacological Contraindications For Antithrombotic Therapy value set (2.16.840.1.113762.1.4.1110.52)

        QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

        Medication, Administered

        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:

        • relevant dateTime references the time the medication is administered if it was given or taken at a single point in time.
        • relevantPeriod references a start and stop time for medication administration if the administration event occurred over a time interval (e.g., an intravenous infusion). The relevantPeriod addresses:
          • startTime - when a single medication administration event starts (e.g., the initiation of an intravenous infusion).
          • stopTime - when a single medication administration event ends (e.g., the end time of the intravenous infusion).
        • author dateTime references the time the action was recorded.
        • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

        Notes:

        • Measure developers should address multiple administrations over a period of time using CQL logic.
        • negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.

        Refer to Special Cases in Appendix A (Section 5.7) for scenarios to consider in calculating cumulative medication duration.
         

        Value Set Description from VSAC
        Clinical Focus: This value set contains concepts that represent medications that are prescribed for thrombolytic (t-PA) therapy for treatment of ischemic stroke.
        Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Medication. The intent of this data element is to identify patients who are administered appropriate thrombolytic (t-PA) therapy for stroke.
        Inclusion Criteria: Includes only relevant concepts associated with RxNorm thrombolytic medications appropriate for stroke treatment consistent with administration by intravenous (IV) route.
        Exclusion Criteria: No exclusions.

        Constrained to codes in the Medication, Administered: Thrombolytic (t-PA) Therapy value set (2.16.840.1.113883.3.117.1.7.1.226)

        QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

        Medication, Administered

        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:

        • relevant dateTime references the time the medication is administered if it was given or taken at a single point in time.
        • relevantPeriod references a start and stop time for medication administration if the administration event occurred over a time interval (e.g., an intravenous infusion). The relevantPeriod addresses:
          • startTime - when a single medication administration event starts (e.g., the initiation of an intravenous infusion).
          • stopTime - when a single medication administration event ends (e.g., the end time of the intravenous infusion).
        • author dateTime references the time the action was recorded.
        • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

        Notes:

        • Measure developers should address multiple administrations over a period of time using CQL logic.
        • negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.

        Refer to Special Cases in Appendix A (Section 5.7) for scenarios to consider in calculating cumulative medication duration.
         

        Value Set Description from VSAC
        Clinical Focus: This value set contains concepts that represent anticoagulant and antiplatelet medications used to reduce stroke mortality and morbidity.
        Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Medication. The intent of this data element is to identify patients who receive antithrombotic therapy following stroke.
        Inclusion Criteria: Includes only relevant concepts associated with single and multi-ingredient drugs. Oral, rectal, and injectable dose forms should be included. Antithrombotic medications includes only relevant concepts associated with anticoagulants and antiplatelet drugs.
        Exclusion Criteria: Excludes codes for enoxaparin and heparin generally given for VTE prophylaxis.

        Constrained to codes in the Medication, Order: Antithrombotic Therapy value set (2.16.840.1.113883.3.117.1.7.1.201)

        QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

        Medication, Order

        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:

        • relevantPeriod addresses the time referenced in the dosage instruction indicating when the medication administration should start and end.
        • In the initial publication of QDM 5.5, relevantPeriod referenced the validity period, i.e., the time period for which the ordered supply is authorized by the prescription authorizing the dispensing event.
        • For clarification, see Appendix 6.4 with additional guidance for referencing relevantPeriod updating the definition for Medication, Order, "Medication Dispensed", and "Substance, Order".
        • author dateTime references the date and time the medication order (prescription) is authored.

        Notes:

        • 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 relevantPeriod start and stop times multiplied by (1 + the number of refills).
        • negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.

        Refer to Special Cases in Appendix A (Section 5.7) for scenarios to consider in calculating cumulative medication duration.

        Value Set Description from VSAC
        Clinical Focus: This value set contains concepts that represent situations that represent medical reasons for not providing treatment.
        Data Element Scope: This value set may use the Quality Data Model (QDM) attribute related to Negation Rationale or Reason. The intent of this data element is to identify medical reasons for not providing treatment.
        Inclusion Criteria: Includes only relevant concepts associated with SNOMED CT codes representing medical reasons for not providing treatment should be included.
        Exclusion Criteria: No exclusions.

        Constrained to codes in the Negation Rationale: Medical Reason value set (2.16.840.1.113883.3.117.1.7.1.473)

        QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

        Negation Rationale

        Indicates the reason that an action was not performed. Only QDM datatypes that represent actions (e.g., performed, recommended, communication, order, dispensed) allow the negation rationale attribute. The intent is to indicate a justification that such action did not happen as expected. This attribute specifically does not address the presence or absence of information in a clinical record (e.g., documented absence of allergies versus lack of documentation about allergies). QDM assumes a world view that absence of evidence indicates information does not exist or an action did not happen. To express such lack of evidence, an eCQM author should use the CQL expression not exists with reference to the data element rather than the QDM data model. negation rationale in QDM signifies only a reason for such absence, i.e., the reason must be present to qualify for negation rationale. The syntax in the human readable HQMF is addressed in CQL examples and in the MAT User Guide. Prior versions of QDM used the syntax, "Procedure, Performed not done." QDM versions starting with 5.3 use the syntax, "Procedure, not Performed." Section A-5 provides examples for expressing negation rationale in CQL.

        A QDM Known Issue has been identified related to this attribute. To see this QDM known Issue, please click here.

        Note: negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.

        Value Set Description from VSAC
        Clinical Focus: This value set contains concepts that represent situations representing a patient's refusal for treatment.
        Data Element Scope: This value set may use the Quality Data Model (QDM) attribute related to Reason. The intent of this data element is to identify reasons a patient refuses treatment.
        Inclusion Criteria: Includes only relevant concepts associated with identifying refusal of any intervention (including procedures, treatment, medication, counseling, screening).​
        Exclusion Criteria: No exclusions.

        Constrained to codes in the Negation Rationale: Patient Refusal value set (2.16.840.1.113883.3.117.1.7.1.93)

        QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

        Negation Rationale

        Indicates the reason that an action was not performed. Only QDM datatypes that represent actions (e.g., performed, recommended, communication, order, dispensed) allow the negation rationale attribute. The intent is to indicate a justification that such action did not happen as expected. This attribute specifically does not address the presence or absence of information in a clinical record (e.g., documented absence of allergies versus lack of documentation about allergies). QDM assumes a world view that absence of evidence indicates information does not exist or an action did not happen. To express such lack of evidence, an eCQM author should use the CQL expression not exists with reference to the data element rather than the QDM data model. negation rationale in QDM signifies only a reason for such absence, i.e., the reason must be present to qualify for negation rationale. The syntax in the human readable HQMF is addressed in CQL examples and in the MAT User Guide. Prior versions of QDM used the syntax, "Procedure, Performed not done." QDM versions starting with 5.3 use the syntax, "Procedure, not Performed." Section A-5 provides examples for expressing negation rationale in CQL.

        A QDM Known Issue has been identified related to this attribute. To see this QDM known Issue, please click here.

        Note: negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.

        Direct Reference Code

        Constrained to 'Birth date' LOINC code

        QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

        Patient Characteristic, Birthdate

        The "Patient Characteristic Birthdate" should document the patient’s date of birth.

        Timing: The "Patient Characteristic, Birthdate" is a single point in time representing the date and time of birth. It does not have a start and stop time.

        Note: "Patient Characteristic Birthdate" is fixed to LOINC code 21112-8 (Birth date) and therefore cannot be further qualified with a value set.

        Value Set Description from VSAC
        Clinical Focus: n/a Data Element Scope: n/a Inclusion Criteria: n/a Exclusion Criteria: n/a

        Constrained to codes in the Patient Characteristic, Ethnicity: Ethnicity value set (2.16.840.1.114222.4.11.837)

        QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

        Patient Characteristic, Ethnicity

        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.

        Value Set Description from VSAC
        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

        Constrained to codes in the Patient Characteristic, Payer: Payer value set (2.16.840.1.114222.4.11.3591)

        QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

        Patient Characteristic, Payer

        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 relevantPeriod addresses:

        • startTime – the first day of insurance coverage with the referenced payer.
        • stopTime – the last day of insurance coverage with the referenced payer.

         

        Value Set Description from VSAC
        Clinical Focus: n/a Data Element Scope: n/a Inclusion Criteria: n/a Exclusion Criteria: n/a

        Constrained to codes in the Patient Characteristic, Race: Race value set (2.16.840.1.114222.4.11.836)

        QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

        Patient Characteristic, Race

        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.

        Value Set Description from VSAC
        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.

        Constrained to codes in the Patient Characteristic, Sex: ONC Administrative Sex value set (2.16.840.1.113762.1.4.1)

        QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

        Patient Characteristic, Sex

        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.

        Value Set Description from VSAC
        Clinical Focus: This value set grouping contains concepts that represent intravenous or intra-arterial thrombolytic (t-PA) therapy procedures.
        Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Procedure. The intent of this data element is to identify intravenous or intra-arterial thrombolytic (t-PA) therapy procedures.
        Inclusion Criteria: Includes only relevant concepts associated with identifying intravenous or intra-arterial thrombolytic (t-PA) therapy procedures.
        Exclusion Criteria: No exclusions.

        Constrained to codes in the Procedure, Performed: Intravenous or Intra-arterial Thrombolytic (t-PA) Therapy value set (2.16.840.1.113762.1.4.1045.21)

        QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

        Procedure, Performed

        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.

        Two QDM Known Issues has been identified related to this datatype.

        • To see the QDM Known Issue related to QDM Procedure, Performed completion time, please click here.
        • To see the QDM Known Issue related to Differentiating Elective Vs Emergent or Urgent Procedures, please click here.

        Timing:

        • relevant dateTime references the time the procedure is performed when the procedure occurs at a single point in time.
        • relevantPeriod references a start and stop time for a procedure that occurs over a time interval. relevantPeriod addresses:
          • startTime - The time the procedure begins.
          • stopTime - The time the procedure ends.
        • author dateTime references the time the action was recorded.
        • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

        Notes:

        • 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.
        • The incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.
        • negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.
        • For clarification, see Appendix 6.6 with 2020 guidance about differentiating between successful and unsuccessful procedures.