eCQM Title

Severe Obstetric Complications

CMS ID

1028

eCQM Version Number

5.1.000

CBE Number

Not Applicable

GUID

44eb11cf-56d6-4dc2-b986-c58c72474b16

Measurement Period

January 1, 2027 through December 31, 2027

Measure Steward

Joint Commission

Measure Developer

Centers for Medicare & Medicaid Services (CMS)

Measure Developer

Joint Commission

Measure Developer

Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation

Endorsed By

None

Description

Patients with severe obstetric complications that occur during the inpatient delivery hospitalization

Measure specifications are in the Public Domain.

This material contains content from LOINC (http://loinc.org). LOINC is copyright (C) Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license at http://loinc.org/license. LOINC (R) is a registered United States trademark of Regenstrief Institute, Inc.

This material includes SNOMED Clinical Terms (R) (SNOMED CT [R]) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO). All rights reserved. SNOMED CT (R) was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.

Disclaimer

These performance measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.

Measure Scoring

Proportion

Measure Type

Outcome

Stratification

None

Risk Adjustment

Please see the Severe Obstetric Complications Risk Adjustment Methodology Report on the eCQI Resource Center: https://ecqi.healthit.gov/.

Pre-existing conditions and variables must be present on admission. Please note that present on admission codes may be extracted from billing/claims data that was entered by coding staff (Leonard et al., 2020; Main et al., 2020).

Anemia (includes sickle cell disease)
Asthma
Autoimmune Disease
Bariatric Surgery
Bleeding Disorder
Cardiac Disease
Economic Housing Instability
Gastrointestinal Disease
Gestational Diabetes
HIV
Hypertension
Long-term Anticoagulant Use
Maternal Age (derived from birthdate)
Mental Health Disorder
Morbid Obesity
Multiple Pregnancy
Neuromuscular Disease
Obstetric VTE
Other Pre-eclampsia
Placenta Previa
Placental Abruption
Placental Accreta Spectrum
Pre-existing Diabetes
Preterm Birth
Previous Cesarean
Pulmonary Hypertension
Renal Disease
Severe Pre-eclampsia
Substance Abuse
Thyrotoxicosis

Lab and Physical Exam Results: Report the first resulted value 24 hours prior to start of encounter and before time of delivery in UCUM units specified:

Heart rate: {beats}/min
Systolic blood pressure: mm[Hg]
Hematocrit: %
White blood cell count: 10*3/uL

Note regarding submission of risk variable data: The risk variable definitions are included in the specifications, and risk variable data should be sent with eCQM data in the QRDA I file. Specific risk variable templates are not needed in the QRDA I files.

Rate Aggregation

Two hospital-level measure scores are calculated as a risk-adjusted proportion reported as a rate per 10,000 delivery hospitalizations:

All Severe Obstetric Complications (SOC). ((Numerator 1 – Numerator Exclusions 1) / Denominator) * 10,000
SOC excluding encounters where transfusion was the only SOC. ((Numerator 2 – Numerator Exclusions 2) / Denominator) * 10,000

Numerator 1: Delivery encounters with SOC

Numerator 2: Delivery encounters with SOC excluding encounters where transfusion was the only SOC

Numerator Exclusions 1: Delivery encounters with blood transfusion or hysterectomy with placenta percreta, placenta increta, or placenta accreta, and no additional SOCs

Numerator Exclusions 2: Delivery encounters with SOC excluding encounters where transfusion was the only SOC with a hysterectomy or blood transfusion with a diagnosis of placenta percreta, placenta increta, or placenta accreta, and no additional SOCs

Denominator: Delivery encounters with > or = 20 weeks' gestation completed

Rationale

The United States (U.S.) experiences higher rates of maternal morbidity and mortality than most other developed countries. The Centers for Disease Control and Prevention (CDC) (2021) report that these rates have continued to trend upward in recent decades. Research indicates that the overall rate of severe maternal morbidity (SMM) increased by almost 200% between 1993 and 2014 to 144 per 10,000 delivery hospitalizations (CDC, 2021), with more than 25,000 women per year experiencing obstetric complications (U.S. Department of Health and Human Services, 2020). Recent maternal mortality data from 2018 reveal that 658 women in the US died from maternal causes, resulting in a rate of 17.4 deaths per 100,000 live births, with 77% of the deaths attributed to direct obstetric causes like hemorrhage, preeclampsia, obstetric embolism, and other complications (Hoyert & Minino, 2020). 144 per 10,000 women hospitalized for delivery have experienced SMM, including hemorrhage, embolism, hypertension, stroke, and other serious complications (CDC, 2021). Racial and ethnic disparities exist: Black women and Hispanic women are at a significantly higher risk for developing these complications than are Non-Hispanic White women (Leonard et al., 2019). Increasing rates of SMM are resulting in increased healthcare costs, longer hospitalization stays and impacts on a woman's health (Callaghan et al., 2012).

There is limited national evaluation of hospitals' performance on maternal morbidity and mortality although SMM is widely used at the population level. SMM is linked to maternal mortality, varies significantly among hospitals, and has significant racial/ethnic and urban/rural disparities. SMM is a cost driver for both Medicaid and commercial plans. This measure is important as it will assist in the discovery and understanding of SMM patterns that can lead to improvements in the safety and quality of maternal care necessary to reduce SMM rates.

Clinical Recommendation Statement

Healthy People 2030 Measure (MICH-05): Reduce severe maternal complications identified during delivery hospitalizations (U.S. Department of Health and Human Services, n.d.).

The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine recommend identifying potential cases of severe maternal morbidity for further review, with a focus on outcomes and complications, and consider this an important step toward promoting safe obstetric care (American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine et al., 2016).

Improvement Notation

Decreased score indicates improvement

Reference

Reference Type: Citation

Reference Text:

American College of Obstetricians & Gynecologists. (2014). ReVITALize: Obstetrics data definitions. https://www.acog.org/practice-management/health-it-and-clinical-informatics/revitalize-obstetrics-data-definitions

Reference

Reference Type: Citation

Reference Text:

American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine, Kilpatrick, S. K., & Ecker, J. L. (2016). Severe maternal morbidity: Screening and review. American Journal of Obstetrics & Gynecology, 215(3), B17–B22. https://doi.org/10.1016/j.ajog.2016.07.050

Reference

Reference Type: Citation

Reference Text:

American College of Obstetricians and Gynecologists, & Society for Maternal-Fetal Medicine. (2018). Obstetric care consensus no. 7: Placenta accreta spectrum. Obstetrics & Gynecology, 132(6), e259–e275. https://doi.org/10.1097/AOG.0000000000002983

Reference

Reference Type: Citation

Reference Text:

Callaghan, W. M., Creanga, A. A., & Kuklina, E. V. (2012). Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstetrics and Gynecology, 120(5), 1029–1036. https://doi.org/10.1097/aog.0b013e31826d60c5

Reference

Reference Type: Citation

Reference Text:

Centers for Disease Control and Prevention. (2021). Severe maternal morbidity in the United States. Division of Reproductive Health. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html

Reference

Reference Type: Citation

Reference Text:

Hoyert, D. L., & Minino, A. M. (2020). Maternal mortality in the United States: Changes in coding, publication, and data release, 2018. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 69(2), 1–18.

Reference

Reference Type: Citation

Reference Text:

Leonard, S. A., Kennedy, C. J., Carmichael, S. L., Lyell, D. J., & Main, E. K. (2020). An expanded obstetric comorbidity scoring system for predicting severe maternal morbidity. Obstetrics and Gynecology, 136(3), 440–449. https://doi.org/10.1097/AOG.0000000000004022

Reference

Reference Type: Citation

Reference Text:

Leonard, S. A., Main, E. K., & Carmichael, S. L. (2019). The contribution of maternal characteristics and cesarean delivery to an increasing trend of severe maternal morbidity. BMC Pregnancy and Childbirth, 19(1), 16. https://doi.org/10.1186/s12884-018-2169-3

Reference

Reference Type: Citation

Reference Text:

Leonard, S. A., Main, E. K., Scott, K. A., Profit, J., & Carmichael, S. L. (2019). Racial and ethnic disparities in severe maternal morbidity prevalence and trends. Annals of Epidemiology, 33, 30–36. https://doi.org/10.1016/j.annepidem.2019.02.007

Reference

Reference Type: Citation

Reference Text:

Main, E. K., Leonard, S. A., & Menard, M. K. (2020). Association of maternal comorbidity with severe maternal morbidity: A cohort study of California mothers delivering between 1997 and 2014. Annals of Internal Medicine, 173(11 Suppl), S11–S18. https://doi.org/10.7326/M19-3253

Reference

Reference Type: Citation

Reference Text:

U.S. Department of Health and Human Services. (2020). The Surgeon General's call to action to improve maternal health. https://www.hhs.gov/sites/default/files/call-to-action-maternal-health.pdf

Reference

Reference Type: Citation

Reference Text:

U.S. Department of Health and Human Services. (n.d.). Reduce severe maternal complications identified during delivery hospitalizations - MICH-05. Healthy People 2030. https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/reduce-severe-maternal-complications-identified-during-delivery-hospitalizations-mich-05

Definition

For this measure, specifications are modeled after the nationally available and adopted CDC definition for Severe Maternal Morbidity (SMM) with the addition of maternal mortality. At times, we may refer to the CDC indicators of morbidity as SMM, but the outcome of the measure, which includes morbidity and mortality, is referred to as Severe Obstetric Complications (SOC).

Guidance

In the case of multiple births, map the first delivery date/time (Baby A) as the delivery date/time for the encounter.

This measure allows for 3 approaches to determine gestational age (GA) in the following order of precedence:

The GA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.*
When the calculated GA is not available, the GA is obtained from a discrete field in the electronic health record. The intent is to capture the last estimated GA in the interval starting 24 hours or less prior to delivery and ending before midnight on the same day of delivery.
The GA is based on ICD10 or SNOMED codes indicative of weeks gestation. This option is only used when results from items #1 and #2 (see above) are not available.

*ACOG ReVITALize Guidelines for Calculating Gestational Age (ACOG, 2014):
Gestational Age = (280-(Estimated Due Date minus Reference Date))/7

Estimated Due Date (EDD): The best obstetrical EDD is determined by last menstrual period if confirmed by early ultrasound or no ultrasound performed, or early ultrasound if no known last menstrual period or the ultrasound is not consistent with last menstrual period, or known date of fertilization (e.g., assisted reproductive technology). The logic will look for the most up to date EDD that is clinically used to estimate gestational age.
Reference Date is the date on which you are trying to determine gestational age. For purposes of this eCQM, Reference Date would be the Date of Delivery.

Note however, the calculation may yield a non-whole number, and gestational age should be rounded down to the nearest completed 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.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

Transmission Format

TBD

Initial Population

Inpatient hospitalizations for patients age >= 8 years and < 65 admitted to the hospital for inpatient acute care who undergo a delivery procedure with a discharge date that ends during the measurement period

Denominator

Inpatient hospitalizations for patients delivering stillborn or live birth with >= 20 weeks, 0 days gestation completed

Denominator Exclusions

None

Numerator

Numerator 1: All SOCs.

Inpatient hospitalizations for patients with SOCs (not present on admission that occur during the current delivery encounter) including the following:

Severe maternal morbidity diagnoses (see list below)
Severe maternal morbidity procedures (see list below)
Discharge disposition of expired

Please note that present on admission codes may be extracted from billing/claims data that was entered by coding staff.

Severe Maternal Morbidity Diagnoses:

Cardiac
- Acute heart failure
- Acute myocardial infarction
- Aortic aneurysm
- Cardiac arrest/ventricular fibrillation Heart failure/arrest during procedure or surgery
Hemorrhage
- Disseminated intravascular coagulation
- Shock
Renal
- Acute renal failure
Respiratory
- Adult respiratory distress syndrome
- Pulmonary edema
Sepsis
Other OB
- Air and thrombotic embolism
- Amniotic fluid embolism
- Eclampsia
- Severe anesthesia complications
Other Medical
- Puerperal cerebrovascular disorder
- Sickle cell disease with crisis

Severe Maternal Morbidity Procedures:

Blood transfusion
Conversion of cardiac rhythm
Hysterectomy
Temporary tracheostomy
Ventilation

Numerator 2: Delivery encounters with SOC excluding encounters where transfusion was the only SOC.

Inpatient hospitalizations for patients with SOCs (not present on admission that occur during the current delivery encounter) including the following:

Severe maternal morbidity diagnoses (see list below)
Severe maternal morbidity procedures (see list below)
Discharge disposition of expired

Please note that present on admission codes may be extracted from billing/claims data that was entered by coding staff.

Severe Maternal Morbidity Diagnoses:

Cardiac
- Acute heart failure
- Acute myocardial infarction
- Aortic aneurysm
- Cardiac arrest/ventricular fibrillation
- Heart failure/arrest during procedure or surgery
Hemorrhage
- Disseminated intravascular coagulation
- Shock
Renal
- Acute renal failure
Respiratory
- Adult respiratory distress syndrome
- Pulmonary edema
Sepsis
Other OB
- Air and thrombotic embolism
- Amniotic fluid embolism
- Eclampsia
- Severe anesthesia complications
Other Medical
- Puerperal cerebrovascular disorder
- Sickle cell disease with crisis

Severe Maternal Morbidity Procedures:

Blood transfusion
Conversion of cardiac rhythm
Hysterectomy
Temporary tracheostomy
Ventilation

Numerator Exclusions

Numerator Exclusion 1: Inpatient hospitalizations with blood transfusion or hysterectomy with a diagnosis of placenta percreta, placenta increta, or placenta accreta, and no additional severe obstetrical complications

Numerator Exclusion 2: Inpatient hospitalizations with SOC excluding encounters where transfusion was the only SOC, with a hysterectomy or blood transfusion with a diagnosis of placenta percreta, placenta increta, or placenta accreta, and no additional severe obstetrical complications

Denominator Exceptions

None

Supplemental Data Elements

For every patient evaluated by this measure also identify payer, race, ethnicity and sex. No additional supplemental data elements are required to be submitted by reporting entities; all other needed data points are calculated following data receipt.

Population Criteria
Definitions
Functions
Terminology
Data Criteria (QDM Data Elements)
Supplemental Data Elements
Risk Adjustment Variables

Population Criteria

Population Criteria 1

Initial Population

  PCMaternal."Delivery Encounter With Age Range"

Denominator

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation"

- Denominator Exclusions
  - None

Numerator

  "Delivery Encounter With Severe Obstetric Complications"

Numerator Exclusions

  "SOC With Hysterectomy Or Blood Transfusion With Placenta Increta, Placenta Percreta, Or Placenta Accreta Without Additional SOC"

- Denominator Exceptions
  - None
- Stratification
  - None

Population Criteria 2

Initial Population

  PCMaternal."Delivery Encounter With Age Range"

Denominator

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation"

- Denominator Exclusions
  - None

Numerator

  "Delivery Encounter With Severe Obstetric Complications Excluding Blood Transfusions Only"

Numerator Exclusions

  "SOC Excluding Blood Transfusions Only With Hysterectomy Or Blood Transfusion With Placenta Increta, Placenta Percreta, Or Placenta Accreta Without Additional SOC"

- Denominator Exceptions
  - None
- Stratification
  - None

Definitions

Cardiac Conversion, Tracheostomy Or Ventilation Procedures

  ["Procedure, Performed": "Conversion of Cardiac Rhythm"]
    union ["Procedure, Performed": "Tracheostomy"]
    union ["Procedure, Performed": "Ventilation"]

Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation

  "Delivery Encounter With Calculated Gestational Age Greater Than Or Equal To 20 Weeks"
    union "Delivery Encounter With Estimated Gestational Age Assessment Greater Than Or Equal To 20 Weeks"
    union "Delivery Encounter With Gestational Age Greater Than Or Equal To 20 Weeks Based On Coding"

Delivery Encounter With Blood Transfusion

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    with ["Procedure, Performed": "Blood Transfusion"] BloodTransfusionProcedure
      such that Global."NormalizeInterval" ( BloodTransfusionProcedure.relevantDatetime, BloodTransfusionProcedure.relevantPeriod ) starts during PCMaternal."HospitalizationWithEDOBTriageObservation" ( TwentyWeeksPlusEncounter )

Delivery Encounter With Calculated Gestational Age Greater Than Or Equal To 20 Weeks

  PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
    where PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ) >= 20

Delivery Encounter With Cardiac Conversion, Tracheostomy Or Ventilation Procedures

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    with "Cardiac Conversion, Tracheostomy Or Ventilation Procedures" ConvTrachVentProcedures
      such that Global."NormalizeInterval" ( ConvTrachVentProcedures.relevantDatetime, ConvTrachVentProcedures.relevantPeriod ) starts during PCMaternal."HospitalizationWithEDOBTriageObservation" ( TwentyWeeksPlusEncounter )

Delivery Encounter With Estimated Gestational Age Assessment Greater Than Or Equal To 20 Weeks

  PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
    where PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ) is null
      and ( PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter ) >= 20 weeks )

Delivery Encounter With Expiration

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.dischargeDisposition in "Patient Expired"

Delivery Encounter With Gestational Age Greater Than Or Equal To 20 Weeks Based On Coding

  PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
    let CGA: PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ),
    EGA: PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter )
    where CGA is null
      and EGA is null
      and exists ( DeliveryEncounter.diagnoses EncounterDiagnoses
          where EncounterDiagnoses.code in "20 to 42 Plus Weeks Gestation"
      )

Delivery Encounter With Hysterectomy

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    with ["Procedure, Performed": "Hysterectomy"] HysterectomyProcedure
      such that Global."NormalizeInterval" ( HysterectomyProcedure.relevantDatetime, HysterectomyProcedure.relevantPeriod ) starts during PCMaternal."HospitalizationWithEDOBTriageObservation" ( TwentyWeeksPlusEncounter )

Delivery Encounter With Severe Obstetric Complications

  "Delivery Encounter With Severe Obstetric Complications Diagnosis Or Procedure Excluding Blood Transfusion"
    union "Delivery Encounter With Expiration"
    union "Delivery Encounter With Blood Transfusion"

Delivery Encounter With Severe Obstetric Complications Diagnosis Or Procedure Excluding Blood Transfusion

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsNoOrUTD"(TwentyWeeksPlusEncounter).code in "Severe Maternal Morbidity Diagnoses"
    
      or exists ( ["Procedure, Performed": "Severe Maternal Morbidity Procedures"] SMMProcedures
          where Global."NormalizeInterval" ( SMMProcedures.relevantDatetime, SMMProcedures.relevantPeriod ) starts during PCMaternal."HospitalizationWithEDOBTriageObservation" ( TwentyWeeksPlusEncounter )
      )

Delivery Encounter With Severe Obstetric Complications Excluding Blood Transfusions

  "Delivery Encounter With Severe Obstetric Complications Diagnosis Or Procedure Excluding Blood Transfusion"
    union "Delivery Encounter With Expiration"

Delivery Encounter With Severe Obstetric Complications Excluding Blood Transfusions Only

  "Delivery Encounter With Severe Obstetric Complications"
    intersect "Delivery Encounter With Severe Obstetric Complications Excluding Blood Transfusions"

Denominator

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation"

Global.Inpatient Encounter

  ["Encounter, Performed": "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.relevantPeriod ends during day of "Measurement Period"

Initial Population

  PCMaternal."Delivery Encounter With Age Range"

Numerator 1

  "Delivery Encounter With Severe Obstetric Complications"

Numerator 2

  "Delivery Encounter With Severe Obstetric Complications Excluding Blood Transfusions Only"

Numerator Exclusion 1

  "SOC With Hysterectomy Or Blood Transfusion With Placenta Increta, Placenta Percreta, Or Placenta Accreta Without Additional SOC"

Numerator Exclusion 2

  "SOC Excluding Blood Transfusions Only With Hysterectomy Or Blood Transfusion With Placenta Increta, Placenta Percreta, Or Placenta Accreta Without Additional SOC"

PCMaternal.Delivery Encounter With Age Range

  "Encounter With Age Range" EncounterWithAge
    with ["Procedure, Performed": "Delivery Procedures"] DeliveryProcedure
      such that Global."NormalizeInterval" ( DeliveryProcedure.relevantDatetime, DeliveryProcedure.relevantPeriod ) starts during "HospitalizationWithEDOBTriageObservation"(EncounterWithAge)

PCMaternal.Encounter With Age Range

  Global."Inpatient Encounter" InpatientEncounter
    where AgeInYearsAt(date from start of InpatientEncounter.relevantPeriod) >= 8
      and AgeInYearsAt(date from start of InpatientEncounter.relevantPeriod) < 65

PCMaternal.Variable Calculated Gestational Age

  //This definition establishes a variable of CGA (Calculated Gestational Age).  CGA is a supplemental data element to store the calculated gestational age result from the "CalculatedGestationalAge" function.  The data element enables the capturing and saving of the CGA for data analysis post data receipt. Hospitals do not need to submit any additional data to comply with this definition.  
  
  "Delivery Encounter With Age Range" DeliveryEncounter
    let CGA: "CalculatedGestationalAge"(DeliveryEncounter)
    return { DeliveryEncounter, CGA }

Risk Variable Anemia

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Anemia"

Risk Variable Asthma

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Acute or Persistent Asthma"

Risk Variable Autoimmune Disease

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Autoimmune Disease"

Risk Variable Bariatric Surgery

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Bariatric Surgery"

Risk Variable Bleeding Disorder

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Bleeding Disorder"

Risk Variable Cardiac Disease

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Cardiac Disease"

Risk Variable Economic Housing Instability

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Economic Housing Instability"

Risk Variable First Heart Rate

    "FirstPhysicalExamWithEncounterId"(["Physical Exam, Performed": "Heart rate"] HeartRateExam
      where HeartRateExam.result.unit = '{beats}/min')

Risk Variable First Hematocrit Lab

    "FirstLabTestWithEncounterId"(["Laboratory Test, Performed": "Hematocrit Lab Test"])

Risk Variable First Systolic Blood Pressure

    "FirstPhysicalExamWithEncounterId"(["Physical Exam, Performed": "Systolic blood pressure"] SystolicBP
      where SystolicBP.result.unit = 'mm[Hg]')

Risk Variable First White Blood Cell Count

    "FirstLabTestWithEncounterId"(["Laboratory Test, Performed": "White Blood Cells Count Lab Test"])

Risk Variable Gastrointestinal Disease

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Gastrointestinal Disease"

Risk Variable Gestational Diabetes

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Gestational Diabetes"

Risk Variable HIV

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "HIV in Pregnancy Childbirth and Puerperium"

Risk Variable Hypertension

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Hypertension"

Risk Variable Long Term Anticoagulant Use

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Long Term Anticoagulant Use"

Risk Variable Maternal Age

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    let MaternalAge: AgeInYearsAt(date from start of TwentyWeeksPlusEncounter.relevantPeriod)
    return { TwentyWeeksPlusEncounter, MaternalAge }

Risk Variable Mental Health Disorder

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Mental Health Disorder"

Risk Variable Morbid Obesity

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Morbid or Severe Obesity"

Risk Variable Multiple Pregnancy

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Multiple Pregnancy"

Risk Variable Neuromuscular Disease

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Neuromuscular Disease"

Risk Variable Obstetrical VTE

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Venous Thromboembolism in Pregnancy"

Risk Variable Other Preeclampsia

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Mild or Moderate Preeclampsia"

Risk Variable Placenta Previa

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Placenta Previa"

Risk Variable Placental Abruption

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Placental Abruption"

Risk Variable Placental Accreta Spectrum

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Placenta Accreta"
      or "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Placenta Increta or Percreta"

Risk Variable Preexisting Diabetes

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Preexisting Diabetes"

Risk Variable Preterm Birth

  //CGA stands for Calculated Gestational Age.  EGA stands for Estimated Gestational Age.
  
  ( PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
      let CGA: PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ),
      EGA: PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter )
      where CGA in Interval[20, 36]
        or ( CGA is null
            and ( EGA >= 20 weeks
                and EGA <= 36 weeks
            )
        )
  )
    union ( PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
        let CGA: PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ),
        EGA: PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter )
        where CGA is null
          and EGA is null
          and "POAIsYesOrExempt"(DeliveryEncounter).code in "Preterm Birth"
    )

Risk Variable Previous Cesarean

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Previous Cesarean"

Risk Variable Pulmonary Hypertension

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Pulmonary Hypertension"

Risk Variable Renal Disease

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Renal Disease"

Risk Variable Severe Preeclampsia

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Severe Preeclampsia"

Risk Variable Substance Abuse

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Substance Abuse"

Risk Variable Thyrotoxicosis

  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Thyrotoxicosis"

SDE Delivery Encounters With Severe Obstetric Complication Diagnosis

  ( "Delivery Encounter With Severe Obstetric Complications"
    except "SOC With Hysterectomy Or Blood Transfusion With Placenta Increta, Placenta Percreta, Or Placenta Accreta Without Additional SOC" ) Encounter
    where "POAIsNoOrUTD"(Encounter).code in "Severe Maternal Morbidity Diagnoses"

SDE Delivery Encounters With Severe Obstetric Complication Procedures

  ( "Delivery Encounter With Severe Obstetric Complications"
    except "SOC With Hysterectomy Or Blood Transfusion With Placenta Increta, Placenta Percreta, Or Placenta Accreta Without Additional SOC" ) Encounter
    where exists ( ["Procedure, Performed": "Severe Maternal Morbidity Procedures"]
      union ["Procedure, Performed": "Blood Transfusion"] ) SMMProcedures
      where Global."NormalizeInterval" ( SMMProcedures.relevantDatetime, SMMProcedures.relevantPeriod ) starts during PCMaternal."HospitalizationWithEDOBTriageObservation" ( Encounter )

SDE Ethnicity

  ["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

  ["Patient Characteristic Payer": "Payer Type"]

SDE Race

  ["Patient Characteristic Race": "Race"]

SDE Sex

  ["Patient Characteristic Sex": "Federal Administrative Sex"]

SDE SOC Diagnoses Detail

  "SDE Delivery Encounters With Severe Obstetric Complication Diagnosis" Encounter
    let complication: "POAIsNoOrUTD"(Encounter)
    return {
      id: Encounter.id,
      code: Encounter.code,
      complications: complication C
        where C.code in "Severe Maternal Morbidity Diagnoses"
        return {
          code: C,
          SOCDxCategory: "SOCDxCategory"(C)
        }
    }

SDE SOC Procedure Detail

  "SDE Delivery Encounters With Severe Obstetric Complication Procedures" Encounter
    let procedure: "SOCProcedures"(Encounter)
    return {
      id: Encounter.id,
      code: Encounter.code,
      procedures: procedure P
        return {
          code: P,
          SOCProcedureCategory: "SOCProcedureCategory"(P)
        }
    }

SDE Variable Calculated Gestational Age

  //This definition establishes a variable of CGA (Calculated Gestational Age).  CGA is a supplemental data element to store the calculated gestational age result from the "CalculatedGestationalAge" function.  The data element enables the capturing and saving of the CGA for data analysis post data receipt. Hospitals do not need to submit any additional data to comply with this definition. 
  
  PCMaternal."Variable Calculated Gestational Age"

SOC Excluding Blood Transfusions Only With Hysterectomy Or Blood Transfusion With Placenta Increta, Placenta Percreta, Or Placenta Accreta Without Additional SOC

  ( "Delivery Encounter With Severe Obstetric Complications Excluding Blood Transfusions Only" SOCExcludingTransfusion
      where exists ( SOCExcludingTransfusion.diagnoses EncounterDiagnoses
          where (EncounterDiagnoses.code in "Placenta Increta or Percreta"
            or EncounterDiagnoses.code in "Placenta Accreta")
      )
        and ( exists "Delivery Encounter With Blood Transfusion"
            or exists "Delivery Encounter With Hysterectomy"
        )
  )
  //The following logic keeps encounter in the numerator if there is an additional SOC besides Blood Transfusion or Hysterectomy
    
    except ( ( "Delivery Encounter With Severe Obstetric Complications Excluding Blood Transfusions Only" SOCExcludingTransfusion
          where ( "POAIsNoOrUTD"(SOCExcludingTransfusion).code in "Severe Maternal Morbidity Diagnoses" )
      )
        union "Delivery Encounter With Cardiac Conversion, Tracheostomy Or Ventilation Procedures"
        union "Delivery Encounter With Expiration"
    )

SOC With Hysterectomy Or Blood Transfusion With Placenta Increta, Placenta Percreta, Or Placenta Accreta Without Additional SOC

  ( "Delivery Encounter With Severe Obstetric Complications" SOCEncounter
      where exists ( SOCEncounter.diagnoses EncounterDiagnoses
          where (EncounterDiagnoses.code in "Placenta Increta or Percreta"
            or EncounterDiagnoses.code in "Placenta Accreta")
      )
        and ( exists "Delivery Encounter With Blood Transfusion"
            or exists "Delivery Encounter With Hysterectomy"
        )
  )
  //The following logic keeps encounter in the numerator if there is an additional SOC besides Blood Transfusion or Hysterectomy
    
    except ( ( "Delivery Encounter With Severe Obstetric Complications" SOCEncounter
          where ( "POAIsNoOrUTD"(SOCEncounter).code in "Severe Maternal Morbidity Diagnoses" )
      )
        union "Delivery Encounter With Cardiac Conversion, Tracheostomy Or Ventilation Procedures"
        union "Delivery Encounter With Expiration"
    )

Functions

FirstLabTestWithEncounterId(LabList List<QDM.PositiveLaboratoryTestPerformed>)

  //(first resulted value 24 hours prior to start of encounter and before time of delivery)
  
  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    let FirstLab: First(LabList Lab
        where Lab.result is not null
          and Lab.resultDatetime during Interval[start of PCMaternal."HospitalizationWithEDOBTriageObservation"(TwentyWeeksPlusEncounter) - 1440 minutes, PCMaternal."LastTimeOfDelivery"(TwentyWeeksPlusEncounter))
        sort by resultDatetime
    )
    return {
      EncounterId: TwentyWeeksPlusEncounter.id,
      FirstResult: FirstLab.result as Quantity,
      Timing: FirstLab.resultDatetime
    }

FirstPhysicalExamWithEncounterId(ExamList List<QDM.PositivePhysicalExamPerformed>)

  //(first resulted value 24 hours prior to start of encounter and before time of delivery)
  
  "Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    let FirstExam: First(ExamList Exam
        where Exam.result is not null
          and Global."EarliestOf"(Exam.relevantDatetime, Exam.relevantPeriod) during Interval[start of PCMaternal."HospitalizationWithEDOBTriageObservation"(TwentyWeeksPlusEncounter) - 1440 minutes, PCMaternal."LastTimeOfDelivery"(TwentyWeeksPlusEncounter))
        sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
    )
    return {
      EncounterId: TwentyWeeksPlusEncounter.id,
      FirstResult: FirstExam.result as Quantity,
      Timing: Global."EarliestOf" ( FirstExam.relevantDatetime, FirstExam.relevantPeriod )
    }

Global.Earliest(period Interval<DateTime>)

  if ( HasStart(period)) then start of period 
    else 
  end of period

Global.EarliestOf(pointInTime DateTime, period Interval<DateTime>)
- - Earliest(NormalizeInterval(pointInTime, period))

Global.HasStart(period Interval<DateTime>)

  not ( start of period is null
      or start of period = minimum DateTime
  )

Global.NormalizeInterval(pointInTime DateTime, period Interval<DateTime>)

  if pointInTime is not null then Interval[pointInTime, pointInTime]
    else if period is not null then period 
    else null as Interval<DateTime>

PCMaternal.CalculatedGestationalAge(Encounter "Encounter, Performed")

  // Age = (280-(Estimated Delivery Date minus Reference Date/Delivery Date))/7
  
  ( 280 - ( difference in days between "LastTimeOfDelivery"(Encounter) and "LastEstimatedDeliveryDate"(Encounter) ) ) div 7

PCMaternal.HospitalizationWithEDOBTriageObservation(Encounter "Encounter, Performed")

  //HospitalizationWithEDOBTriageObservation returns the total interval from the start of any immediately prior emergency department visit or OB Triage visit through the observation visit to the discharge of the given encounter.
  
  Encounter Visit
    let ObsVisit: Last(["Encounter, Performed": "Observation Services"] LastObs
        where LastObs.relevantPeriod ends 1 hour or less on or before start of Visit.relevantPeriod
        sort by end of relevantPeriod
    ),
    VisitStart: Coalesce(start of ObsVisit.relevantPeriod, start of Visit.relevantPeriod),
    EDOBTriageVisit: Last(["Encounter, Performed": "ED Visit and OB Triage"] LastEDOBTriage
        where LastEDOBTriage.relevantPeriod ends 1 hour or less on or before VisitStart
        sort by end of relevantPeriod
    )
    return Interval[Coalesce(start of EDOBTriageVisit.relevantPeriod, VisitStart), 
        end of Visit.relevantPeriod]

PCMaternal.LastEstimatedDeliveryDate(Encounter "Encounter, Performed")

  //This function identifies the last time the Estimated Delivery Date was assessed 42 weeks or less prior to or on delivery and stores the result of that assessment. 
  
  Last(["Assessment, Performed": "Delivery date Estimated"] EstimatedDateOfDelivery
      where Global."EarliestOf"(EstimatedDateOfDelivery.relevantDatetime, EstimatedDateOfDelivery.relevantPeriod) 42 weeks or less before or on "LastTimeOfDelivery"(Encounter)
        and EstimatedDateOfDelivery.result is not null
      sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
  ).result as DateTime

PCMaternal.LastEstimatedGestationalAge(Encounter "Encounter, Performed")

  Last(["Assessment, Performed": "Estimated Gestational Age"] EstimatedGestationalAge
      let EGATiming: Global."EarliestOf"(EstimatedGestationalAge.relevantDatetime, EstimatedGestationalAge.relevantPeriod)
      where (EGATiming 24 hours or less before or on "LastTimeOfDelivery"(Encounter)
          and EstimatedGestationalAge.result is not null
      )
        or (EGATiming same day as "LastTimeOfDelivery"(Encounter)
            and EGATiming during "HospitalizationWithEDOBTriageObservation"(Encounter)
            and EstimatedGestationalAge.result is not null
        )
      sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
  ).result as Quantity

PCMaternal.LastTimeOfDelivery(Encounter "Encounter, Performed")

  Last(["Assessment, Performed": "Date and time of obstetric delivery"] TimeOfDelivery
      where Global."EarliestOf"(TimeOfDelivery.relevantDatetime, TimeOfDelivery.relevantPeriod) during "HospitalizationWithEDOBTriageObservation"(Encounter)
        and TimeOfDelivery.result as DateTime during "HospitalizationWithEDOBTriageObservation"(Encounter)
      sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
  ).result as DateTime

POAIsNoOrUTD(Encounter "Encounter, Performed")

  Encounter.diagnoses EncounterDiagnoses
    where EncounterDiagnoses.presentOnAdmissionIndicator in "Present on Admission is No or Unable To Determine"
    or EncounterDiagnoses.presentOnAdmissionIndicator is null
    return EncounterDiagnoses.code

POAIsYesOrExempt(Encounter "Encounter, Performed")

  Encounter.diagnoses EncounterDiagnoses
    where EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
    return EncounterDiagnoses.code

SOCDxCategory(Dx Code)

  case
    when Dx.code in "Acute Heart Failure" then 'Acute Heart Failure'
    when Dx.code in "Acute Myocardial Infarction" then 'Acute Myocardial Infarction'
    when Dx.code in "Acute Renal Failure" then 'Acute Renal Failure'
    when Dx.code in "Acute Respiratory Distress Syndrome" then 'Acute Respiratory Distress Syndrome'
    when Dx.code in "Air and Thrombotic Embolism" then 'Air and Thrombotic Embolism'
    when Dx.code in "Amniotic Fluid Embolism" then 'Amniotic Fluid Embolism'
    when Dx.code in "Aortic Aneurysm" then 'Aortic Aneurysm'
    when Dx.code in "Cardiac Arrest Ventricular Fibrillation" then 'Cardiac Arrest Ventricular Fibrillation'
    when Dx.code in "Disseminated Intravascular Coagulation" then 'Disseminated Intravascular Coagulation'
    when Dx.code in "Eclampsia" then 'Eclampsia'
    when Dx.code in "Heart Failure Cardiac Arrest Related to Procedure or Surgery" then 'Heart Failure Cardiac Arrest Related to Procedure or Surgery'
    when Dx.code in "Puerperal Cerebrovascular Disorder" then 'Puerperal Cerebrovascular Disorder'
    when Dx.code in "Pulmonary Edema" then 'Pulmonary Edema'
    when Dx.code in "Sepsis" then 'Sepsis'
    when Dx.code in "Severe Anesthesia Complications" then 'Severe Anesthesia Complications'
    when Dx.code in "Shock" then 'Shock'
    when Dx.code in "Sickle Cell Disease with Crisis" then 'Sickle Cell Disease with Crisis' 
    else null end

SOCProcedureCategory(Procedure "Procedure, Performed")

  case
    when Procedure.code in "Blood Transfusion" then 'Blood Transfusion'
    when Procedure.code in "Conversion of Cardiac Rhythm" then 'Conversion of cardiac rhythm'
    when Procedure.code in "Hysterectomy" then 'Hysterectomy'
    when Procedure.code in "Tracheostomy" then 'Tracheostomy'
    when Procedure.code in "Ventilation" then 'Ventilation' 
    else null end

SOCProcedures(Encounter "Encounter, Performed")

  ( ["Procedure, Performed": "Severe Maternal Morbidity Procedures"]
    union ["Procedure, Performed": "Blood Transfusion"] ) SMMProcedures
    where Global."NormalizeInterval" ( SMMProcedures.relevantDatetime, SMMProcedures.relevantPeriod ) starts during PCMaternal."HospitalizationWithEDOBTriageObservation" ( Encounter )

Terminology

code "Date and time of obstetric delivery" ("LOINC Code (93857-1)")
code "Delivery date Estimated" ("LOINC Code (11778-8)")
code "Heart rate" ("LOINC Code (8867-4)")
code "Systolic blood pressure" ("LOINC Code (8480-6)")
valueset "20 to 42 Plus Weeks Gestation" (2.16.840.1.113762.1.4.1110.67)
valueset "Acute Heart Failure" (2.16.840.1.113762.1.4.1029.233)
valueset "Acute Myocardial Infarction" (2.16.840.1.113883.3.666.5.623)
valueset "Acute or Persistent Asthma" (2.16.840.1.113883.3.117.1.7.1.271)
valueset "Acute Renal Failure" (2.16.840.1.113762.1.4.1110.53)
valueset "Acute Respiratory Distress Syndrome" (2.16.840.1.113762.1.4.1029.214)
valueset "Air and Thrombotic Embolism" (2.16.840.1.113762.1.4.1029.243)
valueset "Amniotic Fluid Embolism" (2.16.840.1.113762.1.4.1029.217)
valueset "Anemia" (2.16.840.1.113762.1.4.1029.323)
valueset "Aortic Aneurysm" (2.16.840.1.113762.1.4.1029.219)
valueset "Autoimmune Disease" (2.16.840.1.113762.1.4.1029.311)
valueset "Bariatric Surgery" (2.16.840.1.113762.1.4.1029.317)
valueset "Bleeding Disorder" (2.16.840.1.113762.1.4.1029.287)
valueset "Blood Transfusion" (2.16.840.1.113762.1.4.1029.213)
valueset "Cardiac Arrest Ventricular Fibrillation" (2.16.840.1.113762.1.4.1029.221)
valueset "Cardiac Disease" (2.16.840.1.113762.1.4.1029.341)
valueset "Conversion of Cardiac Rhythm" (2.16.840.1.113762.1.4.1029.357)
valueset "Delivery Procedures" (2.16.840.1.113762.1.4.1045.59)
valueset "Disseminated Intravascular Coagulation" (2.16.840.1.113762.1.4.1029.223)
valueset "Eclampsia" (2.16.840.1.113762.1.4.1029.225)
valueset "Economic Housing Instability" (2.16.840.1.113762.1.4.1029.292)
valueset "ED Visit and OB Triage" (2.16.840.1.113762.1.4.1029.369)
valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
valueset "Estimated Gestational Age" (2.16.840.1.113762.1.4.1045.26)
valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
valueset "Federal Administrative Sex" (2.16.840.1.113762.1.4.1021.121)
valueset "Gastrointestinal Disease" (2.16.840.1.113762.1.4.1029.338)
valueset "Gestational Diabetes" (2.16.840.1.113762.1.4.1029.269)
valueset "Heart Failure Cardiac Arrest Related to Procedure or Surgery" (2.16.840.1.113762.1.4.1029.227)
valueset "Hematocrit Lab Test" (2.16.840.1.113762.1.4.1045.114)
valueset "HIV in Pregnancy Childbirth and Puerperium" (2.16.840.1.113762.1.4.1029.272)
valueset "Hypertension" (2.16.840.1.113762.1.4.1029.332)
valueset "Hysterectomy" (2.16.840.1.113762.1.4.1029.358)
valueset "Long Term Anticoagulant Use" (2.16.840.1.113762.1.4.1029.366)
valueset "Mental Health Disorder" (2.16.840.1.113762.1.4.1029.314)
valueset "Mild or Moderate Preeclampsia" (2.16.840.1.113762.1.4.1029.329)
valueset "Morbid or Severe Obesity" (2.16.840.1.113762.1.4.1029.290)
valueset "Multiple Pregnancy" (2.16.840.1.113762.1.4.1029.284)
valueset "Neuromuscular Disease" (2.16.840.1.113762.1.4.1029.308)
valueset "Observation Services" (2.16.840.1.113762.1.4.1111.143)
valueset "Patient Expired" (2.16.840.1.113883.3.117.1.7.1.309)
valueset "Payer Type" (2.16.840.1.114222.4.11.3591)
valueset "Placenta Accreta" (2.16.840.1.113762.1.4.1029.302)
valueset "Placenta Increta or Percreta" (2.16.840.1.113762.1.4.1029.388)
valueset "Placenta Previa" (2.16.840.1.113762.1.4.1110.78)
valueset "Placental Abruption" (2.16.840.1.113762.1.4.1029.305)
valueset "Preexisting Diabetes" (2.16.840.1.113762.1.4.1029.275)
valueset "Present on Admission is No or Unable To Determine" (2.16.840.1.113762.1.4.1029.370)
valueset "Present On Admission is Yes or Exempt" (2.16.840.1.113762.1.4.1110.63)
valueset "Preterm Birth" (2.16.840.1.113762.1.4.1029.299)
valueset "Previous Cesarean" (2.16.840.1.113762.1.4.1029.278)
valueset "Puerperal Cerebrovascular Disorder" (2.16.840.1.113762.1.4.1029.229)
valueset "Pulmonary Edema" (2.16.840.1.113762.1.4.1029.231)
valueset "Pulmonary Hypertension" (2.16.840.1.113762.1.4.1029.281)
valueset "Race" (2.16.840.1.114222.4.11.836)
valueset "Renal Disease" (2.16.840.1.113762.1.4.1029.335)
valueset "Sepsis" (2.16.840.1.113762.1.4.1029.237)
valueset "Severe Anesthesia Complications" (2.16.840.1.113762.1.4.1029.235)
valueset "Severe Maternal Morbidity Diagnoses" (2.16.840.1.113762.1.4.1029.255)
valueset "Severe Maternal Morbidity Procedures" (2.16.840.1.113762.1.4.1029.256)
valueset "Severe Preeclampsia" (2.16.840.1.113762.1.4.1029.327)
valueset "Shock" (2.16.840.1.113762.1.4.1029.239)
valueset "Sickle Cell Disease with Crisis" (2.16.840.1.113762.1.4.1029.241)
valueset "Substance Abuse" (2.16.840.1.113762.1.4.1029.320)
valueset "Thyrotoxicosis" (2.16.840.1.113762.1.4.1029.296)
valueset "Tracheostomy" (2.16.840.1.113762.1.4.1029.359)
valueset "Venous Thromboembolism in Pregnancy" (2.16.840.1.113762.1.4.1029.363)
valueset "Ventilation" (2.16.840.1.113762.1.4.1029.360)
valueset "White Blood Cells Count Lab Test" (2.16.840.1.113762.1.4.1045.129)

Data Criteria (QDM Data Elements)

"Assessment, Performed: Date and time of obstetric delivery" using "Date and time of obstetric delivery (LOINC Code 93857-1)"
"Assessment, Performed: Delivery date Estimated" using "Delivery date Estimated (LOINC Code 11778-8)"
"Assessment, Performed: Estimated Gestational Age" using "Estimated Gestational Age (2.16.840.1.113762.1.4.1045.26)"
"Encounter, Performed: ED Visit and OB Triage" using "ED Visit and OB Triage (2.16.840.1.113762.1.4.1029.369)"
"Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
"Encounter, Performed: Observation Services" using "Observation Services (2.16.840.1.113762.1.4.1111.143)"
"Laboratory Test, Performed: Hematocrit Lab Test" using "Hematocrit Lab Test (2.16.840.1.113762.1.4.1045.114)"
"Laboratory Test, Performed: White Blood Cells Count Lab Test" using "White Blood Cells Count Lab Test (2.16.840.1.113762.1.4.1045.129)"
"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
"Patient Characteristic Payer: Payer Type" using "Payer Type (2.16.840.1.114222.4.11.3591)"
"Patient Characteristic Race: Race" using "Race (2.16.840.1.114222.4.11.836)"
"Patient Characteristic Sex: Federal Administrative Sex" using "Federal Administrative Sex (2.16.840.1.113762.1.4.1021.121)"
"Physical Exam, Performed: Heart rate" using "Heart rate (LOINC Code 8867-4)"
"Physical Exam, Performed: Systolic blood pressure" using "Systolic blood pressure (LOINC Code 8480-6)"
"Procedure, Performed: Blood Transfusion" using "Blood Transfusion (2.16.840.1.113762.1.4.1029.213)"
"Procedure, Performed: Conversion of Cardiac Rhythm" using "Conversion of Cardiac Rhythm (2.16.840.1.113762.1.4.1029.357)"
"Procedure, Performed: Delivery Procedures" using "Delivery Procedures (2.16.840.1.113762.1.4.1045.59)"
"Procedure, Performed: Hysterectomy" using "Hysterectomy (2.16.840.1.113762.1.4.1029.358)"
"Procedure, Performed: Severe Maternal Morbidity Procedures" using "Severe Maternal Morbidity Procedures (2.16.840.1.113762.1.4.1029.256)"
"Procedure, Performed: Tracheostomy" using "Tracheostomy (2.16.840.1.113762.1.4.1029.359)"
"Procedure, Performed: Ventilation" using "Ventilation (2.16.840.1.113762.1.4.1029.360)"

Supplemental Data Elements

SDE Ethnicity

  ["Patient Characteristic Ethnicity": "Ethnicity"]

SDE SOC Diagnoses Detail

  "SDE Delivery Encounters With Severe Obstetric Complication Diagnosis" Encounter
    let complication: "POAIsNoOrUTD"(Encounter)
    return {
      id: Encounter.id,
      code: Encounter.code,
      complications: complication C
        where C.code in "Severe Maternal Morbidity Diagnoses"
        return {
          code: C,
          SOCDxCategory: "SOCDxCategory"(C)
        }
    }

SDE SOC Procedure Detail

  "SDE Delivery Encounters With Severe Obstetric Complication Procedures" Encounter
    let procedure: "SOCProcedures"(Encounter)
    return {
      id: Encounter.id,
      code: Encounter.code,
      procedures: procedure P
        return {
          code: P,
          SOCProcedureCategory: "SOCProcedureCategory"(P)
        }
    }

SDE Payer

  ["Patient Characteristic Payer": "Payer Type"]

SDE Race

  ["Patient Characteristic Race": "Race"]

SDE Sex

  ["Patient Characteristic Sex": "Federal Administrative Sex"]

SDE Variable Calculated Gestational Age

  //This definition establishes a variable of CGA (Calculated Gestational Age).  CGA is a supplemental data element to store the calculated gestational age result from the "CalculatedGestationalAge" function.  The data element enables the capturing and saving of the CGA for data analysis post data receipt. Hospitals do not need to submit any additional data to comply with this definition. 
  
  PCMaternal."Variable Calculated Gestational Age"

SDE Delivery Encounters With Severe Obstetric Complication Procedures

  ( "Delivery Encounter With Severe Obstetric Complications"
    except "SOC With Hysterectomy Or Blood Transfusion With Placenta Increta, Placenta Percreta, Or Placenta Accreta Without Additional SOC" ) Encounter
    where exists ( ["Procedure, Performed": "Severe Maternal Morbidity Procedures"]
      union ["Procedure, Performed": "Blood Transfusion"] ) SMMProcedures
      where Global."NormalizeInterval" ( SMMProcedures.relevantDatetime, SMMProcedures.relevantPeriod ) starts during PCMaternal."HospitalizationWithEDOBTriageObservation" ( Encounter )

SDE Delivery Encounters With Severe Obstetric Complication Diagnosis

  ( "Delivery Encounter With Severe Obstetric Complications"
    except "SOC With Hysterectomy Or Blood Transfusion With Placenta Increta, Placenta Percreta, Or Placenta Accreta Without Additional SOC" ) Encounter
    where "POAIsNoOrUTD"(Encounter).code in "Severe Maternal Morbidity Diagnoses"

Risk Adjustment Variables

Risk Variable Anemia

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Anemia"

Risk Variable Asthma

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Acute or Persistent Asthma"

Risk Variable Autoimmune Disease

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Autoimmune Disease"

Risk Variable Bariatric Surgery

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Bariatric Surgery"

Risk Variable Bleeding Disorder

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Bleeding Disorder"

Risk Variable Cardiac Disease

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Cardiac Disease"

Risk Variable Economic Housing Instability

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Economic Housing Instability"

Risk Variable Gastrointestinal Disease

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Gastrointestinal Disease"

Risk Variable Gestational Diabetes

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Gestational Diabetes"

Risk Variable HIV

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "HIV in Pregnancy Childbirth and Puerperium"

Risk Variable Hypertension

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Hypertension"

Risk Variable Long Term Anticoagulant Use

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Long Term Anticoagulant Use"

Risk Variable Maternal Age

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    let MaternalAge: AgeInYearsAt(date from start of TwentyWeeksPlusEncounter.relevantPeriod)
    return { TwentyWeeksPlusEncounter, MaternalAge }

Risk Variable Mental Health Disorder

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Mental Health Disorder"

Risk Variable Morbid Obesity

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Morbid or Severe Obesity"

Risk Variable Multiple Pregnancy

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Multiple Pregnancy"

Risk Variable Obstetrical VTE

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Venous Thromboembolism in Pregnancy"

Risk Variable Other Preeclampsia

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Mild or Moderate Preeclampsia"

Risk Variable Placenta Previa

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Placenta Previa"

Risk Variable Placental Abruption

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Placental Abruption"

Risk Variable Placental Accreta Spectrum

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Placenta Accreta"
      or "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Placenta Increta or Percreta"

Risk Variable Preexisting Diabetes

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Preexisting Diabetes"

Risk Variable Preterm Birth

//CGA stands for Calculated Gestational Age.  EGA stands for Estimated Gestational Age.
  
  ( PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
      let CGA: PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ),
      EGA: PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter )
      where CGA in Interval[20, 36]
        or ( CGA is null
            and ( EGA >= 20 weeks
                and EGA <= 36 weeks
            )
        )
  )
    union ( PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
        let CGA: PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ),
        EGA: PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter )
        where CGA is null
          and EGA is null
          and "POAIsYesOrExempt"(DeliveryEncounter).code in "Preterm Birth"
    )

Risk Variable Previous Cesarean

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Previous Cesarean"

Risk Variable Pulmonary Hypertension

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Pulmonary Hypertension"

Risk Variable Renal Disease

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Renal Disease"

Risk Variable Severe Preeclampsia

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Severe Preeclampsia"

Risk Variable Substance Abuse

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Substance Abuse"

Risk Variable Thyrotoxicosis

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Thyrotoxicosis"

Risk Variable Neuromuscular Disease

"Delivery Encounter At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Neuromuscular Disease"

Risk Variable First Heart Rate

"FirstPhysicalExamWithEncounterId"(["Physical Exam, Performed": "Heart rate"] HeartRateExam
      where HeartRateExam.result.unit = '{beats}/min')

Risk Variable First Systolic Blood Pressure

"FirstPhysicalExamWithEncounterId"(["Physical Exam, Performed": "Systolic blood pressure"] SystolicBP
      where SystolicBP.result.unit = 'mm[Hg]')

Risk Variable First Hematocrit Lab

"FirstLabTestWithEncounterId"(["Laboratory Test, Performed": "Hematocrit Lab Test"])

Risk Variable First White Blood Cell Count

"FirstLabTestWithEncounterId"(["Laboratory Test, Performed": "White Blood Cells Count Lab Test"])

Measure Set

Perinatal Care Maternal