eCQM Title | Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) |
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eCQM Identifier (Measure Authoring Tool) | 144 | eCQM Version Number | 9.2.000 |
NQF Number | 0083e | GUID | 8439f671-2932-4d4c-88ca-ea5faeacc89a |
Measurement Period | January 1, 20XX through December 31, 20XX | ||
Measure Steward | PCPI(R) Foundation (PCPI[R]) | ||
Measure Developer | American Medical Association (AMA) | ||
Measure Developer | PCPI(R) Foundation (PCPI[R]) | ||
Endorsed By | National Quality Forum | ||
Description |
Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed beta-blocker therapy either within a 12-month period when seen in the outpatient setting OR at each hospital discharge |
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Copyright |
Copyright 2020 American College of Cardiology, American Heart Association and American Medical Association. All Rights Reserved. |
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Disclaimer |
The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measure require a license agreement between the user and the American Medical Association (AMA), American College of Cardiology (ACC) or the American Heart Association (AHA). Neither the AMA, nor ACC, nor AHA, nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor the PCPI (R) Foundation (PCPI[R]), nor their members shall be responsible for any use of the Measure. AMA and PCPI encourage use of the Measure by other health care professionals, where appropriate. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, ACC, AHA, the PCPI and its members and former members of the AMA-PCPI disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2019 American Medical Association. LOINC(R) is copyright 2004-2019 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2019 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2019 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R]. |
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Measure Scoring | Proportion | ||
Measure Type | Process | ||
Stratification |
None |
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Risk Adjustment |
None |
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Rate Aggregation |
This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes: - Population 1: Patients who were prescribed beta-blocker therapy within a 12-month period when seen in the outpatient setting - Population 2: Patients who were prescribed beta-blocker therapy at each hospital discharge For the purposes of this measure, a single performance rate can be calculated as follows: Performance Rate = (Numerator 1 + Numerator 2)/ [(Denominator 1 - Denominator Exceptions 1) + (Denominator 2 - Denominator Exceptions 2)] |
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Rationale |
Beta-blockers are recommended for all patients with stable heart failure and left ventricular systolic dysfunction, unless contraindicated. Treatment should be initiated as soon as a patient is diagnosed with left ventricular systolic dysfunction and does not have low blood pressure, fluid overload, or recent treatment with an intravenous positive inotropic agent. Beta-blockers have been shown to lessen the symptoms of heart failure, improve the clinical status of patients, reduce future clinical deterioration, and decrease the risk of mortality and the combined risk of mortality and hospitalization. |
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Clinical Recommendation Statement |
Use of 1 of the 3 beta blockers proven to reduce mortality (e.g., bisoprolol, carvedilol, and sustained-release metoprolol succinate) is recommended for all patients with current or prior symptoms of HFrEF [heart failure with reduced ejection fraction], unless contraindicated, to reduce morbidity and mortality (Class I, Level of Evidence: A) (ACCF/AHA, 2013). Treatment with a beta blocker should be initiated at very low doses [see excerpt from guideline table below] followed by gradual increments in dose if lower doses have been well tolerated... Clinicians should make every effort to achieve the target doses of the beta blockers shown to be effective in major clinical trials. Even if symptoms do not improve, long-term treatment should be maintained to reduce the risk of major clinical events. Abrupt withdrawal of treatment with a beta blocker can lead to clinical deterioration and should be avoided (ACCF/AHA, 2013). Drugs Commonly Used for Stage C HFrEF (abbreviated to align with focus of measure to include only Beta-blocker therapy) Drug Initial Daily Dose(s) Maximum Dose(s) Mean Doses Achieved in Clinical Trials Beta Blockers Bisoprolol 1.25 mg once 10 mg once 8.6 mg/d Carvedilol 3.125 mg twice 50 mg twice 37 mg/d Carvedilol CR 10 mg once 80 mg once N/A Metoprolol succinate 12.5 to 25 mg once 200 mg once 159 mg/d extended release (metoprolol CR/XL) For the hospitalized patient: In patients with HFrEF experiencing a symptomatic exacerbation of HF requiring hospitalization during chronic maintenance treatment with GDMT [guideline-directed medical therapy; GDMT represents optimal medical therapy as defined by ACCF/AHA guideline-recommended therapies (primarily Class I)], it is recommended that GDMT be continued in the absence of hemodynamic instability or contraindications (Class I, Level of Evidence: B) (ACCF/AHA, 2013). Initiation of beta-blocker therapy is recommended after optimization of volume status and successful discontinuation of intravenous diuretics, vasodilators, and inotropic agents. Beta-blocker therapy should be initiated at a low dose and only in stable patients. Caution should be used when initiating beta blockers in patients who have required inotropes during their hospital course (Class I, Level of Evidence: B) (ACCF/AHA, 2013). |
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Improvement Notation |
Higher score indicates better quality |
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Reference |
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., … Wilkoff, B. L. (2013). 2013 ACCF/AHA Guideline for the Management of Heart Failure A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 128(16), e240–e327. doi: https://doi.org/10.1161/CIR.0b013e31829e8776 |
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Definition |
Prescribed-Outpatient setting: prescription given to the patient for beta-blocker therapy at one or more visits in the measurement period OR patient already taking beta-blocker therapy as documented in current medication list. Prescribed-Inpatient setting: prescription given to the patient for beta-blocker therapy at discharge OR beta-blocker therapy to be continued after discharge as documented in the discharge medication list. LVEF < 40% corresponds to qualitative documentation of moderate dysfunction or severe dysfunction. |
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Guidance |
This eCQM is to be reported as patient-based or episode-based, depending on the clinical setting. To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period if seen in the outpatient setting. If the patient has an eligible inpatient discharge during the measurement period, as defined in the measure logic, it is expected to be reported at each hospital discharge. A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than 40% threshold noted in the denominator logic. A range that is inclusive of or greater than 40% would not meet the measure requirement. Beta-blocker therapy: -For patients with prior LVEF < 40%, beta-blocker therapy should include bisoprolol, carvedilol, or sustained release metoprolol succinate. The requirement of two or more visits used in Population Criteria 1 is to establish that the eligible professional or eligible clinician has an existing relationship with the patient. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM. |
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Transmission Format |
TBD |
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Initial Population |
All patients aged 18 years and older with a diagnosis of heart failure |
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Denominator |
Equals Initial Population with a current or prior LVEF < 40% |
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Denominator Exclusions |
None |
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Numerator |
Patients who were prescribed beta-blocker therapy either within a 12-month period when seen in the outpatient setting OR at each hospital discharge |
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Numerator Exclusions |
Not Applicable |
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Denominator Exceptions |
Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., low blood pressure, fluid overload, asthma, patients recently treated with an intravenous positive inotropic agent, allergy, intolerance, other medical reasons). Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons). Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons attributable to the healthcare system). |
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Supplemental Data Elements |
For every patient evaluated by this measure also identify payer, race, ethnicity and sex |
exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 18 ) and Count("Qualifying Encounter During Measurement Period")>= 2 and exists "Heart Failure Outpatient Encounter"
"Initial Population 1" and exists "Heart Failure Outpatient Encounter with Moderate or Severe LVSD"
None
exists "Beta Blocker Therapy for LVSD Ordered Outpatient" or exists "Currently Taking Beta Blocker Therapy for LVSD Outpatient"
None
exists "Consecutive Heart Rates Less than 50 Outpatient" or exists "Medical Patient or System Reason for Not Ordering Beta Blocker for LVSD Outpatient" or exists "Arrhythmia Diagnosis Outpatient" or exists "Hypotension Diagnosis Outpatient" or exists "Asthma Diagnosis Outpatient" or exists "Diagnosis of Allergy or Intolerance to Beta Blocker Therapy Outpatient" or exists "Bradycardia Diagnosis Outpatient" or exists "Allergy or Intolerance to Beta Blocker Therapy Ingredient Outpatient" or "Atrioventricular Block without Cardiac Pacer Outpatient"
None
exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 18 ) and exists "Heart Failure Inpatient Encounter"
"Initial Population 2" and exists "Heart Failure Inpatient Encounter with Moderate or Severe LVSD"
None
exists "Beta Blocker Therapy for LVSD at Inpatient Discharge" or exists "Currently Taking Beta Blocker Therapy for LVSD Inpatient"
None
exists "Consecutive Heart Rates Less than 50 Inpatient" or exists "Medical Patient or System Reason for No Beta Blocker for LVSD at Inpatient Discharge" or exists "Arrhythmia Diagnosis Inpatient" or exists "Hypotension Diagnosis Inpatient" or exists "Asthma Diagnosis Inpatient" or exists "Diagnosis of Allergy or Intolerance to Beta Blocker Therapy Inpatient" or exists "Bradycardia Diagnosis Inpatient" or exists "Allergy or Intolerance to Beta Blocker Therapy Ingredient Inpatient" or "Atrioventricular Block without Cardiac Pacer Inpatient"
None
( ["Allergy/Intolerance": "Beta Blocker Therapy Ingredient"] union ["Allergy/Intolerance": "Substance with beta adrenergic receptor antagonist mechanism of action (substance)"] ) BetaBlockerAllergyIntolerance with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter such that BetaBlockerAllergyIntolerance.prevalencePeriod overlaps after ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod
( ["Allergy/Intolerance": "Beta Blocker Therapy Ingredient"] union ["Allergy/Intolerance": "Substance with beta adrenergic receptor antagonist mechanism of action (substance)"] ) BetaBlockerAllergyIntolerance with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter such that BetaBlockerAllergyIntolerance.prevalencePeriod overlaps after ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
["Diagnosis": "Arrhythmia"] Arrhythmia with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter such that Arrhythmia.prevalencePeriod overlaps ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod
["Diagnosis": "Arrhythmia"] Arrhythmia with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter such that Arrhythmia.prevalencePeriod overlaps ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
["Diagnosis": "Asthma"] Asthma with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter such that Asthma.prevalencePeriod overlaps ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod
["Diagnosis": "Asthma"] Asthma with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter such that Asthma.prevalencePeriod overlaps ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
["Diagnosis": "Atrioventricular Block"] AtrioventricularBlock with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter such that AtrioventricularBlock.prevalencePeriod overlaps ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod
["Diagnosis": "Atrioventricular Block"] AtrioventricularBlock with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter such that AtrioventricularBlock.prevalencePeriod overlaps ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
exists "Atrioventricular Block Diagnosis Inpatient" and not exists "Diagnosis of Cardiac Pacer in Situ Inpatient" and not exists "Cardiac Pacer Device Implanted Inpatient"
exists "Atrioventricular Block Diagnosis Outpatient" and not exists "Diagnosis of Cardiac Pacer in Situ Outpatient" and not exists "Cardiac Pacer Device Implanted Outpatient"
["Medication, Discharge": "Beta Blocker Therapy for LVSD"] BetaBlockerAtDischarge with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter such that BetaBlockerAtDischarge.authorDatetime during ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod
["Medication, Order": "Beta Blocker Therapy for LVSD"] BetaBlockerOrdered with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter such that BetaBlockerOrdered.authorDatetime during ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
["Diagnosis": "Bradycardia"] Bradycardia with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter such that Bradycardia.prevalencePeriod overlaps ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod
["Diagnosis": "Bradycardia"] Bradycardia with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter such that Bradycardia.prevalencePeriod overlaps ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
["Device, Applied": "Cardiac Pacer"] ImplantedCardiacPacer with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter such that ImplantedCardiacPacer.relevantPeriod overlaps after ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod
["Device, Applied": "Cardiac Pacer"] ImplantedCardiacPacer with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter such that ImplantedCardiacPacer.relevantPeriod overlaps after ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
from ["Physical Exam, Performed": "Heart Rate"] HeartRate, "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter let PriorHeartRate: Last(["Physical Exam, Performed": "Heart Rate"] MostRecentPriorHeartRate where MostRecentPriorHeartRate.relevantDatetime during ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod and MostRecentPriorHeartRate.relevantDatetime before HeartRate.relevantDatetime sort by relevantDatetime ) where HeartRate.relevantDatetime during ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod and HeartRate.result < 50 '{beats}/min' and PriorHeartRate.result < 50 '{beats}/min'
from ["Physical Exam, Performed": "Heart Rate"] HeartRate, "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter let PriorHeartRate: Last(["Physical Exam, Performed": "Heart Rate"] MostRecentPriorHeartRate where MostRecentPriorHeartRate.relevantDatetime during ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod and MostRecentPriorHeartRate.relevantDatetime before HeartRate.relevantDatetime sort by relevantDatetime ) where HeartRate.relevantDatetime during ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod and HeartRate.result < 50 '{beats}/min' and PriorHeartRate.result < 50 '{beats}/min'
["Medication, Active": "Beta Blocker Therapy for LVSD"] ActiveBetaBlocker with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter such that ActiveBetaBlocker.relevantPeriod overlaps after ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod
["Medication, Active": "Beta Blocker Therapy for LVSD"] ActiveBetaBlocker with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter such that ActiveBetaBlocker.relevantPeriod overlaps after ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
"Initial Population 1" and exists "Heart Failure Outpatient Encounter with Moderate or Severe LVSD"
"Initial Population 2" and exists "Heart Failure Inpatient Encounter with Moderate or Severe LVSD"
exists "Consecutive Heart Rates Less than 50 Outpatient" or exists "Medical Patient or System Reason for Not Ordering Beta Blocker for LVSD Outpatient" or exists "Arrhythmia Diagnosis Outpatient" or exists "Hypotension Diagnosis Outpatient" or exists "Asthma Diagnosis Outpatient" or exists "Diagnosis of Allergy or Intolerance to Beta Blocker Therapy Outpatient" or exists "Bradycardia Diagnosis Outpatient" or exists "Allergy or Intolerance to Beta Blocker Therapy Ingredient Outpatient" or "Atrioventricular Block without Cardiac Pacer Outpatient"
exists "Consecutive Heart Rates Less than 50 Inpatient" or exists "Medical Patient or System Reason for No Beta Blocker for LVSD at Inpatient Discharge" or exists "Arrhythmia Diagnosis Inpatient" or exists "Hypotension Diagnosis Inpatient" or exists "Asthma Diagnosis Inpatient" or exists "Diagnosis of Allergy or Intolerance to Beta Blocker Therapy Inpatient" or exists "Bradycardia Diagnosis Inpatient" or exists "Allergy or Intolerance to Beta Blocker Therapy Ingredient Inpatient" or "Atrioventricular Block without Cardiac Pacer Inpatient"
( ["Diagnosis": "Allergy to Beta Blocker Therapy"] union ["Diagnosis": "Intolerance to Beta Blocker Therapy"] ) BetaBlockerAllergyOrIntoleranceDiagnosis with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter such that BetaBlockerAllergyOrIntoleranceDiagnosis.prevalencePeriod overlaps after ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod
( ["Diagnosis": "Allergy to Beta Blocker Therapy"] union ["Diagnosis": "Intolerance to Beta Blocker Therapy"] ) BetaBlockerAllergyOrIntoleranceDiagnosis with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter such that BetaBlockerAllergyOrIntoleranceDiagnosis.prevalencePeriod overlaps after ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
["Diagnosis": "Cardiac Pacer in Situ"] CardiacPacerDiagnosis with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter such that CardiacPacerDiagnosis.prevalencePeriod overlaps after ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod
["Diagnosis": "Cardiac Pacer in Situ"] CardiacPacerDiagnosis with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter such that CardiacPacerDiagnosis.prevalencePeriod overlaps after ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
["Encounter, Performed": "Discharge Services - Hospital Inpatient"] InpatientDischarge with ["Diagnosis": "Heart Failure"] HeartFailure such that HeartFailure.prevalencePeriod overlaps InpatientDischarge.relevantPeriod where InpatientDischarge.relevantPeriod during "Measurement Period"
"Heart Failure Inpatient Encounter" HFInpatientEncounter with "Moderate or Severe LVSD Findings" LVSDFindings such that ( LVSDFindings.prevalencePeriod starts before end of HFInpatientEncounter.relevantPeriod or LVSDFindings.relevantDatetime before end of HFInpatientEncounter.relevantPeriod )
( ["Encounter, Performed": "Care Services in Long-Term Residential Facility"] union ["Encounter, Performed": "Home Healthcare Services"] union ["Encounter, Performed": "Nursing Facility Visit"] union ["Encounter, Performed": "Office Visit"] union ["Encounter, Performed": "Outpatient Consultation"] ) FaceToFaceEncounter with ["Diagnosis": "Heart Failure"] HeartFailure such that HeartFailure.prevalencePeriod overlaps FaceToFaceEncounter.relevantPeriod where FaceToFaceEncounter.relevantPeriod during "Measurement Period"
"Heart Failure Outpatient Encounter" HFOutpatientEncounter with "Moderate or Severe LVSD Findings" LVSDFindings such that ( LVSDFindings.prevalencePeriod starts before end of HFOutpatientEncounter.relevantPeriod or LVSDFindings.relevantDatetime before end of HFOutpatientEncounter.relevantPeriod )
["Diagnosis": "Hypotension"] Hypotension with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter such that Hypotension.prevalencePeriod overlaps ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod
["Diagnosis": "Hypotension"] Hypotension with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter such that Hypotension.prevalencePeriod overlaps ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 18 ) and Count("Qualifying Encounter During Measurement Period")>= 2 and exists "Heart Failure Outpatient Encounter"
exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 18 ) and exists "Heart Failure Inpatient Encounter"
["Medication, Not Discharged": "Beta Blocker Therapy for LVSD"] NoBetaBlockerAtDischarge with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter such that NoBetaBlockerAtDischarge.authorDatetime during ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod where ( NoBetaBlockerAtDischarge.negationRationale in "Medical Reason" or NoBetaBlockerAtDischarge.negationRationale in "Patient Reason" or NoBetaBlockerAtDischarge.negationRationale in "System Reason" )
["Medication, Not Ordered": "Beta Blocker Therapy for LVSD"] NoBetaBlockerOrdered with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter such that NoBetaBlockerOrdered.authorDatetime during ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod where ( NoBetaBlockerOrdered.negationRationale in "Medical Reason" or NoBetaBlockerOrdered.negationRationale in "Patient Reason" or NoBetaBlockerOrdered.negationRationale in "System Reason" )
( ["Diagnostic Study, Performed": "Ejection Fraction"] EjectionFraction where EjectionFraction.result < 40 '%' ) union ["Diagnosis": "Moderate or Severe LVSD"] union ( ["Diagnosis": "Left Ventricular Systolic Dysfunction"] LVSD where LVSD.severity in "Moderate or Severe" )
exists "Beta Blocker Therapy for LVSD Ordered Outpatient" or exists "Currently Taking Beta Blocker Therapy for LVSD Outpatient"
exists "Beta Blocker Therapy for LVSD at Inpatient Discharge" or exists "Currently Taking Beta Blocker Therapy for LVSD Inpatient"
( ["Encounter, Performed": "Care Services in Long-Term Residential Facility"] union ["Encounter, Performed": "Home Healthcare Services"] union ["Encounter, Performed": "Nursing Facility Visit"] union ["Encounter, Performed": "Office Visit"] union ["Encounter, Performed": "Outpatient Consultation"] union ["Encounter, Performed": "Patient Provider Interaction"] ) ValidEncounter where ValidEncounter.relevantPeriod during "Measurement Period"
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
years between ToDate(BirthDateTime)and ToDate(AsOf)
DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezoneoffset from Value)
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
Measure Set |
None |
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