eCQM Title

Chlamydia Screening in Women

CMS ID

153

eCQM Version Number

15.0.000

CBE Number

Not Applicable

GUID

c9930664-be3d-4ffe-ae4a-5cf4933ecb89

Measurement Period

January 1, 2027 through December 31, 2027

Measure Steward

National Committee for Quality Assurance

Measure Developer

National Committee for Quality Assurance

Endorsed By

None

Description

Percentage of women 16-24 years of age who were identified as sexually active at any time during the measurement period and who had at least one test for chlamydia during the measurement period

This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties or endorsements about the quality of any product, test or protocol identified as numerator compliant or otherwise identified as meeting the requirements of the measure or specification. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure may be used for internal, noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. All other uses, including a commercial use (including but not limited to vendors using or embedding the measures and specifications into any product or service to calculate measure results for customers for any purpose), must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2026 National Committee for Quality Assurance. All Rights Reserved.

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Disclaimer

The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Measure Scoring

Proportion

Measure Type

Process

Stratification

Report a total score, and each of the following strata:

Stratum 1: Patients age 16-20 by the end of the measurement period.

Stratum 2: Patients age 21-24 by the end of the measurement period.

Risk Adjustment

None

Rate Aggregation

None

Rationale

Chlamydia trachomatis is the most common sexually transmitted bacterial infection in the U.S., resulting in roughly 1.7 million cases (Centers for Disease Control and Prevention, 2019). Chlamydia infections are often asymptomatic, but, if left untreated, can lead to serious and irreversible complications (U.S. Preventive Services Task Force, 2021; Centers for Disease Control and Prevention, 2019).

Women are particularly vulnerable when infected with chlamydia. Left untreated, chlamydia can cause pelvic inflammatory disease (PID), which can lead to chronic pelvic pain or infertility. Pregnant women may also transmit the infection to their infant, potentially resulting in neonatal pneumonia (Centers for Disease Control and Prevention, 2019).

Clinical Recommendation Statement

U.S. Preventive Services Task Force (2021) recommends screening for chlamydia in all sexually active women aged 24 years or younger and in women 25 years or older who are at increased risk for infection (B recommendation)

Improvement Notation

Higher score indicates better quality

Reference

Reference Type: Citation

Reference Text:

Centers for Disease Control and Prevention (CDC). (2019). Sexually Transmitted Disease Surveillance 2018. Atlanta: U.S. Department of Health and Human Services.

Reference

Reference Type: Citation

Reference Text:

US Preventive Services Task Force, Davidson, K. W., Barry, M. J., Mangione, C. M., Cabana, M., Caughey, A. B., Davis, E. M., Donahue, K. E., Doubeni, C. A., Krist, A. H., Kubik, M., Li, L., Ogedegbe, G., Pbert, L., Silverstein, M., Simon, M. A., Stevermer, J., Tseng, C. W., & Wong, J. B. (2021). Screening for Chlamydia and Gonorrhea: US Preventive Services Task Force Recommendation Statement. JAMA, 326(10), 949–956. https://doi.org/10.1001/jama.2021.14081

Definition

None

Guidance

Codes to identify sexually active women include codes for: pregnancy, sexually transmitted infections, contraceptives or contraceptive devices, and infertility treatments.

The denominator exclusion does not apply to patients who qualify for the initial population (IP) based on services other than the pregnancy test alone. These other services include services for sexually transmitted infections, contraceptives or contraceptive devices and infertility treatments. For example, a patient who has both a pregnancy test and a chlamydia diagnosis, either of which would qualify them for the IP, would not be eligible for this denominator exclusion.

This eCQM is a patient-based measure.

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

Women 16 to 24 years of age by the end of the measurement period who are sexually active and who had a visit in the measurement period

Denominator

Equals Initial Population

Denominator Exclusions

Exclude patients who are in hospice care for any part of the measurement period.

Women who are only eligible for the initial population due to a pregnancy test during the measurement period, and who had an order for an x-ray or for a specified medication on the date of the pregnancy test or the six days after the pregnancy test.

Numerator

Women with at least one chlamydia test during the measurement period

Numerator Exclusions

None

Denominator Exceptions

None

Supplemental Data Elements

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

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

Population Criteria

Initial Population

  AgeInYearsAt(date from 
    end of "Measurement Period"
  ) in Interval[16, 24]
    and exists ( ["Patient Characteristic Sex": "Female (finding)"] )
    and exists ( "Qualifying Encounters" )
    and ( ( "Has Assessments Identifying Sexual Activity" )
        or ( "Has Diagnoses Identifying Sexual Activity" )
        or ( "Has Active Contraceptive Medications" )
        or ( "Has Ordered Contraceptive Medications" )
        or ( "Has Laboratory Tests Identifying Sexual Activity" )
        or ( "Has Diagnostic Studies Identifying Sexual Activity" )
        or ( "Has Procedures Identifying Sexual Activity" )
    )

- Denominator
  - "Initial Population"

Denominator Exclusions

  Hospice."Has Hospice Services"
    or ( ( "Has Pregnancy Test Exclusion" )
        and not ( "Has Assessments Identifying Sexual Activity" )
        and not ( "Has Diagnoses Identifying Sexual Activity" )
        and not ( "Has Active Contraceptive Medications" )
        and not ( "Has Ordered Contraceptive Medications" )
        and not ( "Has Laboratory Tests Identifying Sexual Activity But Not Pregnancy" )
        and not ( "Has Diagnostic Studies Identifying Sexual Activity" )
        and not ( "Has Procedures Identifying Sexual Activity" )
    )

Numerator

  exists ( ["Laboratory Test, Performed": "Chlamydia Screening"] ChlamydiaTest
      where Global."LatestOf" ( ChlamydiaTest.relevantDatetime, ChlamydiaTest.relevantPeriod ) during day of "Measurement Period"
        and ChlamydiaTest.result is not null
  )

- Numerator Exclusions
  - None

- Denominator Exceptions
  - None

Stratification 1

  AgeInYearsAt(date from 
    end of "Measurement Period"
  ) in Interval[16, 20]

Stratification 2

  AgeInYearsAt(date from 
    end of "Measurement Period"
  ) in Interval[21, 24]

Definitions

Denominator
- - "Initial Population"

Denominator Exclusions

  Hospice."Has Hospice Services"
    or ( ( "Has Pregnancy Test Exclusion" )
        and not ( "Has Assessments Identifying Sexual Activity" )
        and not ( "Has Diagnoses Identifying Sexual Activity" )
        and not ( "Has Active Contraceptive Medications" )
        and not ( "Has Ordered Contraceptive Medications" )
        and not ( "Has Laboratory Tests Identifying Sexual Activity But Not Pregnancy" )
        and not ( "Has Diagnostic Studies Identifying Sexual Activity" )
        and not ( "Has Procedures Identifying Sexual Activity" )
    )

Has Active Contraceptive Medications

  exists ( ["Medication, Active": "Contraceptive Medications"] ActiveContraceptives
      where ActiveContraceptives.relevantPeriod overlaps "Measurement Period"
  )

Has Assessments Identifying Sexual Activity

  exists ( ["Assessment, Performed": "Have you ever had vaginal intercourse [PhenX]"] SexualActivityAssessment
      where SexualActivityAssessment.result ~ "Yes (qualifier value)"
        and Global."NormalizeInterval" ( SexualActivityAssessment.relevantDatetime, SexualActivityAssessment.relevantPeriod ) on or before end of "Measurement Period"
  )

Has Diagnoses Identifying Sexual Activity

  exists ( ( ["Diagnosis": "Diagnoses Used to Indicate Sexual Activity"]
      union ["Diagnosis": "HIV"]
      union ["Diagnosis": "Complications of Pregnancy, Childbirth and the Puerperium"] ) SexualActivityDiagnosis
      where SexualActivityDiagnosis.prevalencePeriod overlaps "Measurement Period"
  )

Has Diagnostic Studies Identifying Sexual Activity

  exists ( ["Diagnostic Study, Order": "Diagnostic Studies During Pregnancy"] SexualActivityDiagnostics
      where SexualActivityDiagnostics.authorDatetime during day of "Measurement Period"
  )

Has Laboratory Tests Identifying Sexual Activity

  exists ( ["Laboratory Test, Order": "Pregnancy Test"] PregnancyTest
      where PregnancyTest.authorDatetime during day of "Measurement Period"
  )
    or "Has Laboratory Tests Identifying Sexual Activity But Not Pregnancy"

Has Laboratory Tests Identifying Sexual Activity But Not Pregnancy

  exists ( ( ["Laboratory Test, Order": "Pap Test"]
      union ["Laboratory Test, Order": "Lab Tests During Pregnancy"]
      union ["Laboratory Test, Order": "Lab Tests for Sexually Transmitted Infections"] ) LabOrders
      where LabOrders.authorDatetime during day of "Measurement Period"
  )

Has Ordered Contraceptive Medications

  exists ( ["Medication, Order": "Contraceptive Medications"] OrderedContraceptives
      where OrderedContraceptives.authorDatetime during day of "Measurement Period"
  )

Has Pregnancy Test Exclusion

  exists ( ( ["Laboratory Test, Order": "Pregnancy Test"] PregnancyTest
        with ["Diagnostic Study, Order": "XRay Study"] XrayOrder
          such that XrayOrder.authorDatetime occurs 6 days or less on or after day of PregnancyTest.authorDatetime
        where PregnancyTest.authorDatetime during "Measurement Period"
    )
      union ( ["Laboratory Test, Order": "Pregnancy Test"] PregnancyTestOrder
          with ["Medication, Order": "Isotretinoin"] AccutaneOrder
            such that AccutaneOrder.authorDatetime occurs 6 days or less on or after day of PregnancyTestOrder.authorDatetime
          where PregnancyTestOrder.authorDatetime during "Measurement Period"
      )
  )

Has Procedures Identifying Sexual Activity

  exists ( ["Procedure, Performed": "Procedures Used to Indicate Sexual Activity"] ProceduresForSexualActivity
      where Global."NormalizeInterval" ( ProceduresForSexualActivity.relevantDatetime, ProceduresForSexualActivity.relevantPeriod ) during day of "Measurement Period"
  )

Hospice.Has Hospice Services

  exists ( ["Encounter, Performed": "Encounter Inpatient"] InpatientEncounter
      where ( InpatientEncounter.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
          or InpatientEncounter.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
      )
        and InpatientEncounter.relevantPeriod ends during day of "Measurement Period"
  )
    or exists ( ["Encounter, Performed": "Hospice Encounter"] HospiceEncounter
        where HospiceEncounter.relevantPeriod overlaps day of "Measurement Period"
    )
    or exists ( ["Assessment, Performed": "Hospice care [Minimum Data Set]"] HospiceAssessment
        where HospiceAssessment.result ~ "Yes (qualifier value)"
          and Global."NormalizeInterval" ( HospiceAssessment.relevantDatetime, HospiceAssessment.relevantPeriod ) overlaps day of "Measurement Period"
    )
    or exists ( ["Intervention, Order": "Hospice Care Ambulatory"] HospiceOrder
        where HospiceOrder.authorDatetime during day of "Measurement Period"
    )
    or exists ( ["Intervention, Performed": "Hospice Care Ambulatory"] HospicePerformed
        where Global."NormalizeInterval" ( HospicePerformed.relevantDatetime, HospicePerformed.relevantPeriod ) overlaps day of "Measurement Period"
    )
  or exists ( ["Diagnosis": "Hospice Diagnosis"] HospiceCareDiagnosis
        where HospiceCareDiagnosis.prevalencePeriod overlaps day of "Measurement Period"
    )

Initial Population

  AgeInYearsAt(date from 
    end of "Measurement Period"
  ) in Interval[16, 24]
    and exists ( ["Patient Characteristic Sex": "Female (finding)"] )
    and exists ( "Qualifying Encounters" )
    and ( ( "Has Assessments Identifying Sexual Activity" )
        or ( "Has Diagnoses Identifying Sexual Activity" )
        or ( "Has Active Contraceptive Medications" )
        or ( "Has Ordered Contraceptive Medications" )
        or ( "Has Laboratory Tests Identifying Sexual Activity" )
        or ( "Has Diagnostic Studies Identifying Sexual Activity" )
        or ( "Has Procedures Identifying Sexual Activity" )
    )

Numerator

  exists ( ["Laboratory Test, Performed": "Chlamydia Screening"] ChlamydiaTest
      where Global."LatestOf" ( ChlamydiaTest.relevantDatetime, ChlamydiaTest.relevantPeriod ) during day of "Measurement Period"
        and ChlamydiaTest.result is not null
  )

Qualifying Encounters

  ( ( ["Encounter, Performed": "Office Visit"]
      union ["Encounter, Performed": "Preventive Care Services Established Office Visit, 18 and Up"]
      union ["Encounter, Performed": "Preventive Care Services Initial Office Visit, 18 and Up"]
      union ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"]
      union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"]
      union ["Encounter, Performed": "Home Healthcare Services"]
      union ["Encounter, Performed": "Telephone Visits"]
      union ["Encounter, Performed": "Virtual Encounter"] ) ValidEncounters
      where ValidEncounters.relevantPeriod during day of "Measurement Period"
  )

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"]

Stratification 1

  AgeInYearsAt(date from 
    end of "Measurement Period"
  ) in Interval[16, 20]

Stratification 2

  AgeInYearsAt(date from 
    end of "Measurement Period"
  ) in Interval[21, 24]

Functions

Global.HasEnd(period Interval<DateTime>)

  not ( 
    end of period is null
      or 
      end of period = maximum DateTime
  )

Global.Latest(period Interval<DateTime>)

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

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

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>

Terminology

code "Discharge to healthcare facility for hospice care (procedure)" ("SNOMEDCT Code (428371000124100)")
code "Discharge to home for hospice care (procedure)" ("SNOMEDCT Code (428361000124107)")
code "Female (finding)" ("SNOMEDCT Code (248152002)")
code "Have you ever had vaginal intercourse [PhenX]" ("LOINC Code (64728-9)")
code "Hospice care [Minimum Data Set]" ("LOINC Code (45755-6)")
code "Yes (qualifier value)" ("SNOMEDCT Code (373066001)")
valueset "Chlamydia Screening" (2.16.840.1.113883.3.464.1003.110.12.1052)
valueset "Complications of Pregnancy, Childbirth and the Puerperium" (2.16.840.1.113883.3.464.1003.111.12.1012)
valueset "Contraceptive Medications" (2.16.840.1.113883.3.464.1003.196.12.1080)
valueset "Diagnoses Used to Indicate Sexual Activity" (2.16.840.1.113883.3.464.1003.111.12.1018)
valueset "Diagnostic Studies During Pregnancy" (2.16.840.1.113883.3.464.1003.111.12.1008)
valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
valueset "Federal Administrative Sex" (2.16.840.1.113762.1.4.1021.121)
valueset "HIV" (2.16.840.1.113883.3.464.1003.120.12.1003)
valueset "Home Healthcare Services" (2.16.840.1.113883.3.464.1003.101.12.1016)
valueset "Hospice Care Ambulatory" (2.16.840.1.113883.3.526.3.1584)
valueset "Hospice Diagnosis" (2.16.840.1.113883.3.464.1003.1165)
valueset "Hospice Encounter" (2.16.840.1.113883.3.464.1003.1003)
valueset "Isotretinoin" (2.16.840.1.113883.3.464.1003.196.12.1143)
valueset "Lab Tests During Pregnancy" (2.16.840.1.113883.3.464.1003.111.12.1007)
valueset "Lab Tests for Sexually Transmitted Infections" (2.16.840.1.113883.3.464.1003.110.12.1051)
valueset "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001)
valueset "Pap Test" (2.16.840.1.113883.3.464.1003.108.12.1017)
valueset "Payer Type" (2.16.840.1.114222.4.11.3591)
valueset "Pregnancy Test" (2.16.840.1.113883.3.464.1003.111.12.1011)
valueset "Preventive Care Services Established Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1025)
valueset "Preventive Care Services Initial Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1023)
valueset "Preventive Care Services, Initial Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1022)
valueset "Preventive Care, Established Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1024)
valueset "Procedures Used to Indicate Sexual Activity" (2.16.840.1.113883.3.464.1003.111.12.1017)
valueset "Race" (2.16.840.1.114222.4.11.836)
valueset "Telephone Visits" (2.16.840.1.113883.3.464.1003.101.12.1080)
valueset "Virtual Encounter" (2.16.840.1.113883.3.464.1003.101.12.1089)
valueset "XRay Study" (2.16.840.1.113883.3.464.1003.198.12.1034)

Data Criteria (QDM Data Elements)

"Assessment, Performed: Have you ever had vaginal intercourse [PhenX]" using "Have you ever had vaginal intercourse [PhenX] (LOINC Code 64728-9)"
"Assessment, Performed: Hospice care [Minimum Data Set]" using "Hospice care [Minimum Data Set] (LOINC Code 45755-6)"
"Diagnosis: Complications of Pregnancy, Childbirth and the Puerperium" using "Complications of Pregnancy, Childbirth and the Puerperium (2.16.840.1.113883.3.464.1003.111.12.1012)"
"Diagnosis: Diagnoses Used to Indicate Sexual Activity" using "Diagnoses Used to Indicate Sexual Activity (2.16.840.1.113883.3.464.1003.111.12.1018)"
"Diagnosis: HIV" using "HIV (2.16.840.1.113883.3.464.1003.120.12.1003)"
"Diagnosis: Hospice Diagnosis" using "Hospice Diagnosis (2.16.840.1.113883.3.464.1003.1165)"
"Diagnostic Study, Order: Diagnostic Studies During Pregnancy" using "Diagnostic Studies During Pregnancy (2.16.840.1.113883.3.464.1003.111.12.1008)"
"Diagnostic Study, Order: XRay Study" using "XRay Study (2.16.840.1.113883.3.464.1003.198.12.1034)"
"Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
"Encounter, Performed: Home Healthcare Services" using "Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016)"
"Encounter, Performed: Hospice Encounter" using "Hospice Encounter (2.16.840.1.113883.3.464.1003.1003)"
"Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)"
"Encounter, Performed: Preventive Care Services Established Office Visit, 18 and Up" using "Preventive Care Services Established Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1025)"
"Encounter, Performed: Preventive Care Services Initial Office Visit, 18 and Up" using "Preventive Care Services Initial Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1023)"
"Encounter, Performed: Preventive Care Services, Initial Office Visit, 0 to 17" using "Preventive Care Services, Initial Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1022)"
"Encounter, Performed: Preventive Care, Established Office Visit, 0 to 17" using "Preventive Care, Established Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1024)"
"Encounter, Performed: Telephone Visits" using "Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080)"
"Encounter, Performed: Virtual Encounter" using "Virtual Encounter (2.16.840.1.113883.3.464.1003.101.12.1089)"
"Intervention, Order: Hospice Care Ambulatory" using "Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584)"
"Intervention, Performed: Hospice Care Ambulatory" using "Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584)"
"Laboratory Test, Order: Lab Tests During Pregnancy" using "Lab Tests During Pregnancy (2.16.840.1.113883.3.464.1003.111.12.1007)"
"Laboratory Test, Order: Lab Tests for Sexually Transmitted Infections" using "Lab Tests for Sexually Transmitted Infections (2.16.840.1.113883.3.464.1003.110.12.1051)"
"Laboratory Test, Order: Pap Test" using "Pap Test (2.16.840.1.113883.3.464.1003.108.12.1017)"
"Laboratory Test, Order: Pregnancy Test" using "Pregnancy Test (2.16.840.1.113883.3.464.1003.111.12.1011)"
"Laboratory Test, Performed: Chlamydia Screening" using "Chlamydia Screening (2.16.840.1.113883.3.464.1003.110.12.1052)"
"Medication, Active: Contraceptive Medications" using "Contraceptive Medications (2.16.840.1.113883.3.464.1003.196.12.1080)"
"Medication, Order: Contraceptive Medications" using "Contraceptive Medications (2.16.840.1.113883.3.464.1003.196.12.1080)"
"Medication, Order: Isotretinoin" using "Isotretinoin (2.16.840.1.113883.3.464.1003.196.12.1143)"
"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)"
"Patient Characteristic Sex: Female (finding)" using "Female (finding) (SNOMEDCT Code 248152002)"
"Procedure, Performed: Procedures Used to Indicate Sexual Activity" using "Procedures Used to Indicate Sexual Activity (2.16.840.1.113883.3.464.1003.111.12.1017)"

Supplemental Data Elements

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"]

Risk Adjustment Variables

None

Measure Set

None