eCQM Title | Controlling High Blood Pressure |
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eCQM Identifier (Measure Authoring Tool) | 165 | eCQM Version Number | 9.2.000 |
NQF Number | Not Applicable | GUID | abdc37cc-bac6-4156-9b91-d1be2c8b7268 |
Measurement Period | January 1, 20XX through December 31, 20XX | ||
Measure Steward | National Committee for Quality Assurance | ||
Measure Developer | National Committee for Quality Assurance | ||
Endorsed By | None | ||
Description |
Percentage of patients 18-85 years of age who had a diagnosis of hypertension overlapping the measurement period or the year prior to the measurement period, and whose most recent blood pressure was adequately controlled (<140/90mmHg) during the measurement period |
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Copyright |
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 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 can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, 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. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2019 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2019 American Medical Association. LOINC(R) 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 copyright 2019 World Health Organization. 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]. |
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Measure Scoring | Proportion | ||
Measure Type | Intermediate Clinical Outcome | ||
Stratification |
None |
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Risk Adjustment |
None |
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Rate Aggregation |
None |
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Rationale |
High blood pressure (HBP), also known as hypertension, is when the pressure in blood vessels is higher than normal (Centers for Disease Control and Prevention [CDC], 2016). The causes of hypertension are multiple and multifaceted and can be based on genetic predisposition, environmental risk factors, being overweight and obese, sodium intake, potassium intake, physical activity, and alcohol use. High Blood Pressure is common, according to the National Health and Nutrition Examination Survey (NHANES), approximately 85.7 million adults >= 20 years of age had HBP (140/90 mm Hg) between 2011 to 2014 (Crim, 2012). Between 2011-2014 the prevalence of hypertension (>=140/90 mm Hg) among US adults 60 and older was approximately 67.2 percent (Benjamin et al., 2017). HBP, known as the “silent killer,” increases risks of heart disease and stroke which are two of the leading causes of death in the U.S. (Yoon, Fryar, & Carroll, 2015). A person who has HBP is four times more likely to die from a stroke and three times more likely to die from heart disease (CDC, 2012) The National Vital Statistics Systems Center for Disease Control and Prevention reported that in 2014 there were approximately 73,300 deaths directly due to HBP and 410,624 deaths with any mention of HBP (CDC, 20145).Between 2004 and 2014 the number of deaths due to HBP rose by 34.1 percent (Benjamin et al., 2017). Managing and treating HBP would reduce cardiovascular disease mortality for males and females by 30.4 percent and 38.0 percent, respectively (Patel et al., 2015). The estimated annual average direct and indirect cost of HBP from 2012 to 2013 was $51.2 billion (Benjamin et al., 2017). Total direct costs of HBP is projected to increase to $200 billion by 2030 (Benjamin et al., 2017). A study on cost-effectiveness on treating hypertension found that controlling HBP in patients with cardiovascular disease and systolic blood pressures of >=160 mm Hg could be effective and cost-saving (Moran et al., 2015). Many studies have shown that controlling high blood pressure reduces cardiovascular events and mortality. The Systolic Blood Pressure Intervention Trial (SPRINT) investigated the impact of obtaining a SBP goal of <120 mm Hg compared to a SBP goal of <140 mm Hg among patients 50 and older with established cardiovascular disease and found that the patients with the former goal had reduced cardiovascular events and mortality (SPRINT Research Group et al., 2015). Controlling HBP will significantly reduce the risks of cardiovascular disease mortality and lead to better health outcomes like reduction of heart attacks, stroke, and kidney disease (James et al., 2014). Thus, the relationship between the measure (control of hypertension) and the long-term clinical outcomes listed is well established. |
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Clinical Recommendation Statement |
The U.S. Preventive Services Task Force (2015) recommends screening for high blood pressure in adults age 18 years and older. This is a grade A recommendation. American College of Cardiology/American Heart Association (2017) -For adults with confirmed hypertension and known CVD or 10-year ASCVD event risk of 10% or higher, a blood pressure target of less than 130/80 mmHg is recommended (Level of evidence: B-R (for systolic blood pressures), Level of evidence: C-EO (for diastolic blood pressure)) -For adults with confirmed hypertension, without additional markers of increased CVD risk, a blood pressure target of less than 130/80 mmHg may be reasonable (Note: clinical trial evidence is strongest for a target blood pressure of 140/90 mmHg in this population. However, observational studies suggest that these individuals often have a high lifetime risk and would benefit from blood pressure control earlier in life) (Level of evidence: B-NR (for systolic blood pressure), Level of evidence: C-EO (for diastolic blood pressure)) American College of Physicians and the American Academy of Family Physicians (2017): -Initiate or intensify pharmacologic treatment in some adults aged 60 years or older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mmHg (Grade: weak recommendation, Quality of evidence: low) -Initiate or intensify pharmacologic treatment in adults aged 60 years or older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mmHg to reduce the risk of recurrent stroke (Grade: weak recommendation, Quality of evidence: moderate) American Diabetes Association (2019): -For individuals with diabetes and hypertension at higher cardiovascular risk (existing atherosclerotic cardiovascular disease or 10-year atherosclerotic cardiovascular disease risk >15%), a blood pressure target of <130/80 mmHg may be appropriate, if it can be safely attained (Level of evidence: C)-For individuals with diabetes and hypertension at lower risk for cardiovascular disease (10-year atherosclerotic cardiovascular disease risk <15%), treat to a blood pressure target of <140/90 mmHg (Level of evidence: A) |
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Improvement Notation |
Higher score indicates better quality |
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Reference |
American Diabetes Association. (2019). 10. Cardiovascular disease and risk management: Standards of medical care in diabetes—2019. Diabetes Care, 42(Suppl. 1), S103-S123. https://doi.org/10.2337/dc19S010 |
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Reference |
Benjamin, E. J., Blaha, M. J., Chiuve, S. E., et al. (2017). Heart disease and stroke statistics-2017 update: A report from the American Heart Association. Circulation, 135(10), e146-e603.doi: 10.1161/CIR.0000000000000485 |
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Reference |
Centers for Disease Control and Prevention. (2012). Vital signs: Getting blood pressure under control. Retrieved from https://www.cdc.gov/vitalsigns/hypertension/index.html |
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Reference |
Centers for Disease Control and Prevention. Division for Heart Disease and Stroke Prevention. (2016). High blood pressure fact sheet. Retrieved from https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_bloodpressure.htm |
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Reference |
Centers for Disease Control and Prevention, National Center for Health Statistics. (2015). Underlying Cause of Death 1999-2013 on CDC WONDER Online Database. Data are from the Multiple Cause of Death Files, 1999-2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Retrieved from http://wonder.cdc.gov/ucd-icd10.html |
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Reference |
Crim, M. T., Yoon, S. S., Ortiz, E., et al. (2012). National surveillance definitions for hypertension prevalence and control among adults. Circulation: Cardiovascular Quality and Outcomes. 2012, ;5(3), :343-–351. doi: 10.1161/ CIRCOUTCOMES.111.963439. |
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Reference |
Moran, A. E., Odden, M. C., Thanataveerat, A., et al.Tzong KY, Rasmussen PW, Guzman D, Williams L, Bibbins-Domingo K, Coxson PG, Goldman L. (2015). Cost-effectiveness of hypertension therapy according to 2014 guidelines. [published correction appears in N Engl J. Med. 2015;372:1677]. New England Journal of Medicine. 2015 ;372, 447-455. doi: 10.1056/NEJMsa1406751. [published correction appears on page 1677] |
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Reference |
Patel, S. A., Winkel, M., Ali, M. K., et al. (2015). Cardiovascular mortality associated with 5 leading risk factors: National and state preventable fractions estimated from survey data. Annals of Internal Medicine, 163(4), 245-253. doi: 10.7326/M14-1753 |
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Reference |
Qaseem, A., Wilt, T. J., Rich, R., et al. (2017). Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: A clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Annals of Internal Medicine, 166(6), 430-437. Retrieved from https://annals.org/aim/fullarticle/2598413/pharmacologic-treatment-hypertension-adults-aged-60-years-older-higher-versus |
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Reference |
SPRINT Research Group, Wright, J. T., Jr., Williamson, J. D., et al. (2015). A randomized trial of intensive versus standard blood-pressure control. New England Journal of Medicine, 373(22), 2103–2116. |
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Reference |
U.S. Preventive Services Task Force. (2015). Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 163(10), 778-787. Retrieved from https://annals.org/aim/fullarticle/2456129/screening-high-blood-pressure-adults-u-s-preventive-services-task |
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Reference |
Whelton, P. K., Carey, R. M., Aronow, W. S., et al. (2017). Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. https://doi.org/10.1161/HYP.0000000000000065 |
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Reference |
Yoon, S. S., Fryar, C. D., & Carroll, M. D. (2015). Hypertension prevalence and control among adults: United States, 2011-2014. NCHS Data Brief No. 220. Hyattsville, MD: National Center for Health Statistics. |
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Reference |
Farley TA, Dalal MA, Mostashari F, Frieden TR. Deaths preventable in the US by improvements in the use of clinical preventive services. Am J Prev Med. 2010;38:600-9. Retrieved from https://www.ajpmonline.org/article/S0749-3797(10)00207-2/fulltext |
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Definition |
None |
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Guidance |
In reference to the numerator element, only blood pressure readings performed by a clinician or a remote monitoring device are acceptable for numerator compliance with this measure. Do not include BP readings: -Taken during an acute inpatient stay or an ED visit -Taken on the same day as a diagnostic test or diagnostic or therapeutic procedure that requires a change in diet or change in medication on or one day before the day of the test or procedure, with the exception of fasting blood tests. -Reported by or taken by the member If no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed "not controlled." If there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading. This eCQM is a patient-based measure. 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 |
Patients 18-85 years of age who had a visit and diagnosis of essential hypertension overlapping the measurement period or the year prior to the measurement period |
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Denominator |
Equals Initial Population |
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Denominator Exclusions |
Patients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period. Also exclude patients with a diagnosis of pregnancy during the measurement period. Exclude patients whose hospice care overlaps the measurement period. Exclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period. Exclude patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured. |
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Numerator |
Patients whose most recent blood pressure is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement period |
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Numerator Exclusions |
Not Applicable |
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Denominator Exceptions |
None |
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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" ) in Interval[18, 85 ) and exists "Essential Hypertension Diagnosis" and exists AdultOutpatientEncounters."Qualifying Encounters"
"Initial Population"
Hospice."Has Hospice" or exists ( "Pregnancy Or Renal Diagnosis Exclusions" ) or ( exists ( "End Stage Renal Disease Procedures" ) or exists ( "End Stage Renal Disease Encounter" ) ) or ( exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 65 ) and ( FrailtyLTI."Long Term Care Periods Longer Than 90 Consecutive Days" ) ) or FrailtyLTI."Advanced Illness and Frailty Exclusion Including Over Age 80"
"Has Diastolic Blood Pressure Less Than 90" and "Has Systolic Blood Pressure Less Than 140"
None
None
None
( ["Encounter, Performed": "Office Visit"] union ["Encounter, Performed": "Annual Wellness 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": "Home Healthcare Services"] ) ValidEncounter where ValidEncounter.relevantPeriod during "Measurement Period"
//If the measure includes populations age 80 and older, then use this logic: exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate where ( Global."CalendarAgeInYearsAt"(BirthDate.birthDatetime, start of "Measurement Period")in Interval[66, 80]) and "Has Criteria Indicating Frailty" and ( Count("Outpatient Encounters with Advanced Illness")>= 2 or exists ( "Inpatient Encounter with Advanced Illness" ) or exists "Dementia Medications In Year Before or During Measurement Period" ) ) or exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate where ( Global."CalendarAgeInYearsAt"(BirthDate.birthDatetime, start of "Measurement Period")>= 81 ) and "Has Criteria Indicating Frailty" )
["Medication, Active": "Dementia Medications"] DementiaMed where DementiaMed.relevantPeriod overlaps Interval[( start of "Measurement Period" - 1 year ), end of "Measurement Period"]
exists ( ["Device, Order": "Frailty Device"] FrailtyDeviceOrder where FrailtyDeviceOrder.authorDatetime during "Measurement Period" ) or exists ( ["Device, Applied": "Frailty Device"] FrailtyDeviceApplied where FrailtyDeviceApplied.relevantPeriod overlaps "Measurement Period" ) or exists ( ["Diagnosis": "Frailty Diagnosis"] FrailtyDiagnosis where FrailtyDiagnosis.prevalencePeriod overlaps "Measurement Period" ) or exists ( ["Encounter, Performed": "Frailty Encounter"] FrailtyEncounter where FrailtyEncounter.relevantPeriod overlaps "Measurement Period" ) or exists ( ["Symptom": "Frailty Symptom"] FrailtySymptom where FrailtySymptom.prevalencePeriod overlaps "Measurement Period" )
["Encounter, Performed": "Acute Inpatient"] InpatientEncounter where exists ( InpatientEncounter.diagnoses Diagnosis where Diagnosis.code in "Advanced Illness" ) and InpatientEncounter.relevantPeriod starts 2 years or less on or before end of "Measurement Period"
( ["Encounter, Performed": "Care Services in Long-Term Residential Facility"] union ["Encounter, Performed": "Nursing Facility Visit"] ) LongTermFacilityEncounter where LongTermFacilityEncounter.relevantPeriod overlaps "Measurement Period" return LongTermFacilityEncounter.relevantPeriod intersect "Measurement Period"
exists ( "Long Term Care Periods During Measurement Period" LongTermCareDuringMP where duration in days of LongTermCareDuringMP > 90 )
( ["Encounter, Performed": "Outpatient"] union ["Encounter, Performed": "Observation"] union ["Encounter, Performed": "ED"] union ["Encounter, Performed": "Nonacute Inpatient"] ) OutpatientEncounter where exists ( OutpatientEncounter.diagnoses Diagnosis where Diagnosis.code in "Advanced Illness" ) and OutpatientEncounter.relevantPeriod starts 2 years or less on or before end of "Measurement Period"
( ( "Qualifying Diastolic Blood Pressure Reading" DBPExam return date from DBPExam.relevantDatetime ) intersect ( "Qualifying Systolic Blood Pressure Reading" SBPExam return date from SBPExam.relevantDatetime ) )
"Initial Population"
Hospice."Has Hospice" or exists ( "Pregnancy Or Renal Diagnosis Exclusions" ) or ( exists ( "End Stage Renal Disease Procedures" ) or exists ( "End Stage Renal Disease Encounter" ) ) or ( exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 65 ) and ( FrailtyLTI."Long Term Care Periods Longer Than 90 Consecutive Days" ) ) or FrailtyLTI."Advanced Illness and Frailty Exclusion Including Over Age 80"
["Encounter, Performed": "ESRD Monthly Outpatient Services"] ESRDEncounter where ESRDEncounter.relevantPeriod starts before end of "Measurement Period"
( ["Procedure, Performed": "Vascular Access for Dialysis"] union ["Procedure, Performed": "Kidney Transplant"] union ["Procedure, Performed": "Dialysis Services"] ) ESRDProcedure where ESRDProcedure.relevantPeriod starts before end of "Measurement Period"
["Diagnosis": "Essential Hypertension"] Hypertension where Hypertension.prevalencePeriod overlaps Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"]
"Lowest Diastolic Reading on Most Recent Blood Pressure Day".result < 90 'mm[Hg]'
"Lowest Systolic Reading on Most Recent Blood Pressure Day".result < 140 'mm[Hg]'
exists ( ["Encounter, Performed": "Encounter Inpatient"] DischargeHospice where ( DischargeHospice.dischargeDisposition ~ "Discharge to home for hospice care (procedure)" or DischargeHospice.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)" ) and DischargeHospice.relevantPeriod ends during "Measurement Period" ) or exists ( ["Intervention, Order": "Hospice care ambulatory"] HospiceOrder where HospiceOrder.authorDatetime during "Measurement Period" ) or exists ( ["Intervention, Performed": "Hospice care ambulatory"] HospicePerformed where HospicePerformed.relevantPeriod overlaps "Measurement Period" )
exists ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) in Interval[18, 85 ) and exists "Essential Hypertension Diagnosis" and exists AdultOutpatientEncounters."Qualifying Encounters"
First("Qualifying Diastolic Blood Pressure Reading" DBPReading where DBPReading.relevantDatetime same day as "Most Recent Blood Pressure Day" sort by(result as Quantity) )
First("Qualifying Systolic Blood Pressure Reading" SBPReading where SBPReading.relevantDatetime same day as "Most Recent Blood Pressure Day" sort by(result as Quantity) )
Last("Blood Pressure Days" BPDays sort ascending )
"Has Diastolic Blood Pressure Less Than 90" and "Has Systolic Blood Pressure Less Than 140"
( ["Diagnosis": "Pregnancy"] union ["Diagnosis": "End Stage Renal Disease"] union ["Diagnosis": "Kidney Transplant Recipient"] union ["Diagnosis": "Chronic Kidney Disease, Stage 5"] ) PregnancyESRDDiagnosis where PregnancyESRDDiagnosis.prevalencePeriod overlaps "Measurement Period"
["Physical Exam, Performed": "Diastolic blood pressure"] DiastolicBP without ( ["Encounter, Performed": "Encounter Inpatient"] union ["Encounter, Performed": "ED"] ) DisqualifyingEncounter such that DiastolicBP.relevantDatetime during DisqualifyingEncounter.relevantPeriod where DiastolicBP.result.unit = 'mm[Hg]' // and DiastolicBP.result is Quantity and DiastolicBP.relevantDatetime during "Measurement Period"
["Physical Exam, Performed": "Systolic blood pressure"] SystolicBP without ( ["Encounter, Performed": "Encounter Inpatient"] union ["Encounter, Performed": "ED"] ) DisqualifyingEncounter such that SystolicBP.relevantDatetime during DisqualifyingEncounter.relevantPeriod where SystolicBP.result.unit = 'mm[Hg]' // and SystolicBP.result is Quantity and SystolicBP.relevantDatetime 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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