Table of Contents


Population Criteria

        • 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
         
  • Definitions

    Functions

    Terminology

    • code "Birth date" ("LOINC Code (21112-8)")
    • code "Diastolic blood pressure" ("LOINC Code (8462-4)")
    • code "Discharge to healthcare facility for hospice care (procedure)" ("SNOMEDCT Code (428371000124100)")
    • code "Discharge to home for hospice care (procedure)" ("SNOMEDCT Code (428361000124107)")
    • code "Systolic blood pressure" ("LOINC Code (8480-6)")
    • valueset "Acute Inpatient" (2.16.840.1.113883.3.464.1003.101.12.1083)
    • valueset "Advanced Illness" (2.16.840.1.113883.3.464.1003.110.12.1082)
    • valueset "Annual Wellness Visit" (2.16.840.1.113883.3.526.3.1240)
    • valueset "Care Services in Long-Term Residential Facility" (2.16.840.1.113883.3.464.1003.101.12.1014)
    • valueset "Chronic Kidney Disease, Stage 5" (2.16.840.1.113883.3.526.3.1002)
    • valueset "Dementia Medications" (2.16.840.1.113883.3.464.1003.196.12.1510)
    • valueset "Dialysis Services" (2.16.840.1.113883.3.464.1003.109.12.1013)
    • valueset "ED" (2.16.840.1.113883.3.464.1003.101.12.1085)
    • valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
    • valueset "End Stage Renal Disease" (2.16.840.1.113883.3.526.3.353)
    • valueset "ESRD Monthly Outpatient Services" (2.16.840.1.113883.3.464.1003.109.12.1014)
    • valueset "Essential Hypertension" (2.16.840.1.113883.3.464.1003.104.12.1011)
    • valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
    • valueset "Frailty Device" (2.16.840.1.113883.3.464.1003.118.12.1300)
    • valueset "Frailty Diagnosis" (2.16.840.1.113883.3.464.1003.113.12.1074)
    • valueset "Frailty Encounter" (2.16.840.1.113883.3.464.1003.101.12.1088)
    • valueset "Frailty Symptom" (2.16.840.1.113883.3.464.1003.113.12.1075)
    • valueset "Home Healthcare Services" (2.16.840.1.113883.3.464.1003.101.12.1016)
    • valueset "Hospice care ambulatory" (2.16.840.1.113762.1.4.1108.15)
    • valueset "Kidney Transplant" (2.16.840.1.113883.3.464.1003.109.12.1012)
    • valueset "Kidney Transplant Recipient" (2.16.840.1.113883.3.464.1003.109.12.1029)
    • valueset "Nonacute Inpatient" (2.16.840.1.113883.3.464.1003.101.12.1084)
    • valueset "Nursing Facility Visit" (2.16.840.1.113883.3.464.1003.101.12.1012)
    • valueset "Observation" (2.16.840.1.113883.3.464.1003.101.12.1086)
    • valueset "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001)
    • valueset "ONC Administrative Sex" (2.16.840.1.113762.1.4.1)
    • valueset "Outpatient" (2.16.840.1.113883.3.464.1003.101.12.1087)
    • valueset "Payer" (2.16.840.1.114222.4.11.3591)
    • valueset "Pregnancy" (2.16.840.1.113883.3.526.3.378)
    • 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 "Race" (2.16.840.1.114222.4.11.836)
    • valueset "Vascular Access for Dialysis" (2.16.840.1.113883.3.464.1003.109.12.1011)

    Data Criteria (QDM Data Elements)

    • "Device, Applied: Frailty Device" using "Frailty Device (2.16.840.1.113883.3.464.1003.118.12.1300)"
    • "Device, Order: Frailty Device" using "Frailty Device (2.16.840.1.113883.3.464.1003.118.12.1300)"
    • "Diagnosis: Chronic Kidney Disease, Stage 5" using "Chronic Kidney Disease, Stage 5 (2.16.840.1.113883.3.526.3.1002)"
    • "Diagnosis: End Stage Renal Disease" using "End Stage Renal Disease (2.16.840.1.113883.3.526.3.353)"
    • "Diagnosis: Essential Hypertension" using "Essential Hypertension (2.16.840.1.113883.3.464.1003.104.12.1011)"
    • "Diagnosis: Frailty Diagnosis" using "Frailty Diagnosis (2.16.840.1.113883.3.464.1003.113.12.1074)"
    • "Diagnosis: Kidney Transplant Recipient" using "Kidney Transplant Recipient (2.16.840.1.113883.3.464.1003.109.12.1029)"
    • "Diagnosis: Pregnancy" using "Pregnancy (2.16.840.1.113883.3.526.3.378)"
    • "Encounter, Performed: Acute Inpatient" using "Acute Inpatient (2.16.840.1.113883.3.464.1003.101.12.1083)"
    • "Encounter, Performed: Annual Wellness Visit" using "Annual Wellness Visit (2.16.840.1.113883.3.526.3.1240)"
    • "Encounter, Performed: Care Services in Long-Term Residential Facility" using "Care Services in Long-Term Residential Facility (2.16.840.1.113883.3.464.1003.101.12.1014)"
    • "Encounter, Performed: ED" using "ED (2.16.840.1.113883.3.464.1003.101.12.1085)"
    • "Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
    • "Encounter, Performed: ESRD Monthly Outpatient Services" using "ESRD Monthly Outpatient Services (2.16.840.1.113883.3.464.1003.109.12.1014)"
    • "Encounter, Performed: Frailty Encounter" using "Frailty Encounter (2.16.840.1.113883.3.464.1003.101.12.1088)"
    • "Encounter, Performed: Home Healthcare Services" using "Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016)"
    • "Encounter, Performed: Nonacute Inpatient" using "Nonacute Inpatient (2.16.840.1.113883.3.464.1003.101.12.1084)"
    • "Encounter, Performed: Nursing Facility Visit" using "Nursing Facility Visit (2.16.840.1.113883.3.464.1003.101.12.1012)"
    • "Encounter, Performed: Observation" using "Observation (2.16.840.1.113883.3.464.1003.101.12.1086)"
    • "Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)"
    • "Encounter, Performed: Outpatient" using "Outpatient (2.16.840.1.113883.3.464.1003.101.12.1087)"
    • "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)"
    • "Intervention, Order: Hospice care ambulatory" using "Hospice care ambulatory (2.16.840.1.113762.1.4.1108.15)"
    • "Intervention, Performed: Hospice care ambulatory" using "Hospice care ambulatory (2.16.840.1.113762.1.4.1108.15)"
    • "Medication, Active: Dementia Medications" using "Dementia Medications (2.16.840.1.113883.3.464.1003.196.12.1510)"
    • "Patient Characteristic Birthdate: Birth date" using "Birth date (LOINC Code 21112-8)"
    • "Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
    • "Patient Characteristic Payer: Payer" using "Payer (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: ONC Administrative Sex" using "ONC Administrative Sex (2.16.840.1.113762.1.4.1)"
    • "Physical Exam, Performed: Diastolic blood pressure" using "Diastolic blood pressure (LOINC Code 8462-4)"
    • "Physical Exam, Performed: Systolic blood pressure" using "Systolic blood pressure (LOINC Code 8480-6)"
    • "Procedure, Performed: Dialysis Services" using "Dialysis Services (2.16.840.1.113883.3.464.1003.109.12.1013)"
    • "Procedure, Performed: Kidney Transplant" using "Kidney Transplant (2.16.840.1.113883.3.464.1003.109.12.1012)"
    • "Procedure, Performed: Vascular Access for Dialysis" using "Vascular Access for Dialysis (2.16.840.1.113883.3.464.1003.109.12.1011)"
    • "Symptom: Frailty Symptom" using "Frailty Symptom (2.16.840.1.113883.3.464.1003.113.12.1075)"

    Supplemental Data Elements

    Risk Adjustment Variables