eCQM Title | Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented |
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eCQM Identifier (Measure Authoring Tool) | 22 | eCQM Version Number | 9.3.000 |
NQF Number | Not Applicable | GUID | 9a033a94-3d9b-11e1-8634-00237d5bf174 |
Measurement Period | January 1, 20XX through December 31, 20XX | ||
Measure Steward | Centers for Medicare & Medicaid Services (CMS) | ||
Measure Developer | PCPI(R) Foundation (PCPI[R]) | ||
Endorsed By | None | ||
Description |
Percentage of patient visits for patients aged 18 years and older seen during the measurement period who were screened for high blood pressure AND a recommended follow-up plan is documented, as indicated, if blood pressure is pre-hypertensive or hypertensive |
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Copyright |
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. PCPI disclaims 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. |
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Disclaimer |
These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. 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 |
None |
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Rationale |
Hypertension is a prevalent condition that affects approximately 66.9 million people in the United States. It is estimated that about 20-40% of the adult population has hypertension; the majority of people over age 65 have a hypertension diagnosis (Appleton SL, et al., 2012 and Luehr D, et al., 2012). Winter (2013) noted that 1 in 3 American adults have hypertension and the lifetime risk of developing hypertension is 90% (Winter KH, et al., 2013). The African American population or non-Hispanic Blacks, the elderly, diabetics and those with chronic kidney disease are at increased risk of stroke, myocardial infarction and renal disease. Non-Hispanic Blacks have the highest prevalence at 38.6% (Winter KH, et al., 2013). Hypertension is a major risk factor for ischemic heart disease, left ventricular hypertrophy, renal failure, stroke and dementia (Luehr D, et al., 2012). Hypertension is the most common reason for adult office visits other than pregnancy. Garrison (2013) stated that in 2007, 42 million ambulatory visits were attributed to hypertension (Garrison GM and Oberhelman S, 2013). It also has the highest utilization of prescription drugs. Numerous resources and treatment options are available, yet only about 40-50% of the hypertensive patients have their blood pressure under control (<140/90) (Appleton SL, et al., 2012, Luehr D, et al., 2012). In addition to medication non-compliance, poor outcomes are also attributed to poor adherence to lifestyle changes such as a low-sodium diet, weight loss, increased exercise and limiting alcohol intake. Many adults find it difficult to continue medications and lifestyle changes when they are asymptomatic. Symptoms of elevated blood pressure usually do not occur until secondary problems arise such as with vascular diseases (myocardial infarction, stroke, heart failure and renal insufficiency) (Luehr D, et al., 2012). Appropriate follow-up after blood pressure measurement is a pivotal component in preventing the progression of hypertension and the development of heart disease. Detection of marginally or fully elevated blood pressure by a specialty clinician warrants referral to a provider familiar with the management of hypertension and prehypertension. The 2010 ACCF/AHA Guideline for the Assessment of Cardiovascular Risk in Asymptomatic Adults continues to support using a global risk score such as the Framingham Risk Score, to assess risk of coronary heart disease (CHD) in all asymptomatic adults (Greenland P, et al., 2010). Lifestyle modifications have demonstrated effectiveness in lowering blood pressure (JNC 7, 2003). The synergistic effect of several lifestyle modifications results in greater benefits than a single modification alone. Baseline diagnostic/laboratory testing establishes if a co-existing underlying condition is the etiology of hypertension and evaluates if end organ damage from hypertension has already occurred. Landmark trials such as ALLHAT have repeatedly proven the efficacy of pharmacologic therapy to control blood pressure and reduce the complications of hypertension. Follow-up intervals based on blood pressure control have been established by the JNC 7 and the USPSTF. |
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Clinical Recommendation Statement |
The U.S. Preventive Services Task Force (USPSTF) recommends screening for high blood pressure in adults age 18 years and older. This is a grade A recommendation. |
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Improvement Notation |
Higher score indicates better quality |
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Reference |
Appleton, S. L., Neo, C., Hill, C. L., Douglas, K. A., & Adams, R. J. (2013). Untreated hypertension: prevalence and patient factors and beliefs associated with under-treatment in a population sample. Journal of Human Hypertension, 27, 453-462. doi:10.1038/jhh.2012.62ID |
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Reference |
Garrison, G. M. & Oberhelman, S. (2013). Screening for hypertension annually compared with current practice. Annals of Family Medicine, 11 (2), 116-121. doi:10.1370/afm.1467 |
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Reference |
Greenland, P., Alpert, J. S., Beller, G. A., Benjamin, E. J., Budoff, M. J., Fayad, Z. A., Foster, E., Hlatky, M. A., Hodgson, J. M., Kushner, F. G., Lauer, M. S., Shaw, L. J., Smith, S. C., Jr, Taylor, A. J., Weintraub, W. S., Wenger, N. K., Jacobs, A. K., Smith, S. C., Jr, Anderson, J. L., Albert, N., … American Heart Association (2010). 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 56(25), e50–e103. https://doi.org/10.1016/j.jacc.2010.09.001 |
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Reference |
Luehr, D., Woolley, T., Burke, R., Dohmen, F., Hayes, R., Johnson, M...., Schoenleber, M. (2012). Hypertension diagnosis and treatment; Institute for Clinical Systems Improvement health care guideline. Updated November, 2012. |
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Reference |
U.S. Preventive Services Task Force (USPSTF) (2007). Screening for high blood pressure: U.S. Preventive Services Task Force reaffirmation recommendation statement. Annals of Internal Medicine; 147(11):783-6 |
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Reference |
U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute & National High Blood Pressure Education Program (2003). The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7). NIH Publication No. 03-5233 |
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Reference |
Winter, K. H., Tuttle, L. A. & Viera, A.J. (2013). Hypertension. Primary Care Clinics in Office Practice, 40, 179-194. doi:10.1016/j.pop.2012.11.008 |
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Definition |
Blood Pressure (BP) Classification: BP is defined by four (4) BP reading classifications: Normal, Pre-Hypertensive, First Hypertensive, and Second Hypertensive Readings Recommended BP Follow-Up: The Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends BP screening intervals, lifestyle modifications and interventions based on the current BP reading as listed in the "Recommended Blood Pressure Follow-Up Interventions" listed below Recommended Lifestyle Modifications: The JNC 7 report outlines lifestyle modifications which must include one or more of the following as indicated: * Weight Reduction * Dietary Approaches to Stop Hypertension (DASH) Eating Plan * Dietary Sodium Restriction * Increased Physical Activity * Moderation in alcohol (ETOH) Consumption Second Hypertensive Reading: Requires a BP reading of systolic BP >= 140 mmHg OR diastolic BP >= 90 mmHg during the current encounter AND a most recent BP reading within the last 12 months systolic BP >= 140 mmHg OR diastolic BP >= 90 mmHg Second Hypertensive Reading BP Interventions: The JNC 7 report outlines BP follow-up interventions for a second hypertensive BP reading and must include one or more of the following as indicated: * Anti-Hypertensive Pharmacologic Therapy * Laboratory Tests * Electrocardiogram (ECG) Recommended Blood Pressure Follow-Up Interventions: * Normal BP: No follow-up required for systolic BP < 120 mmHg AND diastolic BP < 80 mmHg * Pre-Hypertensive BP: Follow-up with rescreen every year with systolic BP of 120-139 mmHg OR diastolic BP of 80-89 mmHg AND recommend lifestyle modifications OR referral to Alternative/Primary Care Provider * First Hypertensive BP Reading: Patients with one elevated reading of systolic BP >= 140 mmHg OR diastolic BP >= 90 mmHg: * Follow-up with rescreen > 1 day and < 4 weeks AND recommend lifestyle modifications OR referral to Alternative/Primary Care Provider * Second Hypertensive BP Reading: Patients with second elevated reading of systolic BP >= 140 mmHg OR diastolic BP >= 90 mmHg: * Follow-up with Recommended lifestyle recommendations AND one or more of the Second Hypertensive Reading Interventions OR referral to Alternative/Primary Care Provider |
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Guidance |
This eCQM is an episode-based measure and should be reported at every visit for patients aged 18 years and older. This measure will be calculated based upon the clinical actions performed at every visit during the measurement period for each patient. The measure requires that blood pressure measurements (i.e., diastolic and systolic) be obtained during each visit in order to determine the blood pressure reading used to evaluate if an intervention is needed. Both the systolic and diastolic blood pressure measurements are required for inclusion. If there are multiple blood pressures obtained during a patient visit, only the last, or most recent, pressure measurement will be used to evaluate the measure requirements. The intent of this measure is to screen patients for high blood pressure and provide recommended follow-up as indicated. The documented follow-up plan must be related to the current blood pressure reading as indicated, example: "Patient referred to primary care provider for BP management." 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 patient visits for patients aged 18 years and older at the beginning of the measurement period |
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Denominator |
Equals Initial Population |
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Denominator Exclusions |
Patient has an active diagnosis of hypertension |
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Numerator |
Patient visits where patients were screened for high blood pressure AND have a recommended follow-up plan documented, as indicated, if the blood pressure is pre-hypertensive or hypertensive |
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Numerator Exclusions |
Not Applicable |
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Denominator Exceptions |
Documentation of medical reason(s) for not screening for high blood pressure (e.g., patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient's health status). Documentation of patient reason(s) for not screening for blood pressure measurements or for not ordering an appropriate follow-up intervention if patient is pre-hypertensive or hypertensive (e.g., patient refuses). |
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Supplemental Data Elements |
For every patient evaluated by this measure also identify payer, race, ethnicity and sex |
"Qualifying Encounter During Measurement Period" QualifyingEncounter with ["Patient Characteristic Birthdate": "Birth date"] BirthDate such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 18
"Initial Population"
"Qualifying Encounter During Measurement Period" QualifyingEncounter with ["Diagnosis": "Diagnosis of Hypertension"] Hypertension such that Hypertension.prevalencePeriod overlaps before QualifyingEncounter.relevantPeriod
"Encounter with Normal Blood Pressure Reading" union ( "Encounter with Prehypertensive Blood Pressure Reading" intersect ( ( "Encounter with Order for Intervention for Hypertension" intersect "Encounter with Order for Follow Up Within One Year" ) union "Encounter with Referral to Alternate Provider for High Blood Pressure Reading" ) ) union ( "Encounter with First Hypertensive Reading" intersect ( ( "Encounter with Order for Intervention for Hypertension" intersect "Encounter with Order for Follow Up Within 4 Weeks" ) union "Encounter with Referral to Alternate Provider for High Blood Pressure Reading" ) ) union ( "Encounter with Second Hypertensive Reading" intersect ( ( "Encounter with Order for Intervention for Hypertension" intersect ( "Encounter with Order for Laboratory Test for Hypertension" union "Encounter with Order for Electrocardiogram for Hypertension" union "Encounter with Order for Hypertension Medication" ) ) union "Encounter with Referral to Alternate Provider for High Blood Pressure Reading" ) )
None
"Encounter with Medical Reason for Not Obtaining or Patient Declined Blood Pressure Measurement" union "Encounter with Order for Hypertension Follow Up Declined by Patient"
None
"Initial Population"
"Encounter with Medical Reason for Not Obtaining or Patient Declined Blood Pressure Measurement" union "Encounter with Order for Hypertension Follow Up Declined by Patient"
"Qualifying Encounter During Measurement Period" QualifyingEncounter with ["Diagnosis": "Diagnosis of Hypertension"] Hypertension such that Hypertension.prevalencePeriod overlaps before QualifyingEncounter.relevantPeriod
"Encounter with High Blood Pressure Reading" except "Encounter with High Blood Pressure Reading Within Year Prior"
"Qualifying Encounter During Measurement Period" QualifyingEncounter let EncounterLastSystolicBP: Last(["Physical Exam, Performed": "Systolic blood pressure"] SystolicBP where SystolicBP.relevantDatetime during QualifyingEncounter.relevantPeriod sort by relevantDatetime ), EncounterLastDiastolicBP: Last(["Physical Exam, Performed": "Diastolic blood pressure"] DiastolicBP where DiastolicBP.relevantDatetime during QualifyingEncounter.relevantPeriod sort by relevantDatetime ) where EncounterLastSystolicBP.result > 0 'mm[Hg]' and EncounterLastDiastolicBP.result > 0 'mm[Hg]' and ( EncounterLastSystolicBP.result >= 140 'mm[Hg]' or EncounterLastDiastolicBP.result >= 90 'mm[Hg]' )
"Qualifying Encounter During Measurement Period" QualifyingEncounter let EncounterLastSystolicBP: Last(["Physical Exam, Performed": "Systolic blood pressure"] SystolicBP where SystolicBP.relevantDatetime 1 year or less before start of QualifyingEncounter.relevantPeriod sort by relevantDatetime ), EncounterLastDiastolicBP: Last(["Physical Exam, Performed": "Diastolic blood pressure"] DiastolicBP where DiastolicBP.relevantDatetime 1 year or less before start of QualifyingEncounter.relevantPeriod sort by relevantDatetime ) where EncounterLastSystolicBP.result > 0 'mm[Hg]' and EncounterLastDiastolicBP.result > 0 'mm[Hg]' and ( EncounterLastSystolicBP.result >= 140 'mm[Hg]' or EncounterLastDiastolicBP.result >= 90 'mm[Hg]' )
"Qualifying Encounter During Measurement Period" QualifyingEncounter with ( ["Physical Exam, Not Performed": "Systolic blood pressure"] union ["Physical Exam, Not Performed": "Diastolic blood pressure"] ) NoBPScreen such that ( NoBPScreen.negationRationale in "Medical Reason" or NoBPScreen.negationRationale in "Patient Declined" ) and NoBPScreen.authorDatetime same day as start of QualifyingEncounter.relevantPeriod
"Qualifying Encounter During Measurement Period" QualifyingEncounter let EncounterLastSystolicBP: Last(["Physical Exam, Performed": "Systolic blood pressure"] SystolicBP where SystolicBP.relevantDatetime during QualifyingEncounter.relevantPeriod sort by relevantDatetime ), EncounterLastDiastolicBP: Last(["Physical Exam, Performed": "Diastolic blood pressure"] DiastolicBP where DiastolicBP.relevantDatetime during QualifyingEncounter.relevantPeriod sort by relevantDatetime ) where EncounterLastSystolicBP.result included in Interval[1 'mm[Hg]', 120 'mm[Hg]' ) and EncounterLastDiastolicBP.result included in Interval[1 'mm[Hg]', 80 'mm[Hg]' )
"Qualifying Encounter During Measurement Period" QualifyingEncounter with ( ["Diagnostic Study, Order": "EKG 12 channel panel"] union ["Diagnostic Study, Order": "EKG study"] ) ECG such that ECG.authorDatetime same day as start of QualifyingEncounter.relevantPeriod
"Qualifying Encounter During Measurement Period" QualifyingEncounter with ["Intervention, Order": "Follow Up Within 4 Weeks"] Followup4Weeks such that Followup4Weeks.authorDatetime same day as start of QualifyingEncounter.relevantPeriod
"Qualifying Encounter During Measurement Period" QualifyingEncounter with ["Intervention, Order": "Follow Up Within One Year"] FollowupOneYear such that FollowupOneYear.authorDatetime same day as start of QualifyingEncounter.relevantPeriod
"Qualifying Encounter During Measurement Period" QualifyingEncounter with ( ["Diagnostic Study, Not Ordered": "EKG 12 channel panel"] union ["Diagnostic Study, Not Ordered": "EKG study"] union ["Intervention, Not Ordered": "Follow Up Within One Year"] union ["Intervention, Not Ordered": "Follow Up Within 4 Weeks"] union ["Intervention, Not Ordered": "Referral to Primary Care or Alternate Provider"] union ["Intervention, Not Ordered": "Lifestyle Recommendation"] union ["Intervention, Not Ordered": "Weight Reduction Recommended"] union ["Intervention, Not Ordered": "Dietary Recommendations"] union ["Intervention, Not Ordered": "Recommendation to Increase Physical Activity"] union ["Intervention, Not Ordered": "Referral or Counseling for Alcohol Consumption"] union ["Laboratory Test, Not Ordered": "Laboratory Tests for Hypertension"] union ["Medication, Not Ordered": "Pharmacologic Therapy for Hypertension"] ) NoFollowUpOrdered such that NoFollowUpOrdered.negationRationale in "Patient Declined" and NoFollowUpOrdered.authorDatetime same day as start of QualifyingEncounter.relevantPeriod
"Qualifying Encounter During Measurement Period" QualifyingEncounter with ["Medication, Order": "Pharmacologic Therapy for Hypertension"] AntihypertensiveMedication such that AntihypertensiveMedication.authorDatetime same day as start of QualifyingEncounter.relevantPeriod
"Qualifying Encounter During Measurement Period" QualifyingEncounter with ( ["Intervention, Order": "Lifestyle Recommendation"] union ["Intervention, Order": "Weight Reduction Recommended"] union ["Intervention, Order": "Dietary Recommendations"] union ["Intervention, Order": "Recommendation to Increase Physical Activity"] union ["Intervention, Order": "Referral or Counseling for Alcohol Consumption"] ) HighBloodPressureIntervention such that HighBloodPressureIntervention.authorDatetime same day as start of QualifyingEncounter.relevantPeriod
"Qualifying Encounter During Measurement Period" QualifyingEncounter with ["Laboratory Test, Order": "Laboratory Tests for Hypertension"] HypertensionLabs such that HypertensionLabs.authorDatetime same day as start of QualifyingEncounter.relevantPeriod
"Qualifying Encounter During Measurement Period" QualifyingEncounter let EncounterLastSystolicBP: Last(["Physical Exam, Performed": "Systolic blood pressure"] SystolicBP where SystolicBP.relevantDatetime during QualifyingEncounter.relevantPeriod sort by relevantDatetime ), EncounterLastDiastolicBP: Last(["Physical Exam, Performed": "Diastolic blood pressure"] DiastolicBP where DiastolicBP.relevantDatetime during QualifyingEncounter.relevantPeriod sort by relevantDatetime ) where EncounterLastSystolicBP.result included in Interval[1 'mm[Hg]', 140 'mm[Hg]' ) and EncounterLastDiastolicBP.result included in Interval[1 'mm[Hg]', 90 'mm[Hg]' ) and ( EncounterLastSystolicBP.result >= 120 'mm[Hg]' or EncounterLastDiastolicBP.result >= 80 'mm[Hg]' )
"Qualifying Encounter During Measurement Period" QualifyingEncounter with ["Intervention, Order": "Referral to Primary Care or Alternate Provider"] Referral such that Referral.authorDatetime same day as start of QualifyingEncounter.relevantPeriod and Referral.reason in "Finding of Elevated Blood Pressure or Hypertension"
"Encounter with High Blood Pressure Reading" intersect "Encounter with High Blood Pressure Reading Within Year Prior"
"Qualifying Encounter During Measurement Period" QualifyingEncounter with ["Patient Characteristic Birthdate": "Birth date"] BirthDate such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 18
"Encounter with Normal Blood Pressure Reading" union ( "Encounter with Prehypertensive Blood Pressure Reading" intersect ( ( "Encounter with Order for Intervention for Hypertension" intersect "Encounter with Order for Follow Up Within One Year" ) union "Encounter with Referral to Alternate Provider for High Blood Pressure Reading" ) ) union ( "Encounter with First Hypertensive Reading" intersect ( ( "Encounter with Order for Intervention for Hypertension" intersect "Encounter with Order for Follow Up Within 4 Weeks" ) union "Encounter with Referral to Alternate Provider for High Blood Pressure Reading" ) ) union ( "Encounter with Second Hypertensive Reading" intersect ( ( "Encounter with Order for Intervention for Hypertension" intersect ( "Encounter with Order for Laboratory Test for Hypertension" union "Encounter with Order for Electrocardiogram for Hypertension" union "Encounter with Order for Hypertension Medication" ) ) union "Encounter with Referral to Alternate Provider for High Blood Pressure Reading" ) )
["Encounter, Performed": "Encounter to Screen for Blood Pressure"] 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 |
Preventive Care and Screening |
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