eCQM Title

Childhood Immunization Status

eCQM Identifier (Measure Authoring Tool)

117

eCQM Version Number

11.0.000

NQF Number

Not Applicable

GUID

b2802b7a-3580-4be8-9458-921aea62b78c

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 children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three or four H influenza type B (Hib); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday

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) 2012-2021 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 2004-2021 American Medical Association. LOINC(R) copyright 2004-2021 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2021 International Health Terminology Standards Development Organisation. ICD-10 copyright 2021 World Health Organization. All Rights Reserved.

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

None

Risk Adjustment

None

Rate Aggregation

None

Rationale

Infants and toddlers are particularly vulnerable to infectious diseases because their immune systems have not built up the necessary defenses to fight infection (Centers for Disease Control and Prevention (CDC, 2019). Most childhood vaccines are between 90 and 99 percent effective in preventing diseases (American Academy of Pediatrics, 2013). Vaccination of each U.S. birth cohort with the current childhood immunization schedule prevents approximately 42,000 deaths and 20 million cases of disease and saves nearly $14 billion in direct costs and $69 billion in societal costs each year (Zhou et al., 2014). 

Immunizing a child not only protects that child's health but also the health of the community, especially for those who are not immunized or are unable to be immunized due to other health complications (CDC, 2018).

Clinical Recommendation Statement

This measure looks for childhood vaccinations that should be completed by age 2, in accordance with the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (CDC ACIP) recommended child and adolescent immunization schedule (CDC ACIP 2021). 

-- For the 2021–22 season, see the 2021–22 ACIP influenza vaccine recommendations.

Improvement Notation

Higher score indicates better quality

Reference

Reference Type: CITATION

Reference Text: 'American Academy of Pediatrics. (2013). Why Immunize Your Child. Retrieved September 10, 2020, from: http://www.healthychildren.org/english/safety-prevention/immunizations/Pages/Why-Immunize-Your-Child.aspx'

Reference

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention (CDC). (2019). Common Questions About Vaccines. Retrieved September 10, 2020, from https://www.cdc.gov/vaccines/parents/FAQs.html'

Reference

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention. (2021). Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States. Retrieved July 26, 2021, from https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html#note-flu'

Reference

Reference Type: CITATION

Reference Text: 'Grohskopf LA, Alyanak E, Ferdinands JM, et al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021–22 Influenza Season. MMWR Recomm Rep 2021;70(No. RR-5),1–28. DOI: http://dx.doi.org/10.15585/mmwr.rr7005a1 external icon.'

Reference

Reference Type: CITATION

Reference Text: 'Zhou, F., Shefer, A., Wenger, J., Messonnier, M., Wang, L. Y., Lopez, A., … Rodewald, L. (2014). Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009. Pediatrics, 133(4), 577–585. https://doi.org/10.1542/peds.2013-0698'

Definition

Recommended vaccines: Vaccines and the schedule of vaccines as recommended by the ACIP for children two years of age. The measure may differ slightly from the ACIP recommendations because the measure focuses on immunizations that are appropriate by age 2. Also, there may be small differences when there are shortages for a particular vaccine.

Guidance

The measure allows a grace period by measuring compliance with these recommendations between birth and age two.

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

Children who turn 2 years of age during the measurement period and have a visit during the measurement period

Denominator

Equals Initial Population

Denominator Exclusions

Exclude children with any of the following on or before the child’s second birthday:
•	Severe combined immunodeficiency
•	Immunodeficiency
•	HIV
•	Lymphoreticular cancer, multiple myeloma or leukemia
•	Intussusception

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

Numerator

Diphtheria, tetanus, and pertussis (DTaP) vaccination
Children with any of the following on or before the child’s second birthday meet criteria:
• At least four DTaP vaccinations, with different dates of service. Do not count a vaccination administered prior to 42 days after birth.
• Anaphylaxis due to the diphtheria, tetanus or pertussis vaccine.
• Encephalitis due to the diphtheria, tetanus or pertussis vaccine.

Poliovirus vaccination (IPV)
At least three IPV vaccinations, with different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.

Measles, mumps, and rubella vaccination (MMR)
Children with either of the following meet criteria:
• At least one MMR vaccination on or between the child’s first and second birthdays.
• All of the following anytime on or before the child’s second birthday (on the same or different date of service):
o History of measles
o History of mumps
o History of rubella

Haemophilus influenzae type b vaccination (HiB)
Children with either of the following meet criteria on or before the child’s second birthday:
• At least three HiB vaccinations, with different dates of service. Do not count a vaccination administered prior to 42 days after birth.
• Anaphylaxis due to the HiB vaccine.

Hepatitis B
Children with any of the following on or before the child’s second birthday meet criteria:
• At least three hepatitis B vaccinations, with different dates of service.
o One of the three vaccinations can be a newborn hepatitis B vaccination during the eight-day period that begins on the date of birth and ends seven days after the date of birth. For example, if the member’s date of birth is December 1, the newborn hepatitis B vaccination must be on or between December 1 and December 8.
• Anaphylaxis due to the hepatitis B vaccine.
• History of hepatitis B illness.

Varicella vaccination (VZV)
Children with either of the following meet criteria:
• At least one VZV vaccination, with a date of service on or between the child’s first and second birthdays.
• History of varicella zoster (e.g., chicken pox) illness on or before the child’s second birthday.

Pneumococcal Conjugate
At least four pneumococcal conjugate vaccinations, with different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.

Hepatitis A
Children with either of the following meet criteria:
• At least one hepatitis A vaccination, with a date of service on or between the child’s first and second birthdays.
• History of hepatitis A illness on or before the child’s second birthday.

Rotavirus
Children with any of the following meet criteria:
• At least two doses of the two-dose rotavirus vaccine on different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.
• At least three doses of the three-dose rotavirus vaccine on different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.
• At least one dose of the two-dose rotavirus vaccine and at least two doses of the three-dose rotavirus vaccine, all on different dates of service, on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.
• Anaphylaxis due to the rotavirus vaccine on or before the child’s second birthday.

Influenza
At least two influenza vaccinations, with different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 6 months (180 days) after birth.
• One of the two vaccinations can be an LAIV vaccination administered on the child’s second birthday. Do not count an LAIV vaccination administered before the child’s second birthday.

Numerator Exclusions

Not Applicable

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"
)= 2
  and exists ( "Qualifying Encounters" )

- Denominator
  - "Initial Population"

Denominator Exclusions

Hospice."Has Hospice Services"
  or "Has Severe Combined Immunodeficiency"
  or "Has Immunodeficiency"
  or "Has HIV"
  or "Has Lymphoreticular Cancer, Multiple Myeloma or Leukemia"
  or "Has Intussusception"

Numerator

( exists ( "Four DTaP Vaccinations" )
    or exists ( "DTaP Numerator Inclusion Conditions" )
)
  and ( exists ( "Three Polio Vaccinations" ) )
  and ( exists ( "One MMR Vaccination" )
      or ( exists ( "Measles Indicators" )
          and exists ( "Mumps Indicators" )
          and exists ( "Rubella Indicators" )
      )
  )
  and ( "Has Appropriate Number of Hib Immunizations"
      or exists ( "Hib Numerator Inclusion Conditions" )
  )
  and ( exists ( "Three Hepatitis B Vaccinations" )
      or ( exists ( "Meets HepB Vaccination Requirement" )
          or exists ( "Hepatitis B Numerator Inclusion Conditions" )
      )
  )
  and ( exists ( "One Chicken Pox Vaccination" )
      or exists ( "Varicella Zoster Numerator Inclusion Conditions" )
  )
  and ( exists ( "Four Pneumococcal Conjugate Vaccinations" ) )
  and ( exists ( "One Hepatitis A Vaccinations" )
      or exists ( "Hepatitis A Numerator Inclusion Conditions" )
  )
  and ( "Has Appropriate Number of Rotavirus Immunizations"
      or exists ( "Rotavirus Numerator Inclusion Conditions" )
  )
  and ( exists ( "Two Influenza Vaccinations" )
      or ( "Two Influenza Vaccinations Including One LAIV Vaccination" )
  )

- Numerator Exclusions
  - None

- Denominator Exceptions
  - None

- Stratification
  - None

Definitions

All Hib Vaccinations

"Hib 3 or 4 Dose Immunizations" AllHibDoses1
  without "Hib 3 or 4 Dose Immunizations" AllHibDoses2
    such that AllHibDoses1.relevantDatetime less than 1 day before AllHibDoses2.relevantDatetime

All Rotavirus Vaccinations

"Rotavirus 2 or 3 Dose Immunizations" AllRotavirusDoses1
  without "Rotavirus 2 or 3 Dose Immunizations" AllRotavirusDoses2
    such that AllRotavirusDoses1.relevantDatetime less than 1 day before AllRotavirusDoses2.relevantDatetime

Date of First Birthday

date from Patient.birthDatetime + 1 year

Date of First Birthday to Date of Second Birthday

Interval["Date of First Birthday", "Date of Second Birthday"]

Date of Second Birthday

date from Patient.birthDatetime + 2 years

Denominator
- - "Initial Population"

Denominator Exclusions

Hospice."Has Hospice Services"
  or "Has Severe Combined Immunodeficiency"
  or "Has Immunodeficiency"
  or "Has HIV"
  or "Has Lymphoreticular Cancer, Multiple Myeloma or Leukemia"
  or "Has Intussusception"

DTaP Immunizations or Procedures

( ( ["Immunization, Administered": "DTaP Vaccine"]
    union ["Procedure, Performed": "DTaP Vaccine Administered"] ) DTaPVaccination
    where Global."ToDateInterval" ( Global."NormalizeInterval" ( DTaPVaccination.relevantDatetime, DTaPVaccination.relevantPeriod ) ) during day of "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

DTaP Numerator Inclusion Conditions

( ["Diagnosis": "Anaphylactic Reaction to DTaP Vaccine"]
  union ["Diagnosis": "Encephalitis Due to Diphtheria, Tetanus or Pertussis Vaccine"] ) DTaPConditions
  where date from start of DTaPConditions.prevalencePeriod during day of "First Two Years"

First Two Years

Interval[date from Patient.birthDatetime, "Date of Second Birthday"]

Four DTaP Vaccinations

from
  "DTaP Immunizations or Procedures" DTaPVaccination1,
  "DTaP Immunizations or Procedures" DTaPVaccination2,
  "DTaP Immunizations or Procedures" DTaPVaccination3,
  "DTaP Immunizations or Procedures" DTaPVaccination4
  where DTaPVaccination2.relevantDatetime 1 day or more after day of DTaPVaccination1.relevantDatetime
    and DTaPVaccination3.relevantDatetime 1 day or more after day of DTaPVaccination2.relevantDatetime
    and DTaPVaccination4.relevantDatetime 1 day or more after day of DTaPVaccination3.relevantDatetime
  return DTaPVaccination1

Four Pneumococcal Conjugate Vaccinations

from
  "Pneumococcal Conjugate Immunizations or Procedures" PneumococcalVaccination1,
  "Pneumococcal Conjugate Immunizations or Procedures" PneumococcalVaccination2,
  "Pneumococcal Conjugate Immunizations or Procedures" PneumococcalVaccination3,
  "Pneumococcal Conjugate Immunizations or Procedures" PneumococcalVaccination4
  where PneumococcalVaccination2.relevantDatetime 1 day or more after day of PneumococcalVaccination1.relevantDatetime
    and PneumococcalVaccination3.relevantDatetime 1 day or more after day of PneumococcalVaccination2.relevantDatetime
    and PneumococcalVaccination4.relevantDatetime 1 day or more after day of PneumococcalVaccination3.relevantDatetime
  return PneumococcalVaccination1

Has Appropriate Number of Hib Immunizations

exists ( "All Hib Vaccinations" HibImmunization //union of 3 and 4 dose immunizations
//4 dose test
    let HasFourDose: Count("Hib 4 Dose Immunizations or Procedures")> 0
    where ( HasFourDose //if pt had at least one 4 dose code
        and Count(distinct("All Hib Vaccinations" HibVaccinations
              return HibVaccinations.relevantDatetime
          )
        )>= 4 //pt must have 4 regimens (e.g., 3,3,4,4 or 4,3,4,4)
    )
      or ( HasFourDose is false //if pt did not have at least one 4 dose code
          and Count(distinct("All Hib Vaccinations" HibVaccinations
                return HibVaccinations.relevantDatetime
            )
          )>= 3 //pt must have 3 regimens of 3 dose codes
      )
)

Has Appropriate Number of Rotavirus Immunizations

exists ( "All Rotavirus Vaccinations" RotavirusImmunization
    let HasThreeDose: Count("Rotavirus 3 Dose Immunizations or Procedures")> 0
    where ( HasThreeDose
        and Count(distinct("All Rotavirus Vaccinations" RotavirusVaccinations
              return RotavirusVaccinations.relevantDatetime
          )
        )>= 3
    )
      or ( HasThreeDose is false
          and Count(distinct("All Rotavirus Vaccinations" RotavirusVaccinations
                return RotavirusVaccinations.relevantDatetime
            )
          )>= 2
      )
)

Has HIV

exists ( ["Diagnosis": "HIV"] HIV
    where date from start of HIV.prevalencePeriod during day of "First Two Years"
)

Has Immunodeficiency

exists ( ["Diagnosis": "Disorders of the Immune System"] ImmuneDisorder
    where date from start of ImmuneDisorder.prevalencePeriod during day of "First Two Years"
)

Has Intussusception

exists ( ["Diagnosis": "Intussusception"] IntussusceptionDisorder
    where date from start of IntussusceptionDisorder.prevalencePeriod during day of "First Two Years"
)

Has Lymphoreticular Cancer, Multiple Myeloma or Leukemia

exists ( ["Diagnosis": "Malignant Neoplasm of Lymphatic and Hematopoietic Tissue"] LymphaticMalignantNeoplasm
    where date from start of LymphaticMalignantNeoplasm.prevalencePeriod during day of "First Two Years"
)

Has Severe Combined Immunodeficiency

exists ( ["Diagnosis": "Severe Combined Immunodeficiency"] SevereImmuneDisorder
    where date from start of SevereImmuneDisorder.prevalencePeriod during day of "First Two Years"
)

Hepatitis A Numerator Inclusion Conditions

["Diagnosis": "Hepatitis A"] HepatitisADiagnosis
  where date from start of HepatitisADiagnosis.prevalencePeriod during day of "First Two Years"

Hepatitis B Immunizations or Procedures

( ( ["Immunization, Administered": "Hepatitis B Vaccine"]
    union ["Procedure, Performed": "Hepatitis B Vaccine Administered"] ) HepatitisBVaccination
    where Global."ToDateInterval" ( Global."NormalizeInterval" ( HepatitisBVaccination.relevantDatetime, HepatitisBVaccination.relevantPeriod ) ) during day of "First Two Years"
)

Hepatitis B Numerator Inclusion Conditions

( ["Diagnosis": "Anaphylaxis due to Hepatitis B vaccine (disorder)"]
  union ["Diagnosis": "Hepatitis B"] ) HepBConditions
  where date from start of HepBConditions.prevalencePeriod during day of "First Two Years"

Hib 3 Dose Immunizations or Procedures

( ( ["Immunization, Administered": "Hib Vaccine (3 dose schedule)"]
    union ["Procedure, Performed": "Hib Vaccine (3 dose schedule) Administered"] ) ThreeDoseHib
    where Global."ToDateInterval" ( Global."NormalizeInterval" ( ThreeDoseHib.relevantDatetime, ThreeDoseHib.relevantPeriod ) ) during day of "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

Hib 3 or 4 Dose Immunizations

"Hib 3 Dose Immunizations or Procedures"
  union "Hib 4 Dose Immunizations or Procedures"

Hib 4 Dose Immunizations or Procedures

( ( ["Immunization, Administered": "Hib Vaccine (4 dose schedule)"]
    union ["Procedure, Performed": "Hib Vaccine (4 dose schedule) Administered"] ) FourDoseHib
    where Global."ToDateInterval" ( Global."NormalizeInterval" ( FourDoseHib.relevantDatetime, FourDoseHib.relevantPeriod ) ) during day of "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

Hib Numerator Inclusion Conditions

["Diagnosis": "Anaphylaxis due to Haemophilus influenzae type b vaccine (disorder)"] HibReaction
  where date from start of HibReaction.prevalencePeriod during day of "First Two Years"

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 "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 "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 "Measurement Period"
  )

Influenza Immunizations or Procedures

( ( ["Immunization, Administered": "Influenza Vaccine"]
    union ["Procedure, Performed": "Influenza Vaccine Administered"] ) InfluenzaAdministration
    where Global."NormalizeInterval" ( InfluenzaAdministration.relevantDatetime, InfluenzaAdministration.relevantPeriod ) during day of "Vaccine Administration Interval - 180 Days up to 2 Years Old"
)

Initial Population

AgeInYearsAt(date from 
  end of "Measurement Period"
)= 2
  and exists ( "Qualifying Encounters" )

LAIV Vaccinations

( ( ["Immunization, Administered": "Influenza Virus LAIV Immunization"]
    union ["Procedure, Performed": "Influenza Virus LAIV Procedure"] ) InfluenzaAdministration
    where Global."ToDateInterval" ( Global."NormalizeInterval" ( InfluenzaAdministration.relevantDatetime, InfluenzaAdministration.relevantPeriod ) ) during day of Interval["Date of Second Birthday", "Date of Second Birthday"]
)

Measles Indicators

["Diagnosis": "Measles"] MeaslesDiagnosis
  where date from start of MeaslesDiagnosis.prevalencePeriod during day of "First Two Years"

Meets HepB Vaccination Requirement

"Three Hepatitis B Vaccinations" HepatitisBRequirement
  where date from HepatitisBRequirement.relevantDatetime during day of Interval[Patient.birthDatetime, Patient.birthDatetime + 7 days]

Mumps Indicators

["Diagnosis": "Mumps"] MumpsDiagnosis
  where date from start of MumpsDiagnosis.prevalencePeriod during day of "First Two Years"

Numerator

( exists ( "Four DTaP Vaccinations" )
    or exists ( "DTaP Numerator Inclusion Conditions" )
)
  and ( exists ( "Three Polio Vaccinations" ) )
  and ( exists ( "One MMR Vaccination" )
      or ( exists ( "Measles Indicators" )
          and exists ( "Mumps Indicators" )
          and exists ( "Rubella Indicators" )
      )
  )
  and ( "Has Appropriate Number of Hib Immunizations"
      or exists ( "Hib Numerator Inclusion Conditions" )
  )
  and ( exists ( "Three Hepatitis B Vaccinations" )
      or ( exists ( "Meets HepB Vaccination Requirement" )
          or exists ( "Hepatitis B Numerator Inclusion Conditions" )
      )
  )
  and ( exists ( "One Chicken Pox Vaccination" )
      or exists ( "Varicella Zoster Numerator Inclusion Conditions" )
  )
  and ( exists ( "Four Pneumococcal Conjugate Vaccinations" ) )
  and ( exists ( "One Hepatitis A Vaccinations" )
      or exists ( "Hepatitis A Numerator Inclusion Conditions" )
  )
  and ( "Has Appropriate Number of Rotavirus Immunizations"
      or exists ( "Rotavirus Numerator Inclusion Conditions" )
  )
  and ( exists ( "Two Influenza Vaccinations" )
      or ( "Two Influenza Vaccinations Including One LAIV Vaccination" )
  )

One Chicken Pox Vaccination

( ( ["Immunization, Administered": "Varicella Zoster Vaccine (VZV)"]
    union ["Procedure, Performed": "Varicella Zoster Vaccine (VZV) Administered"] ) ChickenPoxVaccination
    where Global."ToDateInterval" ( Global."NormalizeInterval" ( ChickenPoxVaccination.relevantDatetime, ChickenPoxVaccination.relevantPeriod ) ) during "Date of First Birthday to Date of Second Birthday"
)

One Hepatitis A Vaccinations

( ( ["Immunization, Administered": "Hepatitis A Vaccine"]
    union ["Procedure, Performed": "Hepatitis A Vaccine Administered"] ) HepatitisAVaccination
    where Global."ToDateInterval" ( Global."NormalizeInterval" ( HepatitisAVaccination.relevantDatetime, HepatitisAVaccination.relevantPeriod ) ) during "Date of First Birthday to Date of Second Birthday"
)

One MMR Vaccination

( ( ["Immunization, Administered": "Measles, Mumps and Rubella (MMR) Vaccine"]
    union ["Procedure, Performed": "Measles, Mumps and Rubella (MMR) Vaccine Administered"] ) MMRVaccination
    where Global."ToDateInterval" ( Global."NormalizeInterval" ( MMRVaccination.relevantDatetime, MMRVaccination.relevantPeriod ) ) during "Date of First Birthday to Date of Second Birthday"
)

Pneumococcal Conjugate Immunizations or Procedures

( ( ["Immunization, Administered": "Pneumococcal Conjugate Vaccine"]
    union ["Procedure, Performed": "Pneumococcal Conjugate Vaccine Administered"] ) PneumococcalVaccination
    where Global."ToDateInterval" ( Global."NormalizeInterval" ( PneumococcalVaccination.relevantDatetime, PneumococcalVaccination.relevantPeriod ) ) during day of "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

Polio Immunizations or Procedures

( ( ["Immunization, Administered": "Inactivated Polio Vaccine (IPV)"]
    union ["Procedure, Performed": "Inactivated Polio Vaccine (IPV) Administered"] ) PolioVaccination
    where Global."ToDateInterval" ( Global."NormalizeInterval" ( PolioVaccination.relevantDatetime, PolioVaccination.relevantPeriod ) ) during day of "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

Qualifying Encounters

( ["Encounter, Performed": "Office Visit"]
  union ["Encounter, Performed": "Home Healthcare Services"]
  union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"]
  union ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"]
  union ["Encounter, Performed": "Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal."]
  union ["Encounter, Performed": "Online Assessments"]
  union ["Encounter, Performed": "Telephone Visits"] ) ValidEncounters
  where ValidEncounters.relevantPeriod during day of "Measurement Period"

Rotavirus 2 Dose Immunizations or Procedures

( ( ["Immunization, Administered": "rotavirus, live, monovalent vaccine"]
    union ["Procedure, Performed": "Rotavirus Vaccine (2 dose schedule) Administered"] ) TwoDoseRotavirus
    where Global."NormalizeInterval" ( TwoDoseRotavirus.relevantDatetime, TwoDoseRotavirus.relevantPeriod ) during day of "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

Rotavirus 2 or 3 Dose Immunizations

"Rotavirus 2 Dose Immunizations or Procedures"
  union "Rotavirus 3 Dose Immunizations or Procedures"

Rotavirus 3 Dose Immunizations or Procedures

( ( ["Immunization, Administered": "Rotavirus Vaccine (3 dose schedule)"]
    union ["Procedure, Performed": "Rotavirus Vaccine (3 dose schedule) Administered"] ) ThreeDoseRotavirus
    where Global."ToDateInterval" ( Global."NormalizeInterval" ( ThreeDoseRotavirus.relevantDatetime, ThreeDoseRotavirus.relevantPeriod ) ) during day of "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

Rotavirus Numerator Inclusion Conditions

( ["Diagnosis": "Anaphylaxis due to rotavirus vaccine (disorder)"] RotavirusConditions
    where date from start of RotavirusConditions.prevalencePeriod during day of "First Two Years"
)

Rubella Indicators

["Diagnosis": "Rubella"] RubellaDiagnosis
  where date from start of RubellaDiagnosis.prevalencePeriod during day of "First Two Years"

SDE Ethnicity

["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

["Patient Characteristic Payer": "Payer"]

SDE Race
- - ["Patient Characteristic Race": "Race"]

SDE Sex

["Patient Characteristic Sex": "ONC Administrative Sex"]

Three Hepatitis B Vaccinations

from
  "Hepatitis B Immunizations or Procedures" HepatitisBVaccination1,
  "Hepatitis B Immunizations or Procedures" HepatitisBVaccination2,
  "Hepatitis B Immunizations or Procedures" HepatitisBVaccination3
  where HepatitisBVaccination2.relevantDatetime 1 day or more after day of HepatitisBVaccination1.relevantDatetime
    and HepatitisBVaccination3.relevantDatetime 1 day or more after day of HepatitisBVaccination2.relevantDatetime
  return HepatitisBVaccination1

Three Polio Vaccinations

from
  "Polio Immunizations or Procedures" PolioVaccination1,
  "Polio Immunizations or Procedures" PolioVaccination2,
  "Polio Immunizations or Procedures" PolioVaccination3
  where PolioVaccination2.relevantDatetime 1 day or more after day of PolioVaccination1.relevantDatetime
    and PolioVaccination3.relevantDatetime 1 day or more after day of PolioVaccination2.relevantDatetime
  return PolioVaccination1

Two Influenza Vaccinations

from
  "Influenza Immunizations or Procedures" FluVaccination1,
  "Influenza Immunizations or Procedures" FluVaccination2
  where FluVaccination2.relevantDatetime 1 day or more after day of FluVaccination1.relevantDatetime
  return FluVaccination1

Two Influenza Vaccinations Including One LAIV Vaccination

exists "LAIV Vaccinations"
  and exists "Influenza Immunizations or Procedures"

Vaccine Administration Interval - 180 Days up to 2 Years Old

Interval[date from Patient.birthDatetime + 180 days, "Date of Second Birthday"]

Vaccine Administration Interval - 42 Days up to 2 Years Old

Interval[date from Patient.birthDatetime + 42 days, "Date of Second Birthday"]

Varicella Zoster Numerator Inclusion Conditions

["Diagnosis": "Varicella Zoster"] VaricellaZoster
  where date from start of VaricellaZoster.prevalencePeriod during day of "First Two Years"

Functions

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>

Global.ToDateInterval(period Interval<DateTime>)

Interval[date from start of period, date from end of period]

Terminology

code "Anaphylaxis due to Haemophilus influenzae type b vaccine (disorder)" ("SNOMEDCT Code (433621000124101)")
code "Anaphylaxis due to Hepatitis B vaccine (disorder)" ("SNOMEDCT Code (428321000124101)")
code "Anaphylaxis due to rotavirus vaccine (disorder)" ("SNOMEDCT Code (428331000124103)")
code "Discharge to healthcare facility for hospice care (procedure)" ("SNOMEDCT Code (428371000124100)")
code "Discharge to home for hospice care (procedure)" ("SNOMEDCT Code (428361000124107)")
code "Hospice care [Minimum Data Set]" ("LOINC Code (45755-6)")
code "Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal." ("CPT Code (99211)")
code "rotavirus, live, monovalent vaccine" ("CVX Code (119)")
code "Yes (qualifier value)" ("SNOMEDCT Code (373066001)")
valueset "Anaphylactic Reaction to DTaP Vaccine" (2.16.840.1.113883.3.464.1003.199.12.1031)
valueset "Disorders of the Immune System" (2.16.840.1.113883.3.464.1003.120.12.1001)
valueset "DTaP Vaccine" (2.16.840.1.113883.3.464.1003.196.12.1214)
valueset "DTaP Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1022)
valueset "Encephalitis Due to Diphtheria, Tetanus or Pertussis Vaccine" (2.16.840.1.113883.3.464.1003.1164)
valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
valueset "Hepatitis A" (2.16.840.1.113883.3.464.1003.110.12.1024)
valueset "Hepatitis A Vaccine" (2.16.840.1.113883.3.464.1003.196.12.1215)
valueset "Hepatitis A Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1041)
valueset "Hepatitis B" (2.16.840.1.113883.3.464.1003.110.12.1025)
valueset "Hepatitis B Vaccine" (2.16.840.1.113883.3.464.1003.196.12.1216)
valueset "Hepatitis B Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1042)
valueset "Hib Vaccine (3 dose schedule)" (2.16.840.1.113883.3.464.1003.110.12.1083)
valueset "Hib Vaccine (3 dose schedule) Administered" (2.16.840.1.113883.3.464.1003.110.12.1084)
valueset "Hib Vaccine (4 dose schedule)" (2.16.840.1.113883.3.464.1003.110.12.1085)
valueset "Hib Vaccine (4 dose schedule) Administered" (2.16.840.1.113883.3.464.1003.110.12.1086)
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 Encounter" (2.16.840.1.113883.3.464.1003.1003)
valueset "Inactivated Polio Vaccine (IPV)" (2.16.840.1.113883.3.464.1003.196.12.1219)
valueset "Inactivated Polio Vaccine (IPV) Administered" (2.16.840.1.113883.3.464.1003.110.12.1045)
valueset "Influenza Vaccine" (2.16.840.1.113883.3.464.1003.196.12.1218)
valueset "Influenza Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1044)
valueset "Influenza Virus LAIV Immunization" (2.16.840.1.113883.3.464.1003.110.12.1087)
valueset "Influenza Virus LAIV Procedure" (2.16.840.1.113883.3.464.1003.110.12.1088)
valueset "Intussusception" (2.16.840.1.113883.3.464.1003.199.12.1056)
valueset "Malignant Neoplasm of Lymphatic and Hematopoietic Tissue" (2.16.840.1.113883.3.464.1003.108.12.1009)
valueset "Measles" (2.16.840.1.113883.3.464.1003.110.12.1053)
valueset "Measles, Mumps and Rubella (MMR) Vaccine" (2.16.840.1.113883.3.464.1003.196.12.1224)
valueset "Measles, Mumps and Rubella (MMR) Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1031)
valueset "Mumps" (2.16.840.1.113883.3.464.1003.110.12.1032)
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 "Online Assessments" (2.16.840.1.113883.3.464.1003.101.12.1089)
valueset "Payer" (2.16.840.1.114222.4.11.3591)
valueset "Pneumococcal Conjugate Vaccine" (2.16.840.1.113883.3.464.1003.196.12.1221)
valueset "Pneumococcal Conjugate Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1046)
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 "Race" (2.16.840.1.114222.4.11.836)
valueset "Rotavirus Vaccine (2 dose schedule) Administered" (2.16.840.1.113883.3.464.1003.110.12.1048)
valueset "Rotavirus Vaccine (3 dose schedule)" (2.16.840.1.113883.3.464.1003.196.12.1223)
valueset "Rotavirus Vaccine (3 dose schedule) Administered" (2.16.840.1.113883.3.464.1003.110.12.1047)
valueset "Rubella" (2.16.840.1.113883.3.464.1003.110.12.1037)
valueset "Severe Combined Immunodeficiency" (2.16.840.1.113883.3.464.1003.120.12.1007)
valueset "Telephone Visits" (2.16.840.1.113883.3.464.1003.101.12.1080)
valueset "Varicella Zoster" (2.16.840.1.113883.3.464.1003.110.12.1039)
valueset "Varicella Zoster Vaccine (VZV)" (2.16.840.1.113883.3.464.1003.196.12.1170)
valueset "Varicella Zoster Vaccine (VZV) Administered" (2.16.840.1.113883.3.464.1003.110.12.1040)

Data Criteria (QDM Data Elements)

"Assessment, Performed: Hospice care [Minimum Data Set]" using "Hospice care [Minimum Data Set] (LOINC Code 45755-6)"
"Diagnosis: Anaphylactic Reaction to DTaP Vaccine" using "Anaphylactic Reaction to DTaP Vaccine (2.16.840.1.113883.3.464.1003.199.12.1031)"
"Diagnosis: Anaphylaxis due to Haemophilus influenzae type b vaccine (disorder)" using "Anaphylaxis due to Haemophilus influenzae type b vaccine (disorder) (SNOMEDCT Code 433621000124101)"
"Diagnosis: Anaphylaxis due to Hepatitis B vaccine (disorder)" using "Anaphylaxis due to Hepatitis B vaccine (disorder) (SNOMEDCT Code 428321000124101)"
"Diagnosis: Anaphylaxis due to rotavirus vaccine (disorder)" using "Anaphylaxis due to rotavirus vaccine (disorder) (SNOMEDCT Code 428331000124103)"
"Diagnosis: Disorders of the Immune System" using "Disorders of the Immune System (2.16.840.1.113883.3.464.1003.120.12.1001)"
"Diagnosis: Encephalitis Due to Diphtheria, Tetanus or Pertussis Vaccine" using "Encephalitis Due to Diphtheria, Tetanus or Pertussis Vaccine (2.16.840.1.113883.3.464.1003.1164)"
"Diagnosis: Hepatitis A" using "Hepatitis A (2.16.840.1.113883.3.464.1003.110.12.1024)"
"Diagnosis: Hepatitis B" using "Hepatitis B (2.16.840.1.113883.3.464.1003.110.12.1025)"
"Diagnosis: HIV" using "HIV (2.16.840.1.113883.3.464.1003.120.12.1003)"
"Diagnosis: Intussusception" using "Intussusception (2.16.840.1.113883.3.464.1003.199.12.1056)"
"Diagnosis: Malignant Neoplasm of Lymphatic and Hematopoietic Tissue" using "Malignant Neoplasm of Lymphatic and Hematopoietic Tissue (2.16.840.1.113883.3.464.1003.108.12.1009)"
"Diagnosis: Measles" using "Measles (2.16.840.1.113883.3.464.1003.110.12.1053)"
"Diagnosis: Mumps" using "Mumps (2.16.840.1.113883.3.464.1003.110.12.1032)"
"Diagnosis: Rubella" using "Rubella (2.16.840.1.113883.3.464.1003.110.12.1037)"
"Diagnosis: Severe Combined Immunodeficiency" using "Severe Combined Immunodeficiency (2.16.840.1.113883.3.464.1003.120.12.1007)"
"Diagnosis: Varicella Zoster" using "Varicella Zoster (2.16.840.1.113883.3.464.1003.110.12.1039)"
"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 or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal." using "Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. (CPT Code 99211)"
"Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)"
"Encounter, Performed: Online Assessments" using "Online Assessments (2.16.840.1.113883.3.464.1003.101.12.1089)"
"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)"
"Immunization, Administered: DTaP Vaccine" using "DTaP Vaccine (2.16.840.1.113883.3.464.1003.196.12.1214)"
"Immunization, Administered: Hepatitis A Vaccine" using "Hepatitis A Vaccine (2.16.840.1.113883.3.464.1003.196.12.1215)"
"Immunization, Administered: Hepatitis B Vaccine" using "Hepatitis B Vaccine (2.16.840.1.113883.3.464.1003.196.12.1216)"
"Immunization, Administered: Hib Vaccine (3 dose schedule)" using "Hib Vaccine (3 dose schedule) (2.16.840.1.113883.3.464.1003.110.12.1083)"
"Immunization, Administered: Hib Vaccine (4 dose schedule)" using "Hib Vaccine (4 dose schedule) (2.16.840.1.113883.3.464.1003.110.12.1085)"
"Immunization, Administered: Inactivated Polio Vaccine (IPV)" using "Inactivated Polio Vaccine (IPV) (2.16.840.1.113883.3.464.1003.196.12.1219)"
"Immunization, Administered: Influenza Vaccine" using "Influenza Vaccine (2.16.840.1.113883.3.464.1003.196.12.1218)"
"Immunization, Administered: Influenza Virus LAIV Immunization" using "Influenza Virus LAIV Immunization (2.16.840.1.113883.3.464.1003.110.12.1087)"
"Immunization, Administered: Measles, Mumps and Rubella (MMR) Vaccine" using "Measles, Mumps and Rubella (MMR) Vaccine (2.16.840.1.113883.3.464.1003.196.12.1224)"
"Immunization, Administered: Pneumococcal Conjugate Vaccine" using "Pneumococcal Conjugate Vaccine (2.16.840.1.113883.3.464.1003.196.12.1221)"
"Immunization, Administered: Rotavirus Vaccine (3 dose schedule)" using "Rotavirus Vaccine (3 dose schedule) (2.16.840.1.113883.3.464.1003.196.12.1223)"
"Immunization, Administered: rotavirus, live, monovalent vaccine" using "rotavirus, live, monovalent vaccine (CVX Code 119)"
"Immunization, Administered: Varicella Zoster Vaccine (VZV)" using "Varicella Zoster Vaccine (VZV) (2.16.840.1.113883.3.464.1003.196.12.1170)"
"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)"
"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)"
"Procedure, Performed: DTaP Vaccine Administered" using "DTaP Vaccine Administered (2.16.840.1.113883.3.464.1003.110.12.1022)"
"Procedure, Performed: Hepatitis A Vaccine Administered" using "Hepatitis A Vaccine Administered (2.16.840.1.113883.3.464.1003.110.12.1041)"
"Procedure, Performed: Hepatitis B Vaccine Administered" using "Hepatitis B Vaccine Administered (2.16.840.1.113883.3.464.1003.110.12.1042)"
"Procedure, Performed: Hib Vaccine (3 dose schedule) Administered" using "Hib Vaccine (3 dose schedule) Administered (2.16.840.1.113883.3.464.1003.110.12.1084)"
"Procedure, Performed: Hib Vaccine (4 dose schedule) Administered" using "Hib Vaccine (4 dose schedule) Administered (2.16.840.1.113883.3.464.1003.110.12.1086)"
"Procedure, Performed: Inactivated Polio Vaccine (IPV) Administered" using "Inactivated Polio Vaccine (IPV) Administered (2.16.840.1.113883.3.464.1003.110.12.1045)"
"Procedure, Performed: Influenza Vaccine Administered" using "Influenza Vaccine Administered (2.16.840.1.113883.3.464.1003.110.12.1044)"
"Procedure, Performed: Influenza Virus LAIV Procedure" using "Influenza Virus LAIV Procedure (2.16.840.1.113883.3.464.1003.110.12.1088)"
"Procedure, Performed: Measles, Mumps and Rubella (MMR) Vaccine Administered" using "Measles, Mumps and Rubella (MMR) Vaccine Administered (2.16.840.1.113883.3.464.1003.110.12.1031)"
"Procedure, Performed: Pneumococcal Conjugate Vaccine Administered" using "Pneumococcal Conjugate Vaccine Administered (2.16.840.1.113883.3.464.1003.110.12.1046)"
"Procedure, Performed: Rotavirus Vaccine (2 dose schedule) Administered" using "Rotavirus Vaccine (2 dose schedule) Administered (2.16.840.1.113883.3.464.1003.110.12.1048)"
"Procedure, Performed: Rotavirus Vaccine (3 dose schedule) Administered" using "Rotavirus Vaccine (3 dose schedule) Administered (2.16.840.1.113883.3.464.1003.110.12.1047)"
"Procedure, Performed: Varicella Zoster Vaccine (VZV) Administered" using "Varicella Zoster Vaccine (VZV) Administered (2.16.840.1.113883.3.464.1003.110.12.1040)"

Supplemental Data Elements

SDE Ethnicity

["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

["Patient Characteristic Payer": "Payer"]

SDE Race
- - ["Patient Characteristic Race": "Race"]

SDE Sex

["Patient Characteristic Sex": "ONC Administrative Sex"]

Risk Adjustment Variables

None

Measure Set

None