eCQM Title | # Use of High-Risk Medications in Older Adults
eCQM Identifier (Measure Authoring Tool) | 156 | eCQM Version Number | 11.1.000
NQF Number | Not Applicable | GUID | a3837ff8-1abc-4ba9-800e-fd4e7953adbd
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 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported.
    1. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class.
    2. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses.
    3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators).
Copyright |
    This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract HHSM-500-2011-00079C) with the National Committee for Quality Assurance (NCQA) to develop this electronic measure. 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.

    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 |
    Certain medications (MacKinnon & Hepler, 2003) are associated with increased risk of harm from drug side-effects and drug toxicity and pose a concern for patient safety. There is clinical consensus that these drugs pose increased risks in older adults (Kaufman, Brodin, & Sarafian, 2005). Potentially inappropriate medication use in older adults has been connected to significantly longer hospital stay lengths and increased hospitalization costs (Hagstrom et al., 2015) as well as increased risk of death (Lau et al., 2004). Use of specific high-risk medications such as hypnotics, including benzodiazepine receptor agonists, and nonsteroidal anti-inflammatory drugs (NSAIDS) can result in increased risk of delirium, falls, fractures, gastrointestinal bleeding and acute kidney injury (Merel et al., 2017). Long-term use of benzodiazepines in older adults has been associated with increased risk of dementia (Zhong et al., 2015; Takada et al., 2016). Additionally, the use of antipsychotics can lead to increased risk of stroke and greater cognitive decline in older adults with dementia (Tampi et al., 2016).

    Older adults receiving inappropriate medications are more likely to report poorer health status at follow-up, compared to those who receive appropriate medications (Fu, Liu, & Christensen, 2004). A study of the prevalence of potentially inappropriate medication use in older adults found that 40 percent of individuals 65 and older filled at least one prescription for a potentially inappropriate medication and 13 percent filled two or more (Fick et al., 2008). While some adverse drug events (ADEs) are unavoidable, studies estimate that between 30 and 80 percent of ADEs in older adults are preventable (MacKinnon & Hepler, 2003). More recently with the onset of the COVID-19 pandemic, several studies have shown an increase in anxiety, insomnia and depression rates, which could result in an increase in the use of high-risk medications in order to treat these conditions (Agrawal, 2020).

    Reducing the number of inappropriate prescriptions can lead to improved patient safety and significant cost savings. Conservative estimates of extra costs due to potentially inappropriate medications in older adults average $7.2 billion a year (Fu et al., 2007). Medication use by older adults will likely increase further as the U.S. population ages, new drugs are developed, and new therapeutic and preventive uses for medications are discovered (Rothberg et al., 2008). The annual direct costs of preventable ADEs in the Medicare population have been estimated to exceed $800 million (Institute of Medicine, 2007). By the year 2030, nearly one in five U.S. residents is expected to be aged 65 years or older; this age group is projected to more than double from 38.7 million in 2008 to more than 88.5 million in 2050. Likewise, the population aged 85 years or older is expected to increase almost four-fold, from 5.4 million to 19 million between 2008 and 2050. As the older adult population continues to grow, the number of older adults who present with multiple medical conditions for which several medications are prescribed will likely continue to increase, resulting in polypharmacy concerns (Gray & Gardner, 2009).
Clinical Recommendation Statement |
    The measure is based on recommendations from the American Geriatrics Society Beers Criteria[R] for Potentially Inappropriate Medication Use in Older Adults (2019 Update). The criteria were developed through key clinical expert consensus processes by Beers in 1997, Zhan in 2001, and an updated process by Fick et al. in 2003, 2012, 2015, and 2019. The Beers Criteria identifies lists of drugs that are potentially inappropriate for all older adults, except for those with certain conditions for which some high-risk medications may be warranted, and drugs that are potentially inappropriate in older adults based on various high-risk factors such as dosage, days supply and underlying diseases or conditions.
    NCQA's Geriatric Measurement Advisory Panel recommended a subset of drugs that should be used with caution in older adults for inclusion in the measure based upon the recommendations in the Beers Criteria.
Improvement Notation |
    Lower score indicates better quality
Reference |
    Reference Type: CITATION
    Reference Text: 'Agrawal, R. (2020). Careful Prescribing of Benzodiazepines during COVID-19 Pandemic: A Review. Journal of Mental Health & Clinical Psychology 4(4). Retrieved from https://www.mentalhealthjournal.org/articles/careful-prescribing-of-benzodiazepines-during-covid-19-pandemic-a-review.html'
Reference |
    Reference Type: CITATION
    Reference Text: 'American Geriatrics Society 2015 Beers Criteria Update Expert Panel. (2015). American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society, 63(11), 2227-2246.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Beers, M. H. (1997). Explicit criteria for determining potentially inappropriate medication use by the elderly. Archives of Internal Medicine, 157, 1531-1536.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Campanelli, C. M. (2012). American Geriatrics Society updated Beers criteria for potentially inappropriate medication use in older adults: The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. Journal of the American Geriatrics Society, 60(4), 616.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Fick, D. M., Cooper J. W., Wade, W. E., et al. (2003). Updating the Beers criteria for potentially inappropriate medication use in older adults. Archives of Internal Medicine, 163(22), 2716-2724.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Fick, D. M., Mion, L. C., Beers, M. H., et al. (2008). Health outcomes associated with potentially inappropriate medication use in older adults. Research in Nursing & Health, 31(1), 42-51.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Fu, A. Z., Liu, G. G., & Christensen, D. B. (2004). Inappropriate medication use and health outcomes in the elderly. Journal of the American Geriatrics Society, 52(11), 1934-1939.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Gray, C. L., & Gardner, C. (2009). Adverse drug events in the elderly: An ongoing problem. Journal of Managed Care & Specialty Pharmacy, 15(7), 568-571.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Hagstrom, K., Nailor, M., Lindberg, M., Hobbs, L., & Sobieraj, D. M. 2015. Association Between Potentially Inappropriate Medication Use in Elderly Adults and Hospital-Related Outcomes. Journal of the American Geriatrics Society, 63(1), 185-186.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Institute of Medicine, Committee on Identifying and Preventing Medication Errors. (2007). Preventing medication errors. Aspden, P., Wolcott, J. A., Bootman, J. L., & Cronenwatt, L. R. (eds.). Washington, DC: National Academy Press.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Kaufman, M. B., Brodin, K. A., & Sarafian, A. (2005, April/May). Effect of prescriber education on the use of medications contraindicated in older adults in a managed Medicare population. Journal of Managed Care & Specialty Pharmacy, 11(3), 211-219.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Lau, D.T., J.D., Kasper, D.E., Potter, A. Lyles. (2004). Potentially Inappropriate Medication Prescriptions Among Elderly Nursing Home Residents: Their Scope and Associated Resident and Facility Characteristics. Health Services Research, 39(5), 1257-1276.'
Reference |
    Reference Type: CITATION
    Reference Text: 'MacKinnon, N. J., & Hepler, C. D. (2003). Indicators of preventable drug-related morbidity in older adults: Use within a managed care organization. Journal of Managed Care & Specialty Pharmacy, 9(2), 134-141.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Merel, S.E., and D.S. Paauw. (2017). Common Drug Side Effects and Drug-Drug Interactions in Elderly Adults in Primary Care. Journal of the American Geriatrics Society, 65(7), 1578-1585.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Rothberg, M. B., Perkow, P. S., Liu, F., et al. (2008). Potentially inappropriate medication use in hospitalized elders. Journal of Hospital Medicine, 3(2), 91-102.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Takada, M., M. Fujimoto, and K. Hosomi. (2016). Association between benzodiazepine use and dementia: data mining of different medical databases. International Journal of Medical Sciences, 13(11), 825-834.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Tampi, R.R., D.J. Tampi, S. Balachandran, and S. Srinivasan. (2016). Antipsychotic use in dementia: a systematic review of benefits and risks from meta-analyses. Therapeutic Advances in Chronic Disease, 7(5), 229-245.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Zhan, C., Sangl, J., Bierman, A. S., et al. (2001). Potentially inappropriate medication use in the community-dwelling elderly. JAMA, 286(22), 2823-2868.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Zhong, G., Y. Wang, Y. Zhang, and Y. Zhao. (2015). Association between benzodiazepine use and dementia: a meta-analysis. PLoS One, 10(5).'
Reference |
    Reference Type: CITATION
    Reference Text: '2019 American Geriatrics Society Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society, 67(4), 674-694.'
Definition |
    Index Prescription Start Date (IPSD). The start date of the earliest prescription ordered for a high-risk medication during the measurement period.

    A high-risk medication is identified by any one of the following:
    a. A prescription for medications classified as high risk at any dose and for any duration.
    b. A prescription for medications classified as high risk at any dose with greater than a 90 day supply.
    c. A prescription for medications classified as high risk exceeding average daily dose criteria.

    An order is identified by either a prescription order or a prescription refill.
Guidance |
    The intent of the measure is to assess if the patient has been ordered at least two high-risk medication prescriptions from the same drug class on different days.

    The intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication from the same drug class for them.

    Calculate average daily dose for each prescription event. To calculate average daily dose, multiply the quantity of pills prescribed by the dose of each pill and divide by the days supply. For example, a prescription for the 30-days supply of digoxin containing 15 pills, 0.25 mg each pill, has an average daily dose of 0.125 mg. To calculate average daily dose for elixirs and concentrates, multiply the volume prescribed by daily dose and divide by the days supply. Do not round when calculating average daily dose.

    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 |
    Patients 65 years and older at the end of the measurement period who had a visit during the measurement period
Denominator |
    Equals Initial Population
Denominator Exclusions |
    Exclude patients who are in hospice care for any part of the measurement period.

    Exclude patients receiving palliative care for any part of the measurement period.
Numerator |
    Rate 1: Patients with at least two orders of high-risk medications from the same drug class on different days.
    a. At least two orders of high-risk medications from the same drug class.
    b. At least two orders of high-risk medications from the same drug class with summed days supply greater than 90 days.
    c. At least two orders of high-risk medications from the same drug class each exceeding average daily dose criteria.

    Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines) on different days.

    Total rate (the sum of the two previous numerators, deduplicated).
Numerator Exclusions |
    Rate 2: For patients with two or more antipsychotic prescriptions ordered, exclude patients who have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the IPSD for antipsychotics.

    For patients with two or more benzodiazepine prescriptions ordered, exclude patients who have a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between January 1 of the year prior to the measurement period and the IPSD for benzodiazepines.
Denominator Exceptions |
    None
Supplemental Data Elements |
    For every patient evaluated by this measure also identify payer, race, ethnicity and sex

## Table of Contents

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

### Population Criteria

- Population Criteria 1
  - - Initial Population

      - -     AgeInYearsAt(date from
                end of "Measurement Period"
              )>= 65
                and exists ( "Qualifying Encounters" )

  - - Denominator

      - -     "Initial Population"

  - - Denominator Exclusions

      - -     Hospice."Has Hospice Services"
                or PalliativeCare."Palliative Care in the Measurement Period"

  - - Numerator

      - -     exists ( "Same High Risk Medications Ordered on Different Days" )
                or ( "Two High Risk Medications with Prolonged Duration" )
                or ( "High Risk Medications with Average Daily Dose Criteria" )

  - - Numerator Exclusions

      - -     None

  - - Denominator Exceptions

      - -     None

  - - Stratification

      - -     None

- Population Criteria 2
  - - Initial Population

      - -     AgeInYearsAt(date from
                end of "Measurement Period"
              )>= 65
                and exists ( "Qualifying Encounters" )

  - - Denominator

      - -     "Initial Population"

  - - Denominator Exclusions

      - -     Hospice."Has Hospice Services"
                or PalliativeCare."Palliative Care in the Measurement Period"

  - - Numerator

      - -     ( "More than One Antipsychotic Order" )
                or ( "More than One Benzodiazepine Order" )

  - - Numerator Exclusions

      - -     ( "More than One Antipsychotic Order"
                  and not ( "More than One Benzodiazepine Order" )
                  and ( exists ( ( ["Diagnosis": "Schizophrenia"]
                        union ["Diagnosis": "Bipolar Disorder"]
                        union ["Diagnosis": "Other Bipolar Disorder"] ) AntipsychoticTreatedDiagnoses
                        where AntipsychoticTreatedDiagnoses.prevalencePeriod overlaps Interval[start of "Measurement Period" - 1 year, "Antipsychotic Index Prescription Start Date"]
                    )
                  )
              )
                or ( "More than One Benzodiazepine Order"
                    and not ( "More than One Antipsychotic Order" )
                    and ( exists ( ( ["Diagnosis": "Seizure Disorder"]
                          union ["Diagnosis": "REM Sleep Behavior Disorder"]
                          union ["Diagnosis": "Benzodiazepine Withdrawal"]
                          union ["Diagnosis": "Alcohol Withdrawal"]
                          union ["Diagnosis": "Generalized Anxiety Disorder"] ) BenzodiazepineTreatedDiagnoses
                          where BenzodiazepineTreatedDiagnoses.prevalencePeriod overlaps Interval[start of "Measurement Period" - 1 year, "Benzodiazepine Index Prescription Start Date"]
                      )
                    )
                )
                or ( "More than One Benzodiazepine Order"
                    and ( "More than One Antipsychotic Order" )
                    and ( exists ( ( ["Diagnosis": "Seizure Disorder"]
                          union ["Diagnosis": "REM Sleep Behavior Disorder"]
                          union ["Diagnosis": "Benzodiazepine Withdrawal"]
                          union ["Diagnosis": "Alcohol Withdrawal"]
                          union ["Diagnosis": "Generalized Anxiety Disorder"] ) BenzodiazepineTreatedDiagnoses
                          where BenzodiazepineTreatedDiagnoses.prevalencePeriod overlaps Interval[start of "Measurement Period" - 1 year, "Benzodiazepine Index Prescription Start Date"]
                      )
                    )
                    and ( exists ( ( ["Diagnosis": "Schizophrenia"]
                          union ["Diagnosis": "Bipolar Disorder"]
                          union ["Diagnosis": "Other Bipolar Disorder"] ) AntipsychoticTreatedDiagnoses
                          where AntipsychoticTreatedDiagnoses.prevalencePeriod overlaps Interval[start of "Measurement Period" - 1 year, "Antipsychotic Index Prescription Start Date"]
                      )
                    )
                )

  - - Denominator Exceptions

      - -     None

  - - Stratification

      - -     None

- Population Criteria 3
  - - Initial Population

      - -     AgeInYearsAt(date from
                end of "Measurement Period"
              )>= 65
                and exists ( "Qualifying Encounters" )

  - - Denominator

      - -     "Initial Population"

  - - Denominator Exclusions

      - -     Hospice."Has Hospice Services"
                or PalliativeCare."Palliative Care in the Measurement Period"

  - - Numerator

      - -     ( "Numerator 2"
                  and not "Numerator Exclusion"
              )
                or ( "Numerator 1"
                    and not "Numerator 2"
                )

  - - Numerator Exclusions

      - -     None

  - - Denominator Exceptions

      - -     None

  - - Stratification

      - -     None

### Definitions

- - Antipsychotic Index Prescription Start Date

    - -     "First Antipsychotic Medication Ordered"

  - Benzodiazepine Index Prescription Start Date

    - -     "First Benzodiazepine Medication Ordered"

  - Denominator

    - -     "Initial Population"

  - Denominator Exclusions

    - -     Hospice."Has Hospice Services"
              or PalliativeCare."Palliative Care in the Measurement Period"

  - First Antipsychotic Medication Ordered

    - -     First(["Medication, Order": "Antipsychotics"] AntipsychoticMedication
                where AntipsychoticMedication.authorDatetime during "Measurement Period"
                return AntipsychoticMedication.authorDatetime
                sort asc
            )

  - First Benzodiazepine Medication Ordered

    - -     First(["Medication, Order": "Benzodiazepines"] BenzodiazepineMedication
                where BenzodiazepineMedication.authorDatetime during "Measurement Period"
                return BenzodiazepineMedication.authorDatetime
                sort asc
            )

  - High Risk Medications with Average Daily Dose Criteria

    - -     exists ( "More Than One Order"(["Medication, Order": "Reserpine"] ReserpineOrdered
                  where "Average Daily Dose"(ReserpineOrdered)> 0.1 'mg/d'
              )
            )
              or exists ( "More Than One Order"(["Medication, Order": "Digoxin"] DigoxinOrdered
                    where "Average Daily Dose"(DigoxinOrdered)> 0.125 'mg/d'
                )
              )
              or exists ( "More Than One Order"(["Medication, Order": "Doxepin"] DoxepinOrdered
                    where "Average Daily Dose"(DoxepinOrdered)> 6 'mg/d'
                )
              )

  - 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"
              )

  - Initial Population

    - -     AgeInYearsAt(date from
              end of "Measurement Period"
            )>= 65
              and exists ( "Qualifying Encounters" )

  - More than One Antipsychotic Order

    - -     exists ( "More Than One Order"(["Medication, Order": "Antipsychotics"]))

  - More than One Benzodiazepine Order

    - -     exists ( "More Than One Order"(["Medication, Order": "Benzodiazepines"]))

  - Numerator 1

    - -     exists ( "Same High Risk Medications Ordered on Different Days" )
              or ( "Two High Risk Medications with Prolonged Duration" )
              or ( "High Risk Medications with Average Daily Dose Criteria" )

  - Numerator 2

    - -     ( "More than One Antipsychotic Order" )
              or ( "More than One Benzodiazepine Order" )

  - Numerator 3

    - -     ( "Numerator 2"
                and not "Numerator Exclusion"
            )
              or ( "Numerator 1"
                  and not "Numerator 2"
              )

  - Numerator Exclusion

    - -     ( "More than One Antipsychotic Order"
                and not ( "More than One Benzodiazepine Order" )
                and ( exists ( ( ["Diagnosis": "Schizophrenia"]
                      union ["Diagnosis": "Bipolar Disorder"]
                      union ["Diagnosis": "Other Bipolar Disorder"] ) AntipsychoticTreatedDiagnoses
                      where AntipsychoticTreatedDiagnoses.prevalencePeriod overlaps Interval[start of "Measurement Period" - 1 year, "Antipsychotic Index Prescription Start Date"]
                  )
                )
            )
              or ( "More than One Benzodiazepine Order"
                  and not ( "More than One Antipsychotic Order" )
                  and ( exists ( ( ["Diagnosis": "Seizure Disorder"]
                        union ["Diagnosis": "REM Sleep Behavior Disorder"]
                        union ["Diagnosis": "Benzodiazepine Withdrawal"]
                        union ["Diagnosis": "Alcohol Withdrawal"]
                        union ["Diagnosis": "Generalized Anxiety Disorder"] ) BenzodiazepineTreatedDiagnoses
                        where BenzodiazepineTreatedDiagnoses.prevalencePeriod overlaps Interval[start of "Measurement Period" - 1 year, "Benzodiazepine Index Prescription Start Date"]
                    )
                  )
              )
              or ( "More than One Benzodiazepine Order"
                  and ( "More than One Antipsychotic Order" )
                  and ( exists ( ( ["Diagnosis": "Seizure Disorder"]
                        union ["Diagnosis": "REM Sleep Behavior Disorder"]
                        union ["Diagnosis": "Benzodiazepine Withdrawal"]
                        union ["Diagnosis": "Alcohol Withdrawal"]
                        union ["Diagnosis": "Generalized Anxiety Disorder"] ) BenzodiazepineTreatedDiagnoses
                        where BenzodiazepineTreatedDiagnoses.prevalencePeriod overlaps Interval[start of "Measurement Period" - 1 year, "Benzodiazepine Index Prescription Start Date"]
                    )
                  )
                  and ( exists ( ( ["Diagnosis": "Schizophrenia"]
                        union ["Diagnosis": "Bipolar Disorder"]
                        union ["Diagnosis": "Other Bipolar Disorder"] ) AntipsychoticTreatedDiagnoses
                        where AntipsychoticTreatedDiagnoses.prevalencePeriod overlaps Interval[start of "Measurement Period" - 1 year, "Antipsychotic Index Prescription Start Date"]
                    )
                  )
              )

  - PalliativeCare.Palliative Care in the Measurement Period

    - -     exists ( ["Assessment, Performed": "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"] PalliativeAssessment
                where Global."NormalizeInterval"(PalliativeAssessment.relevantDatetime, PalliativeAssessment.relevantPeriod) overlaps "Measurement Period"
            )
            or exists (["Diagnosis": "Encounter for palliative care"] PalliativeDiagnosis
            where PalliativeDiagnosis.prevalencePeriod overlaps "Measurement Period")
              or exists ( ["Encounter, Performed": "Palliative Care Encounter"] PalliativeEncounter
                  where PalliativeEncounter.relevantPeriod overlaps "Measurement Period"
              )
              or exists ( ["Intervention, Performed": "Palliative Care Intervention"] PalliativeIntervention
                  where Global."NormalizeInterval"(PalliativeIntervention.relevantDatetime, PalliativeIntervention.relevantPeriod) overlaps "Measurement Period"
              )

  - Qualifying Encounters

    - -     ( ["Encounter, Performed": "Office Visit"]
              union ["Encounter, Performed": "Ophthalmologic Services"]
              union ["Encounter, Performed": "Preventive Care Services Established Office Visit, 18 and Up"]
              union ["Encounter, Performed": "Discharge Services Nursing Facility"]
              union ["Encounter, Performed": "Nursing Facility Visit"]
              union ["Encounter, Performed": "Care Services in Long Term Residential Facility"]
              union ["Encounter, Performed": "Preventive Care Services Initial Office Visit, 18 and Up"]
              union ["Encounter, Performed": "Annual Wellness Visit"]
              union ["Encounter, Performed": "Home Healthcare Services"]
              union ["Encounter, Performed": "Telephone Visits"]
              union ["Encounter, Performed": "Online Assessments"]
              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."] ) ValidEncounters
              where ValidEncounters.relevantPeriod during "Measurement Period"

  - Same High Risk Medications Ordered on Different Days

    - -     "More Than One Order"(["Medication, Order": "Anticholinergics, first generation antihistamines"])
              union "More Than One Order"(["Medication, Order": "Anticholinergics, anti Parkinson agents"])
              union "More Than One Order"(["Medication, Order": "Antispasmodics"])
              union "More Than One Order"(["Medication, Order": "Antithrombotic"])
              union "More Than One Order"(["Medication, Order": "Cardiovascular, alpha agonists, central"])
              union "More Than One Order"(["Medication, Order": "Cardiovascular, other"])
              union "More Than One Order"(["Medication, Order": "Central nervous system, antidepressants"])
              union "More Than One Order"(["Medication, Order": "Central nervous system, barbiturates"])
              union "More Than One Order"(["Medication, Order": "Central nervous system, vasodilators"])
              union "More Than One Order"(["Medication, Order": "Central nervous system, other"])
              union "More Than One Order"(["Medication, Order": "Endocrine system, estrogens with or without progestins"])
              union "More Than One Order"(["Medication, Order": "Endocrine system, sulfonylureas, long duration"])
              union "More Than One Order"(["Medication, Order": "Endocrine system, other"])
              union "More Than One Order"(["Medication, Order": "Nonbenzodiazepine hypnotics"])
              union "More Than One Order"(["Medication, Order": "Pain medications, skeletal muscle relaxants"])
              union "More Than One Order"(["Medication, Order": "Pain medications, other"])

  - 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"]

  - Two High Risk Medications with Prolonged Duration

    - -     Sum(("More Than One Order"(["Medication, Order": "Anti Infectives, other"]))AntiInfectives
                let DaysSupply: Coalesce(AntiInfectives.daysSupplied, AntiInfectives.supply.value /(AntiInfectives.dosage.value * CMD.ToDaily(AntiInfectives.frequency)))*(1 + Coalesce(AntiInfectives.refills, 0))
                return all DaysSupply
            )> 90

### Functions

- - Average Daily Dose(MedicationOrder "Medication, Order")

    - -     MedicationOrder Order
              let MedicationStrength: "MedicationStrengthPerUnit"(Order.code),
              DaysSupplied: Coalesce(Order.daysSupplied, Order.supply.value /(Order.dosage.value * CMD.ToDaily(Order.frequency)))
              return if DaysSupplied is not null
                and ( MedicationStrength.unit = 'mg'
                    or ( MedicationStrength.unit = 'mg/mL'
                        and Order.supply.unit = 'mL'
                    )
                ) then ( ( Order.supply * MedicationStrength ) / Quantity { value: DaysSupplied, unit: 'd' } )
                else null

  - CMD.CodeToDaily(Frequency Code)

    - -     case
              when Frequency ~ "Once daily (qualifier value)" then 1.0
              when Frequency ~ "Twice a day (qualifier value)" then 2.0
              when Frequency ~ "Three times daily (qualifier value)" then 3.0
              when Frequency ~ "Four times daily (qualifier value)" then 4.0
              when Frequency ~ "Every twenty four hours (qualifier value)" then 1.0
              when Frequency ~ "Every twelve hours (qualifier value)" then 2.0
              when Frequency ~ "Every thirty six hours (qualifier value)" then 0.67
              when Frequency ~ "Every eight hours (qualifier value)" then 3.0
              when Frequency ~ "Every four hours (qualifier value)" then 6.0
              when Frequency ~ "Every six hours (qualifier value)" then 4.0
              when Frequency ~ "Every seventy two hours (qualifier value)" then 0.34
              when Frequency ~ "Every forty eight hours (qualifier value)" then 0.5
              when Frequency ~ "Every eight to twelve hours (qualifier value)" then 2.0
              when Frequency ~ "Every six to eight hours (qualifier value)" then 3.0
              when Frequency ~ "Every three to four hours (qualifier value)" then 6.0
              when Frequency ~ "Every three to six hours (qualifier value)" then 4.0
              when Frequency ~ "Every two to four hours (qualifier value)" then 6.0
              when Frequency ~ "One to four times a day (qualifier value)" then 4.0
              when Frequency ~ "One to three times a day (qualifier value)" then 3.0
              when Frequency ~ "One to two times a day (qualifier value)" then 2.0
              when Frequency ~ "Two to four times a day (qualifier value)" then 4.0
              else null
            end

  - CMD.QuantityToDaily(Frequency Quantity)

    - -     case Frequency.unit
                when 'h' then (24.0 / Frequency.value)
                when 'min' then (24.0 / Frequency.value) * 60
                when 's' then (24.0 / Frequency.value) * 60 * 60
                when 'd' then (24.0 / Frequency.value) / 24
                when 'wk' then (24.0 / Frequency.value) / (24 * 7)
                when 'mo' then (24.0 / Frequency.value) / (24 * 30) /* assuming 30 days in month */
                when 'a' then (24.0 / Frequency.value) / (24 * 365) /* assuming 365 days in year */
                when 'hour' then (24.0 / Frequency.value)
                when 'minute' then (24.0 / Frequency.value) * 60
                when 'second' then (24.0 / Frequency.value) * 60 * 60
                when 'day' then (24.0 / Frequency.value) / 24
                when 'week' then (24.0 / Frequency.value) / (24 * 7)
                when 'month' then (24.0 / Frequency.value) / (24 * 30) /* assuming 30 days in month */
                when 'year' then (24.0 / Frequency.value) / (24 * 365) /* assuming 365 days in year */
                when 'hours' then (24.0 / Frequency.value)
                when 'minutes' then (24.0 / Frequency.value) * 60
                when 'seconds' then (24.0 / Frequency.value) * 60 * 60
                when 'days' then (24.0 / Frequency.value) / 24
                when 'weeks' then (24.0 / Frequency.value) / (24 * 7)
                when 'months' then (24.0 / Frequency.value) / (24 * 30) /* assuming 30 days in month */
                when 'years' then (24.0 / Frequency.value) / (24 * 365) /* assuming 365 days in year */
                else null
              end

  - CMD.ToDaily(Frequency Choice<Quantity, Code>)

    - -     case
              when Frequency is Quantity then QuantityToDaily(Frequency as Quantity)
              else CodeToDaily(Frequency as Code)
            end

  - 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>

  - MedicationStrengthPerUnit(Strength Code)

    - -     case
              when Strength ~ "reserpine 0.1 MG Oral Tablet" then 0.1 'mg'
              when Strength ~ "reserpine 0.25 MG Oral Tablet" then 0.25 'mg'
              when Strength ~ "digoxin 0.05 MG/ML Oral Solution" then 0.05 'mg/mL'
              when Strength ~ "digoxin 0.0625 MG Oral Tablet" then 0.0625 'mg'
              when Strength ~ "1 ML digoxin 0.1 MG/ML Injection" then 0.1 'mg/mL'
              when Strength ~ "digoxin 0.125 MG Oral Tablet" then 0.125 'mg'
              when Strength ~ "digoxin 0.1875 MG Oral Tablet" then 0.1875 'mg'
              when Strength ~ "digoxin 0.25 MG Oral Tablet" then 0.25 'mg'
              when Strength ~ "2 ML digoxin 0.25 MG/ML Injection" then 0.25 'mg/mL'
              when Strength ~ "doxepin 3 MG Oral Tablet" then 3 'mg'
              when Strength ~ "doxepin 6 MG Oral Tablet" then 6 'mg'
              when Strength ~ "doxepin hydrochloride 10 MG Oral Capsule" then 10 'mg'
              when Strength ~ "doxepin hydrochloride 10 MG/ML Oral Solution" then 10 'mg/mL'
              when Strength ~ "doxepin hydrochloride 25 MG Oral Capsule" then 25 'mg'
              when Strength ~ "doxepin hydrochloride 50 MG Oral Capsule" then 50 'mg'
              when Strength ~ "doxepin hydrochloride 75 MG Oral Capsule" then 75 'mg'
              when Strength ~ "doxepin hydrochloride 100 MG Oral Capsule" then 100 'mg'
              when Strength ~ "doxepin hydrochloride 150 MG Oral Capsule" then 150 'mg'
              else null
            end

  - More Than One Order(Medication List<"Medication, Order">)

    - -     "Medication" OrderMedication1
              with "Medication" OrderMedication2
                such that ( OrderMedication1.authorDatetime during "Measurement Period"
                    and OrderMedication1.refills >= 1
                )
                  or ( date from OrderMedication1.authorDatetime !~ date from OrderMedication2.authorDatetime
                      and OrderMedication1.authorDatetime during "Measurement Period"
                      and OrderMedication2.authorDatetime during "Measurement Period"
                  )
              return OrderMedication1

### Terminology

- code "1 ML digoxin 0.1 MG/ML Injection" ("RXNORM Code (204504)")
- code "2 ML digoxin 0.25 MG/ML Injection" ("RXNORM Code (104208)")
- code "digoxin 0.05 MG/ML Oral Solution" ("RXNORM Code (393245)")
- code "digoxin 0.0625 MG Oral Tablet" ("RXNORM Code (245273)")
- code "digoxin 0.125 MG Oral Tablet" ("RXNORM Code (197604)")
- code "digoxin 0.1875 MG Oral Tablet" ("RXNORM Code (1441565)")
- code "digoxin 0.25 MG Oral Tablet" ("RXNORM Code (197606)")
- code "Discharge to healthcare facility for hospice care (procedure)" ("SNOMEDCT Code (428371000124100)")
- code "Discharge to home for hospice care (procedure)" ("SNOMEDCT Code (428361000124107)")
- code "doxepin 3 MG Oral Tablet" ("RXNORM Code (966787)")
- code "doxepin 6 MG Oral Tablet" ("RXNORM Code (966793)")
- code "doxepin hydrochloride 10 MG Oral Capsule" ("RXNORM Code (1000048)")
- code "doxepin hydrochloride 10 MG/ML Oral Solution" ("RXNORM Code (1000054)")
- code "doxepin hydrochloride 100 MG Oral Capsule" ("RXNORM Code (1000058)")
- code "doxepin hydrochloride 150 MG Oral Capsule" ("RXNORM Code (1000064)")
- code "doxepin hydrochloride 25 MG Oral Capsule" ("RXNORM Code (1000070)")
- code "doxepin hydrochloride 50 MG Oral Capsule" ("RXNORM Code (1000076)")
- code "doxepin hydrochloride 75 MG Oral Capsule" ("RXNORM Code (1000097)")
- code "Encounter for palliative care" ("ICD10CM Code (Z51.5)")
- code "Every eight hours (qualifier value)" ("SNOMEDCT Code (307469008)")
- code "Every eight to twelve hours (qualifier value)" ("SNOMEDCT Code (396140003)")
- code "Every forty eight hours (qualifier value)" ("SNOMEDCT Code (396131002)")
- code "Every four hours (qualifier value)" ("SNOMEDCT Code (225756002)")
- code "Every seventy two hours (qualifier value)" ("SNOMEDCT Code (396143001)")
- code "Every six hours (qualifier value)" ("SNOMEDCT Code (307468000)")
- code "Every six to eight hours (qualifier value)" ("SNOMEDCT Code (396139000)")
- code "Every thirty six hours (qualifier value)" ("SNOMEDCT Code (396126004)")
- code "Every three to four hours (qualifier value)" ("SNOMEDCT Code (225754004)")
- code "Every three to six hours (qualifier value)" ("SNOMEDCT Code (396127008)")
- code "Every twelve hours (qualifier value)" ("SNOMEDCT Code (307470009)")
- code "Every twenty four hours (qualifier value)" ("SNOMEDCT Code (396125000)")
- code "Every two to four hours (qualifier value)" ("SNOMEDCT Code (225752000)")
- code "Four times daily (qualifier value)" ("SNOMEDCT Code (307439001)")
- code "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)" ("LOINC Code (71007-9)")
- 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 "Once daily (qualifier value)" ("SNOMEDCT Code (229797004)")
- code "One to four times a day (qualifier value)" ("SNOMEDCT Code (396109005)")
- code "One to three times a day (qualifier value)" ("SNOMEDCT Code (396108002)")
- code "One to two times a day (qualifier value)" ("SNOMEDCT Code (396107007)")
- code "reserpine 0.1 MG Oral Tablet" ("RXNORM Code (198196)")
- code "reserpine 0.25 MG Oral Tablet" ("RXNORM Code (198197)")
- code "Three times daily (qualifier value)" ("SNOMEDCT Code (229798009)")
- code "Twice a day (qualifier value)" ("SNOMEDCT Code (229799001)")
- code "Two to four times a day (qualifier value)" ("SNOMEDCT Code (396111001)")
- code "Yes (qualifier value)" ("SNOMEDCT Code (373066001)")
- valueset "Alcohol Withdrawal" (2.16.840.1.113883.3.464.1003.105.12.1209)
- valueset "Annual Wellness Visit" (2.16.840.1.113883.3.526.3.1240)
- valueset "Anti Infectives, other" (2.16.840.1.113883.3.464.1003.196.12.1481)
- valueset "Anticholinergics, anti Parkinson agents" (2.16.840.1.113883.3.464.1003.1049)
- valueset "Anticholinergics, first generation antihistamines" (2.16.840.1.113883.3.464.1003.1043)
- valueset "Antipsychotics" (2.16.840.1.113883.3.464.1003.196.12.1523)
- valueset "Antispasmodics" (2.16.840.1.113883.3.464.1003.1050)
- valueset "Antithrombotic" (2.16.840.1.113883.3.464.1003.1051)
- valueset "Benzodiazepine Withdrawal" (2.16.840.1.113883.3.464.1003.105.12.1208)
- valueset "Benzodiazepines" (2.16.840.1.113883.3.464.1003.196.12.1522)
- valueset "Bipolar Disorder" (2.16.840.1.113883.3.464.1003.105.12.1157)
- valueset "Cardiovascular, alpha agonists, central" (2.16.840.1.113883.3.464.1003.1052)
- valueset "Cardiovascular, other" (2.16.840.1.113883.3.464.1003.1053)
- valueset "Care Services in Long Term Residential Facility" (2.16.840.1.113883.3.464.1003.101.12.1014)
- valueset "Central nervous system, antidepressants" (2.16.840.1.113883.3.464.1003.1054)
- valueset "Central nervous system, barbiturates" (2.16.840.1.113883.3.464.1003.1055)
- valueset "Central nervous system, other" (2.16.840.1.113883.3.464.1003.1057)
- valueset "Central nervous system, vasodilators" (2.16.840.1.113883.3.464.1003.1056)
- valueset "Digoxin" (2.16.840.1.113883.3.464.1003.1065)
- valueset "Discharge Services Nursing Facility" (2.16.840.1.113883.3.464.1003.101.12.1013)
- valueset "Doxepin" (2.16.840.1.113883.3.464.1003.1067)
- valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
- valueset "Endocrine system, estrogens with or without progestins" (2.16.840.1.113883.3.464.1003.1058)
- valueset "Endocrine system, other" (2.16.840.1.113883.3.464.1003.1060)
- valueset "Endocrine system, sulfonylureas, long duration" (2.16.840.1.113883.3.464.1003.1059)
- valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
- valueset "Generalized Anxiety Disorder" (2.16.840.1.113883.3.464.1003.105.12.1210)
- 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 "Nonbenzodiazepine hypnotics" (2.16.840.1.113883.3.464.1003.196.12.1480)
- valueset "Nursing Facility Visit" (2.16.840.1.113883.3.464.1003.101.12.1012)
- 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 "Ophthalmologic Services" (2.16.840.1.113883.3.464.1003.101.11.1206)
- valueset "Other Bipolar Disorder" (2.16.840.1.113883.3.464.1003.105.12.1204)
- valueset "Pain medications, other" (2.16.840.1.113883.3.464.1003.1063)
- valueset "Pain medications, skeletal muscle relaxants" (2.16.840.1.113883.3.464.1003.1062)
- valueset "Palliative Care Encounter" (2.16.840.1.113883.3.464.1003.101.12.1090)
- valueset "Palliative Care Intervention" (2.16.840.1.113883.3.464.1003.198.12.1135)
- valueset "Payer" (2.16.840.1.114222.4.11.3591)
- 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 "REM Sleep Behavior Disorder" (2.16.840.1.113883.3.464.1003.105.12.1207)
- valueset "Reserpine" (2.16.840.1.113883.3.464.1003.1044)
- valueset "Schizophrenia" (2.16.840.1.113883.3.464.1003.105.12.1205)
- valueset "Seizure Disorder" (2.16.840.1.113883.3.464.1003.105.12.1206)
- valueset "Telephone Visits" (2.16.840.1.113883.3.464.1003.101.12.1080)

### Data Criteria (QDM Data Elements)

- "Assessment, Performed: Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)" using "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal) (LOINC Code 71007-9)"
- "Assessment, Performed: Hospice care [Minimum Data Set]" using "Hospice care [Minimum Data Set] (LOINC Code 45755-6)"
- "Diagnosis: Alcohol Withdrawal" using "Alcohol Withdrawal (2.16.840.1.113883.3.464.1003.105.12.1209)"
- "Diagnosis: Benzodiazepine Withdrawal" using "Benzodiazepine Withdrawal (2.16.840.1.113883.3.464.1003.105.12.1208)"
- "Diagnosis: Bipolar Disorder" using "Bipolar Disorder (2.16.840.1.113883.3.464.1003.105.12.1157)"
- "Diagnosis: Encounter for palliative care" using "Encounter for palliative care (ICD10CM Code Z51.5)"
- "Diagnosis: Generalized Anxiety Disorder" using "Generalized Anxiety Disorder (2.16.840.1.113883.3.464.1003.105.12.1210)"
- "Diagnosis: Other Bipolar Disorder" using "Other Bipolar Disorder (2.16.840.1.113883.3.464.1003.105.12.1204)"
- "Diagnosis: REM Sleep Behavior Disorder" using "REM Sleep Behavior Disorder (2.16.840.1.113883.3.464.1003.105.12.1207)"
- "Diagnosis: Schizophrenia" using "Schizophrenia (2.16.840.1.113883.3.464.1003.105.12.1205)"
- "Diagnosis: Seizure Disorder" using "Seizure Disorder (2.16.840.1.113883.3.464.1003.105.12.1206)"
- "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: Discharge Services Nursing Facility" using "Discharge Services Nursing Facility (2.16.840.1.113883.3.464.1003.101.12.1013)"
- "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: Nursing Facility Visit" using "Nursing Facility Visit (2.16.840.1.113883.3.464.1003.101.12.1012)"
- "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: Ophthalmologic Services" using "Ophthalmologic Services (2.16.840.1.113883.3.464.1003.101.11.1206)"
- "Encounter, Performed: Palliative Care Encounter" using "Palliative Care Encounter (2.16.840.1.113883.3.464.1003.101.12.1090)"
- "Encounter, Performed: Preventive Care Services Established Office Visit, 18 and Up" using "Preventive Care Services Established Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1025)"
- "Encounter, Performed: Preventive Care Services Initial Office Visit, 18 and Up" using "Preventive Care Services Initial Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1023)"
- "Encounter, Performed: Telephone Visits" using "Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080)"
- "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)"
- "Intervention, Performed: Palliative Care Intervention" using "Palliative Care Intervention (2.16.840.1.113883.3.464.1003.198.12.1135)"
- "Medication, Order: Anti Infectives, other" using "Anti Infectives, other (2.16.840.1.113883.3.464.1003.196.12.1481)"
- "Medication, Order: Anticholinergics, anti Parkinson agents" using "Anticholinergics, anti Parkinson agents (2.16.840.1.113883.3.464.1003.1049)"
- "Medication, Order: Anticholinergics, first generation antihistamines" using "Anticholinergics, first generation antihistamines (2.16.840.1.113883.3.464.1003.1043)"
- "Medication, Order: Antipsychotics" using "Antipsychotics (2.16.840.1.113883.3.464.1003.196.12.1523)"
- "Medication, Order: Antispasmodics" using "Antispasmodics (2.16.840.1.113883.3.464.1003.1050)"
- "Medication, Order: Antithrombotic" using "Antithrombotic (2.16.840.1.113883.3.464.1003.1051)"
- "Medication, Order: Benzodiazepines" using "Benzodiazepines (2.16.840.1.113883.3.464.1003.196.12.1522)"
- "Medication, Order: Cardiovascular, alpha agonists, central" using "Cardiovascular, alpha agonists, central (2.16.840.1.113883.3.464.1003.1052)"
- "Medication, Order: Cardiovascular, other" using "Cardiovascular, other (2.16.840.1.113883.3.464.1003.1053)"
- "Medication, Order: Central nervous system, antidepressants" using "Central nervous system, antidepressants (2.16.840.1.113883.3.464.1003.1054)"
- "Medication, Order: Central nervous system, barbiturates" using "Central nervous system, barbiturates (2.16.840.1.113883.3.464.1003.1055)"
- "Medication, Order: Central nervous system, other" using "Central nervous system, other (2.16.840.1.113883.3.464.1003.1057)"
- "Medication, Order: Central nervous system, vasodilators" using "Central nervous system, vasodilators (2.16.840.1.113883.3.464.1003.1056)"
- "Medication, Order: Digoxin" using "Digoxin (2.16.840.1.113883.3.464.1003.1065)"
- "Medication, Order: Doxepin" using "Doxepin (2.16.840.1.113883.3.464.1003.1067)"
- "Medication, Order: Endocrine system, estrogens with or without progestins" using "Endocrine system, estrogens with or without progestins (2.16.840.1.113883.3.464.1003.1058)"
- "Medication, Order: Endocrine system, other" using "Endocrine system, other (2.16.840.1.113883.3.464.1003.1060)"
- "Medication, Order: Endocrine system, sulfonylureas, long duration" using "Endocrine system, sulfonylureas, long duration (2.16.840.1.113883.3.464.1003.1059)"
- "Medication, Order: Nonbenzodiazepine hypnotics" using "Nonbenzodiazepine hypnotics (2.16.840.1.113883.3.464.1003.196.12.1480)"
- "Medication, Order: Pain medications, other" using "Pain medications, other (2.16.840.1.113883.3.464.1003.1063)"
- "Medication, Order: Pain medications, skeletal muscle relaxants" using "Pain medications, skeletal muscle relaxants (2.16.840.1.113883.3.464.1003.1062)"
- "Medication, Order: Reserpine" using "Reserpine (2.16.840.1.113883.3.464.1003.1044)"
- "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)"

### 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