eCQM Title | # Functional Status Assessment for Total Hip Replacement
eCQM Identifier (Measure Authoring Tool) | 56 | eCQM Version Number | 12.0.000
NQF Number | Not Applicable | GUID | 2f291003-3f2f-48af-bef9-e5aacb95ac3e
Measurement Period | January 1, 20XX through December 31, 20XX
Measure Steward | Centers for Medicare & Medicaid Services (CMS)
Measure Developer | National Committee for Quality Assurance
Endorsed By | None
Description |
    Percentage of patients 19 years of age and older who received an elective primary total hip arthroplasty (THA) and completed a functional status assessment within 90 days prior to the surgery and in the 300 - 425 days after the surgery
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 HHSP23320095627WC; HHSP23337008T) 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) codes, descriptions and other data are copyright 2022. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

    LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation.

    ICD-10 copyright 2022 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 |
    THAs are common surgical procedures that address hip pain and functional impairment, primarily caused by osteoarthritis. Although THA is an effective procedure for addressing osteoarthritis for many patients, some people, particularly those with more severe preoperative pain and impairment, do not experience the improvements in pain, function, and quality of life expected from the procedure (Beswick et al., 2012; Fortin et al., 1999; Tilbury et al., 2016). In 2010, providers performed 326,100 THAs, with 95 percent of them in patients age 45 and older (Wolford, Palso, & Bercovitz, 2015). Although THAs were introduced as a procedure for older adults, the percentage of patients age 55 to 64 (29 percent) who had a THA in 2010 exceeded the percentage of patients age 75 and older (26 percent) who had a THA (Wolford, Palso, & Bercovitz, 2015). Kurtz et al. (2009) projected that patients younger than 65 would account for 52 percent of THAs by 2030. This growth in hip surgeries for patients younger than 65 is significant because these patients often require more expensive joint arthroplasties that will better withstand the wear caused by physical activity (Bozic et al., 2006).

    This measure evaluates whether patients complete a patient-reported functional status assessment (FSA) before and after a THA. Measuring functional status for patients undergoing THA permits longitudinal assessment - from the patient's perspective - of the impact of surgical intervention on pain, physical function, as well as health-related quality of life (Rothrock, 2010).
Clinical Recommendation Statement |
    While there is no clinical guideline recommending that clinicians assess patients who are undergoing total hip replacements using patient-reported outcomes of function and pain, several clinical specialty societies support the use of a general health questionnaire and a disease-specific questionnaire for these patients. In particular, they recommend the Veterans RAND 12-item health survey (VR-12) or the Patient-Reported Outcomes Measurement Information System [PROMIS]-10-Global as the general health questionnaire and the Hip Disability and Osteoarthritis Outcome Score [HOOS], Jr. as the disease-specific questionnaire (American Association of Orthopaedic Surgeons, the American Joint Replacement Registry, The Hip Society, The Knee Society, & the American Association of Hip and Knee Surgeons, 2015).

    Peer-reviewed and grey literature support additional exclusions for patients undergoing total hip replacements. Staged procedures, concurrent procedures, partial procedures, resurfacing procedures, revision procedures, and removal of implant devices or prosthesis were linked to significant morbidity; complications (such as dislocation, infection, and reinfection); and high failure rates (Ludwick, 2021). In addition, mechanical complications, such as instability and dislocation, are also linked to complications and are associated with primary and revision THA/TKA (Gkiatas, 2021). Malignant neoplasms (such as osteonecrosis of the femoral head) are associated with substantial pain and functional disabilities before THA/TKA (Bernhard, 2021).

    Additionally, peer-reviewed and grey literature support various postoperative time frames, including follow-up within 10 to 14 months (Franklin, 2021) (Holte, 2021).
Improvement Notation |
    A higher score indicates better quality
Reference |
    Reference Type: CITATION
    Reference Text: 'American Association of Orthopaedic Surgeons, The American Joint Replacement Registry, The Hip Society, The Knee Society, & the American Association of Hip and Knee Surgeons. (2015). Patient-reported outcomes summit for total joint arthroplasty report. Retrieved from http://www.aahks.org/wp-content/uploads/2018/08/comment-letter-pro-summit-09082015.pdf'
Reference |
    Reference Type: CITATION
    Reference Text: 'Bernhard ME, Barnes CL, DeFeo BM, et al. Total Hip Arthroplasty in Adolescents and Young Adults for Management of Advanced Corticosteroid-Induced Osteonecrosis Secondary to Treatment for Hematologic Malignancies. J Arthroplasty. 2021;36(4):1352-1360. doi:10.1016/j.arth.2020.10.019'
Reference |
    Reference Type: CITATION
    Reference Text: 'Beswick, A. D., Wylde, V., Gooberman-Hill, R., et al. (2012). What Proportion of Patients Report Long-Term Pain after Total Hip or Knee Replacement for Osteoarthritis? A Systematic Review of Prospective Studies in Unselected Patients. British Medical Journal Open, 2(1), 1-12'
Reference |
    Reference Type: CITATION
    Reference Text: 'Bozic, K. J., Morsehed, S., Silverstein, M. D., et al. (2006). Use of Cost-Effectiveness Analysis to Evaluate New Technologies in Orthopaedics: The Case of Alternative Bearing Surfaces in Total Hip Arthroplasty. Journal of Bone and Joint Surgery, American Volume, 88(4), 706-714'
Reference |
    Reference Type: CITATION
    Reference Text: 'Fortin, P. R., Clarke, A. E., Joseph, L., et al. (1999). Outcomes of Total Hip and Knee Replacement Preoperative Functional Status Predicts Outcomes at Six Months After Surgery. American College of Rheumatology, 42(8), 1722-1728'
Reference |
    Reference Type: CITATION
    Reference Text: 'Franklin PD, Bond CP, Rothrock NE, Cella D. Strategies for Effective Implementation of Patient-Reported Outcome Measures in Arthroplasty Practice. J Bone Joint Surg Am. 2021;103(24):e97. doi:10.2106/JBJS.20.02072'
Reference |
    Reference Type: CITATION
    Reference Text: 'Gkiatas, I., Sharma, A. K., Driscoll, D. A., McLawhorn, A. S., Chalmers, B. P., & Sculco, P. K. (2021). Nonconcentric and Irregular Dislocations of Total Hip Arthroplasties: Radiographic Analysis and Review of the Literature. The Journal of Emergency Medicine, 60(4), 451–459. https://doi.org/10.1016/j.jemermed.2020.11.023'
Reference |
    Reference Type: CITATION
    Reference Text: 'Holte AJ, Molloy IB, Werth PM, Jevsevar DS. Do Patient Engagement Platforms in Total Joint Arthroplasty Improve Patient-Reported Outcomes? J Arthroplasty. 2021 Dec;36(12):3850-3858. doi: 10.1016/j.arth.2021.08.003. Epub 2021 Aug 10. PMID: 34481693'
Reference |
    Reference Type: CITATION
    Reference Text: 'Kurtz, S. M., Lau, E., Ong, K., et al. (2009). Future Young Patient Demand for Primary and Revision Joint Arthroplasty: National projections from 2010 to 2030. Clinical Orthopaedics and Related Research, 467(10), 2606-2612'
Reference |
    Reference Type: CITATION
    Reference Text: 'Ludwick, L., Chisari, E., Wang, J., Clarkson, S., Collins, L., & Parvizi, J. (2021). Emergence of Antibiotic Resistance Across Two-Stage Revision for Periprosthetic Joint Infection. The Journal of Arthroplasty, 36(8), 2946–2950. https://doi.org/10.1016/j.arth.2021.04.007'
Reference |
    Reference Type: CITATION
    Reference Text: 'Rothrock, N. E., Hays, R. D., Spritzer, K., et al. (2010). Relative to the General U.S. Population, Chronic Diseases are Associated with Poorer Health-Related Quality of Life as Measured by the Patient-Reported Outcomes Measurement Information System (PROMIS). Journal of Clinical Epidemiology, 63(11), 1195-1204'
Reference |
    Reference Type: CITATION
    Reference Text: 'Tilbury, C., Haanstra, T. M., Leichtenberg, C. S., et al. (2016). Unfulfilled Expectations after Total Hip and Knee Arthroplasty Surgery: There is a Need for Better Preoperative Patient Information and Education. Journal of Arthroplasty, 31(10), 2136-2145'
Reference |
    Reference Type: CITATION
    Reference Text: 'Wolford, M. L., Palso, K., & Bercovitz, A. (2015, February). Hospitalization for Total Hip Replacement Among Inpatients Aged 45 and Over: United States, 2000-2010. NCHS Data Brief No. 186. Hyattsville, MD: National Center for Health Statistics'
Definition |
    None
Guidance |
    The same FSA instrument must be used for the initial and follow-up assessment.

    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 19 years of age and older who had a primary THA between November two years prior to the measurement period and October of the year prior to measurement period; and who had an outpatient encounter between November of the year prior to the measurement period and the end of 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 with severe cognitive impairment that starts before or in any part of the measurement period.

    Exclude patients with one or more specific lower body fractures indicating trauma in the 24 hours before or at the start of the total hip arthroplasty.

    Exclude patients with a partial hip arthroplasty procedure on the day of the total hip arthroplasty.

    Exclude patients with a revision hip arthroplasty procedure, an implanted device/prosthesis removal procedure or a resurfacing/supplement procedure on the day of the total hip arthroplasty.

    Exclude patients with a malignant neoplasm of the pelvis, sacrum, coccyx, lower limbs, or bone/bone marrow or a disseminated malignant neoplasm on the day of the total hip arthroplasty.

    Exclude patients with a mechanical complication on the day of the total hip arthroplasty.

    Exclude patients with a second total hip arthroplasty procedure 1 year before or after the original total hip arthroplasty procedure.

    Exclude patients who die on the day of the total hip arthroplasty procedure or in the 300 days after.
Numerator |
    Patients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12], Patient-Reported Outcomes Measurement Information System [PROMIS]-10-Global Health, Hip Disability and Osteoarthritis Outcome Score [HOOS], HOOS Jr.) in the 90 days prior to or on the day of the primary THA procedure, and in the 300 - 425 days after the THA procedure
Numerator Exclusions |
    Not Applicable
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

- - Initial Population

    - -     "Has Qualifying Encounter"
              and exists ( "Total Hip Arthroplasty Procedure" )
              and AgeInYearsAt(date from start of "Measurement Period")>= 19

- - Denominator

    - -     "Initial Population"

- - Denominator Exclusions

    - -     Hospice."Has Hospice Services"
              or "Has Severe Cognitive Impairment"
              or "Has Total Hip Arthroplasty with 1 or More Lower Body Fractures"
              or "Has Partial Hip Arthroplasty Procedure"
              or "Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure"
              or "Has Malignant Neoplasm of Lower and Unspecified Limbs"
              or "Has Mechanical Complication"
              or "Has More Than One Elective Primary Total Hip Arthroplasty Performed"
              or "Death Within 300 Days of the THA Procedure"

- - Numerator

    - -     ( "Has THA with Initial and Follow Up HOOS Assessments" )
              or ( "Has THA with Initial and Follow Up HOOSJr Assessments" )
              or ( "Has THA with Initial and Follow Up PROMIS10 Assessments" )
              or ( "Has THA with Initial and Follow Up VR12 Oblique Assessments" )
              or ( "Has THA with Initial and Follow Up VR12 Orthogonal Assessments" )

- - Numerator Exclusions

    - -     None

- - Denominator Exceptions

    - -     None

- - Stratification

    - -     None

### Definitions

- - Date HOOS Total Assessment Completed

    - -     from
              ["Assessment, Performed": "Quality of life score [HOOS]"] HOOSLifeQuality,
              ["Assessment, Performed": "Sport-recreation score [HOOS]"] HOOSSport,
              ["Assessment, Performed": "Activities of daily living score [HOOS]"] HOOSActivityScore,
              ["Assessment, Performed": "Symptoms score [HOOS]"] HOOSSymptoms,
              ["Assessment, Performed": "Pain score [HOOS]"] HOOSPain
              let HOOSLifeQualityDate: date from start of Global."NormalizeInterval" ( HOOSLifeQuality.relevantDatetime, HOOSLifeQuality.relevantPeriod ),
              HOOSSportDate: date from start of Global."NormalizeInterval" ( HOOSSport.relevantDatetime, HOOSSport.relevantPeriod ),
              HOOSActivityScoreDate: date from start of Global."NormalizeInterval" ( HOOSActivityScore.relevantDatetime, HOOSActivityScore.relevantPeriod ),
              HOOSSymptomsDate: date from start of Global."NormalizeInterval" ( HOOSSymptoms.relevantDatetime, HOOSSymptoms.relevantPeriod ),
              HOOSPainDate: date from start of Global."NormalizeInterval" ( HOOSPain.relevantDatetime, HOOSPain.relevantPeriod )
              where HOOSLifeQualityDate same day as HOOSSportDate
                and HOOSSport.result is not null
                and HOOSLifeQualityDate same day as HOOSActivityScoreDate
                and HOOSActivityScore.result is not null
                and HOOSLifeQualityDate same day as HOOSSymptomsDate
                and HOOSSymptoms.result is not null
                and HOOSLifeQualityDate same day as HOOSPainDate
                and HOOSPain.result is not null
                and HOOSLifeQuality.result is not null
              return Max({ HOOSLifeQualityDate, HOOSSportDate, HOOSActivityScoreDate, HOOSSymptomsDate, HOOSPainDate })

  - Date HOOSJr Total Assessment Completed

    - -     ( ["Assessment, Performed": "Total interval score [HOOSJR]"] HOOSJr
              where HOOSJr.result is not null ) DocumentedHOOSJr
              return date from start of Global."NormalizeInterval" ( DocumentedHOOSJr.relevantDatetime, DocumentedHOOSJr.relevantPeriod )

  - Date PROMIS10 Total Assessment Completed

    - -     from
              ["Assessment, Performed": "PROMIS-10 Global Mental Health (GMH) score T-score"] PROMIS10MentalScore,
              ["Assessment, Performed": "PROMIS-10 Global Physical Health (GPH) score T-score"] PROMIS10PhysicalScore
              let PROMIS10MentalScoreDate: date from start of Global."NormalizeInterval" ( PROMIS10MentalScore.relevantDatetime, PROMIS10MentalScore.relevantPeriod ),
              PROMIS10PhysicalScoreDate: date from start of Global."NormalizeInterval" ( PROMIS10PhysicalScore.relevantDatetime, PROMIS10PhysicalScore.relevantPeriod )
              where PROMIS10MentalScoreDate same day as PROMIS10PhysicalScoreDate
                and PROMIS10PhysicalScore.result is not null
                and PROMIS10MentalScore.result is not null
              return Max({ PROMIS10MentalScoreDate, PROMIS10PhysicalScoreDate })

  - Date VR12 Oblique Total Assessment Completed

    - -     from
              ["Assessment, Performed": "VR-12 Mental component summary (MCS) score - oblique method T-score"] VR12MentalAssessment,
              ["Assessment, Performed": "VR-12 Physical component summary (PCS) score - oblique method T-score"] VR12PhysicalAssessment
              let VR12MentalAssessmentDate: date from start of Global."NormalizeInterval" ( VR12MentalAssessment.relevantDatetime, VR12MentalAssessment.relevantPeriod ),
              VR12PhysicalAssessmentDate: date from start of Global."NormalizeInterval" ( VR12PhysicalAssessment.relevantDatetime, VR12PhysicalAssessment.relevantPeriod )
              where VR12MentalAssessmentDate same day as VR12PhysicalAssessmentDate
                and VR12MentalAssessment.result is not null
                and VR12PhysicalAssessment.result is not null
              return Max({ VR12MentalAssessmentDate, VR12PhysicalAssessmentDate })

  - Date VR12 Orthogonal Total Assessment Completed

    - -     from
              ["Assessment, Performed": "VR-12 Mental component summary (MCS) score - orthogonal method T-score"] VR12MentalAssessment,
              ["Assessment, Performed": "VR-12 Physical component summary (PCS) score - orthogonal method T-score"] VR12PhysicalAssessment
              let VR12MentalAssessmentDate: date from start of Global."NormalizeInterval" ( VR12MentalAssessment.relevantDatetime, VR12MentalAssessment.relevantPeriod ),
              VR12PhysicalAssessmentDate: date from start of Global."NormalizeInterval" ( VR12PhysicalAssessment.relevantDatetime, VR12PhysicalAssessment.relevantPeriod )
              where VR12MentalAssessmentDate same day as VR12PhysicalAssessmentDate
                and VR12MentalAssessment.result is not null
                and VR12PhysicalAssessment.result is not null
              return Max({ VR12MentalAssessmentDate, VR12PhysicalAssessmentDate })

  - Death Within 300 Days of the THA Procedure

    - -     exists ( ["Patient Characteristic Expired": "Dead (finding)"] Deceased
                with "Total Hip Arthroplasty Procedure" THAProcedure
                  such that date from Deceased.expiredDatetime during day of Interval[date from start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ), date from start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) + 300 days]
            )

  - Denominator

    - -     "Initial Population"

  - Denominator Exclusions

    - -     Hospice."Has Hospice Services"
              or "Has Severe Cognitive Impairment"
              or "Has Total Hip Arthroplasty with 1 or More Lower Body Fractures"
              or "Has Partial Hip Arthroplasty Procedure"
              or "Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure"
              or "Has Malignant Neoplasm of Lower and Unspecified Limbs"
              or "Has Mechanical Complication"
              or "Has More Than One Elective Primary Total Hip Arthroplasty Performed"
              or "Death Within 300 Days of the THA Procedure"

  - Has Malignant Neoplasm of Lower and Unspecified Limbs

    - -     exists ( ["Diagnosis": "Malignant Neoplasms of Lower and Unspecified Limbs"] MalignantNeoplasm
                with "Total Hip Arthroplasty Procedure" THAProcedure
                  such that MalignantNeoplasm.prevalencePeriod overlaps Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod )
            )

  - Has Mechanical Complication

    - -     exists ( ["Diagnosis": "Mechanical Complications Excluding Upper Body"] MechanicalComplications
                with "Total Hip Arthroplasty Procedure" THAProcedure
                  such that MechanicalComplications.prevalencePeriod overlaps Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod )
            )

  - Has More Than One Elective Primary Total Hip Arthroplasty Performed

    - -     exists ( "Total Hip Arthroplasty Procedure" THAProcedure
                with ["Procedure, Performed": "Primary THA Procedure"] ElectiveTHAProcedure
                  such that THAProcedure.id !~ ElectiveTHAProcedure.id
                    and start of Global."NormalizeInterval" ( ElectiveTHAProcedure.relevantDatetime, ElectiveTHAProcedure.relevantPeriod ) during day of Interval[( start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) ) - 1 year, ( start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) ) + 1 year]
            )

  - Has Partial Hip Arthroplasty Procedure

    - -     exists ( ["Procedure, Performed": "Partial Arthroplasty of Hip"] PartialTHAProcedure
                with "Total Hip Arthroplasty Procedure" THAProcedure
                  such that Global."NormalizeInterval" ( PartialTHAProcedure.relevantDatetime, PartialTHAProcedure.relevantPeriod ) during day of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod )
            )

  - Has Qualifying Encounter

    - -     exists ( ( ["Encounter, Performed": "Outpatient Consultation"]
                union ["Encounter, Performed": "Office Visit"]
                union ["Encounter, Performed": "Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure"]
                union ["Encounter, Performed": "Telephone Visits"]
                union ["Encounter, Performed": "Online Assessments"] ) ValidEncounters
                where ValidEncounters.relevantPeriod during day of Interval["November 1 Year Prior to the Measurement Period",
                end of "Measurement Period"]
            )

  - Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure

    - -     exists ( "Total Hip Arthroplasty Procedure" THAProcedure
                with ["Procedure, Performed": "Removal, Revision and Supplement Procedures of the Lower Body and Spine"] RevisionTHAProcedure
                  such that Global."NormalizeInterval" ( RevisionTHAProcedure.relevantDatetime, RevisionTHAProcedure.relevantPeriod ) during day of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod )
            )

  - Has Severe Cognitive Impairment

    - -     exists ( ["Diagnosis": "Severe cognitive impairment (finding)"] Dementia
                where Dementia.prevalencePeriod overlaps "Measurement Period"
            )

  - Has THA with Initial and Follow Up HOOS Assessments

    - -     exists ( ( "Total Hip Arthroplasty Procedure" THAProcedure
                return Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) ) TotalHip
                with "Date HOOS Total Assessment Completed" InitialHipAssessmentHOOS
                  such that TotalHip starts 90 days or less on or after day of InitialHipAssessmentHOOS
                with "Date HOOS Total Assessment Completed" FollowUpHipAssessmentHOOS
                  such that date from FollowUpHipAssessmentHOOS during day of Interval[date from
                  end of TotalHip + 300 days, date from
                  end of TotalHip + 425 days]
            )

  - Has THA with Initial and Follow Up HOOSJr Assessments

    - -     exists ( ( "Total Hip Arthroplasty Procedure" THAProcedure
                return Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) ) TotalHip
                with "Date HOOSJr Total Assessment Completed" InitialHipAssessment
                  such that TotalHip starts 90 days or less on or after day of InitialHipAssessment
                with "Date HOOSJr Total Assessment Completed" FollowUpHipAssessment
                  such that date from FollowUpHipAssessment during day of Interval[date from
                  end of TotalHip + 300 days, date from
                  end of TotalHip + 425 days]
            )

  - Has THA with Initial and Follow Up PROMIS10 Assessments

    - -     exists ( ( "Total Hip Arthroplasty Procedure" THAProcedure
                return Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) ) TotalHip
                with "Date PROMIS10 Total Assessment Completed" InitialHipAssessmentPROMIS10
                  such that TotalHip starts 90 days or less on or after day of InitialHipAssessmentPROMIS10
                with "Date PROMIS10 Total Assessment Completed" FollowUpHipAssessmentPROMIS10
                  such that date from FollowUpHipAssessmentPROMIS10 during day of Interval[date from
                  end of TotalHip + 300 days, date from
                  end of TotalHip + 425 days]
            )

  - Has THA with Initial and Follow Up VR12 Oblique Assessments

    - -     exists ( ( "Total Hip Arthroplasty Procedure" THAProcedure
                return Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) ) TotalHip
                with "Date VR12 Oblique Total Assessment Completed" InitialHipAssessmentOblique
                  such that TotalHip starts 90 days or less on or after day of InitialHipAssessmentOblique
                with "Date VR12 Oblique Total Assessment Completed" FollowUpHipAssessmentOblique
                  such that date from FollowUpHipAssessmentOblique during day of Interval[date from
                  end of TotalHip + 300 days, date from
                  end of TotalHip + 425 days]
            )

  - Has THA with Initial and Follow Up VR12 Orthogonal Assessments

    - -     exists ( ( "Total Hip Arthroplasty Procedure" THAProcedure
                return Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) ) TotalHip
                with "Date VR12 Orthogonal Total Assessment Completed" InitialHipAssessmentOrthogonal
                  such that TotalHip starts 90 days or less on or after day of InitialHipAssessmentOrthogonal
                with "Date VR12 Orthogonal Total Assessment Completed" FollowUpHipAssessmentOrthogonal
                  such that date from FollowUpHipAssessmentOrthogonal during day of Interval[date from
                  end of TotalHip + 300 days, date from
                  end of TotalHip + 425 days]
            )

  - Has Total Hip Arthroplasty with 1 or More Lower Body Fractures

    - -     exists ( "Total Hip Arthroplasty Procedure" THAProcedure
                with ["Diagnosis": "Lower Body Fractures Excluding Ankle and Foot"] LowerBodyFracture
                  such that LowerBodyFracture.prevalencePeriod starts 24 hours or less on or before start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod )
            )

  - 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 day of "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 day of "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 day of "Measurement Period"
              )
            or exists ( ["Diagnosis": "Hospice Diagnosis"] HospiceCareDiagnosis
                  where HospiceCareDiagnosis.prevalencePeriod overlaps day of "Measurement Period"
              )

  - Initial Population

    - -     "Has Qualifying Encounter"
              and exists ( "Total Hip Arthroplasty Procedure" )
              and AgeInYearsAt(date from start of "Measurement Period")>= 19

  - November 1 Two Years Prior to the Measurement Period

    - -     DateTime((year from start of "Measurement Period" - 2), 11, 1, 0, 0, 0, 0, 0)

  - November 1 Year Prior to the Measurement Period

    - -     DateTime((year from start of "Measurement Period" - 1), 11, 1, 0, 0, 0, 0, 0)

  - Numerator

    - -     ( "Has THA with Initial and Follow Up HOOS Assessments" )
              or ( "Has THA with Initial and Follow Up HOOSJr Assessments" )
              or ( "Has THA with Initial and Follow Up PROMIS10 Assessments" )
              or ( "Has THA with Initial and Follow Up VR12 Oblique Assessments" )
              or ( "Has THA with Initial and Follow Up VR12 Orthogonal Assessments" )

  - October 31 Year Prior to the Measurement Period

    - -     DateTime((year from start of "Measurement Period" - 1), 10, 31, 23, 59, 59, 0, 0)

  - 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"]

  - Total Hip Arthroplasty Procedure

    - -     ["Procedure, Performed": "Primary THA Procedure"] THAProcedure
              where Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) starts during day of Interval["November 1 Two Years Prior to the Measurement Period", "October 31 Year Prior to the Measurement Period"]

### 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>

### Terminology

- code "Activities of daily living score [HOOS]" ("LOINC Code (72095-3)")
- code "Dead (finding)" ("SNOMEDCT Code (419099009)")
- 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 "Pain score [HOOS]" ("LOINC Code (72097-9)")
- code "Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure" ("CPT Code (99024)")
- code "PROMIS-10 Global Mental Health (GMH) score T-score" ("LOINC Code (71969-0)")
- code "PROMIS-10 Global Physical Health (GPH) score T-score" ("LOINC Code (71971-6)")
- code "Quality of life score [HOOS]" ("LOINC Code (72093-8)")
- code "Severe cognitive impairment (finding)" ("SNOMEDCT Code (702956004)")
- code "Sport-recreation score [HOOS]" ("LOINC Code (72094-6)")
- code "Symptoms score [HOOS]" ("LOINC Code (72096-1)")
- code "Total interval score [HOOSJR]" ("LOINC Code (82323-7)")
- code "VR-12 Mental component summary (MCS) score - oblique method T-score" ("LOINC Code (72026-8)")
- code "VR-12 Mental component summary (MCS) score - orthogonal method T-score" ("LOINC Code (72028-4)")
- code "VR-12 Physical component summary (PCS) score - oblique method T-score" ("LOINC Code (72025-0)")
- code "VR-12 Physical component summary (PCS) score - orthogonal method T-score" ("LOINC Code (72027-6)")
- code "Yes (qualifier value)" ("SNOMEDCT Code (373066001)")
- valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
- valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
- valueset "Hospice Care Ambulatory" (2.16.840.1.113883.3.526.3.1584)
- valueset "Hospice Diagnosis" (2.16.840.1.113883.3.464.1003.1165)
- valueset "Hospice Encounter" (2.16.840.1.113883.3.464.1003.1003)
- valueset "Lower Body Fractures Excluding Ankle and Foot" (2.16.840.1.113883.3.464.1003.1178)
- valueset "Malignant Neoplasms of Lower and Unspecified Limbs" (2.16.840.1.113883.3.464.1003.1180)
- valueset "Mechanical Complications Excluding Upper Body" (2.16.840.1.113883.3.464.1003.1182)
- 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 "Outpatient Consultation" (2.16.840.1.113883.3.464.1003.101.12.1008)
- valueset "Partial Arthroplasty of Hip" (2.16.840.1.113883.3.464.1003.1184)
- valueset "Payer" (2.16.840.1.114222.4.11.3591)
- valueset "Primary THA Procedure" (2.16.840.1.113883.3.464.1003.198.12.1006)
- valueset "Race" (2.16.840.1.114222.4.11.836)
- valueset "Removal, Revision and Supplement Procedures of the Lower Body and Spine" (2.16.840.1.113883.3.464.1003.1189)
- valueset "Telephone Visits" (2.16.840.1.113883.3.464.1003.101.12.1080)

### Data Criteria (QDM Data Elements)

- "Assessment, Performed: Activities of daily living score [HOOS]" using "Activities of daily living score [HOOS] (LOINC Code 72095-3)"
- "Assessment, Performed: Hospice care [Minimum Data Set]" using "Hospice care [Minimum Data Set] (LOINC Code 45755-6)"
- "Assessment, Performed: Pain score [HOOS]" using "Pain score [HOOS] (LOINC Code 72097-9)"
- "Assessment, Performed: PROMIS-10 Global Mental Health (GMH) score T-score" using "PROMIS-10 Global Mental Health (GMH) score T-score (LOINC Code 71969-0)"
- "Assessment, Performed: PROMIS-10 Global Physical Health (GPH) score T-score" using "PROMIS-10 Global Physical Health (GPH) score T-score (LOINC Code 71971-6)"
- "Assessment, Performed: Quality of life score [HOOS]" using "Quality of life score [HOOS] (LOINC Code 72093-8)"
- "Assessment, Performed: Sport-recreation score [HOOS]" using "Sport-recreation score [HOOS] (LOINC Code 72094-6)"
- "Assessment, Performed: Symptoms score [HOOS]" using "Symptoms score [HOOS] (LOINC Code 72096-1)"
- "Assessment, Performed: Total interval score [HOOSJR]" using "Total interval score [HOOSJR] (LOINC Code 82323-7)"
- "Assessment, Performed: VR-12 Mental component summary (MCS) score - oblique method T-score" using "VR-12 Mental component summary (MCS) score - oblique method T-score (LOINC Code 72026-8)"
- "Assessment, Performed: VR-12 Mental component summary (MCS) score - orthogonal method T-score" using "VR-12 Mental component summary (MCS) score - orthogonal method T-score (LOINC Code 72028-4)"
- "Assessment, Performed: VR-12 Physical component summary (PCS) score - oblique method T-score" using "VR-12 Physical component summary (PCS) score - oblique method T-score (LOINC Code 72025-0)"
- "Assessment, Performed: VR-12 Physical component summary (PCS) score - orthogonal method T-score" using "VR-12 Physical component summary (PCS) score - orthogonal method T-score (LOINC Code 72027-6)"
- "Diagnosis: Hospice Diagnosis" using "Hospice Diagnosis (2.16.840.1.113883.3.464.1003.1165)"
- "Diagnosis: Lower Body Fractures Excluding Ankle and Foot" using "Lower Body Fractures Excluding Ankle and Foot (2.16.840.1.113883.3.464.1003.1178)"
- "Diagnosis: Malignant Neoplasms of Lower and Unspecified Limbs" using "Malignant Neoplasms of Lower and Unspecified Limbs (2.16.840.1.113883.3.464.1003.1180)"
- "Diagnosis: Mechanical Complications Excluding Upper Body" using "Mechanical Complications Excluding Upper Body (2.16.840.1.113883.3.464.1003.1182)"
- "Diagnosis: Severe cognitive impairment (finding)" using "Severe cognitive impairment (finding) (SNOMEDCT Code 702956004)"
- "Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
- "Encounter, Performed: Hospice Encounter" using "Hospice Encounter (2.16.840.1.113883.3.464.1003.1003)"
- "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: Outpatient Consultation" using "Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008)"
- "Encounter, Performed: Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure" using "Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure (CPT Code 99024)"
- "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)"
- "Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
- "Patient Characteristic Expired: Dead (finding)" using "Dead (finding) (SNOMEDCT Code 419099009)"
- "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: Partial Arthroplasty of Hip" using "Partial Arthroplasty of Hip (2.16.840.1.113883.3.464.1003.1184)"
- "Procedure, Performed: Primary THA Procedure" using "Primary THA Procedure (2.16.840.1.113883.3.464.1003.198.12.1006)"
- "Procedure, Performed: Removal, Revision and Supplement Procedures of the Lower Body and Spine" using "Removal, Revision and Supplement Procedures of the Lower Body and Spine (2.16.840.1.113883.3.464.1003.1189)"

### 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 |
    Not Applicable