eCQM Title | # Colorectal Cancer Screening
eCQM Identifier (Measure Authoring Tool) | 130 | eCQM Version Number | 12.0.000
NQF Number | Not Applicable | GUID | aa2a4bbc-864f-45ee-b17a-7ebcc62e6aac
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 adults 45-75 years of age who had appropriate screening for colorectal cancer
Copyright |
    This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2022 National Committee for Quality Assurance. All Rights Reserved.

    Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications.

    CPT(R) 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 |
    Report a total rate, and each of the following age strata:
    Stratum 1: Patients age 46-49 by the end of the measurement period
    Stratum 2: Patients age 50-75 by the end of the measurement period
Risk Adjustment |
    None
Rate Aggregation |
    None
Rationale |
    Colorectal cancer represents eight percent of all new cancer cases in the United States. In 2020, there were an estimated 147,950 new cases of colorectal cancer and an estimated 53,200 deaths attributed to it. According to the National Cancer Institute, about 4.2 percent of men and women will be diagnosed with colorectal cancer at some point during their lifetimes. For most adults, older age is the most important risk factor for colorectal cancer, although being male and black are also associated with higher incidence and mortality. Colorectal cancer is most frequently diagnosed among people 65 to 74 years old (National Cancer Institute, 2020).

    Screening can be effective for finding precancerous lesions (polyps) that could later become malignant, and for detecting early cancers that can be more easily and effectively treated. Precancerous polyps usually take about 10 to 15 years to develop into colorectal cancer, and most can be found and removed before turning into cancer. The five-year relative survival rate for people whose colorectal cancer is found in the early stage before it has spread is about 90 percent (SEERS, 2022).
Clinical Recommendation Statement |
    The U.S. Preventive Services Task Force (2021) recommends screening for colorectal cancer in adults aged 45 to 49 years. This is a Grade B recommendation (U.S. Preventive Services Task Force, 2021).

    The U.S. Preventive Services Task Force (2021) recommends screening for colorectal cancer in adults aged 50 to 75 years. This is a Grade A recommendation (U.S. Preventive Services Task Force, 2021).

    Appropriate screenings are defined by any one of the following:
    - Fecal occult blood test (annually)
    - Stool DNA (sDNA) with FIT test (every 3 years)
    - Flexible sigmoidoscopy (every 5 years)
    - Computed tomographic (CT) colonography (every 5 years)
    - Colonoscopy (every 10 years)
Improvement Notation |
    Higher score indicates better quality
Reference |
    Reference Type: CITATION
    Reference Text: 'National Cancer Institute. (2020). SEER Cancer Statistics Review, 195-2017. Retrieved September 22, 2020, from SEER website: https://seer.cancer.gov/csr/1975_2017/'
Reference |
    Reference Type: CITATION
    Reference Text: 'SEER. “Cancer of the Colon and Rectum - Cancer Stat Facts.” Accessed December 15, 2022. https://seer.cancer.gov/statfacts/html/colorect.html'
Reference |
    Reference Type: CITATION
    Reference Text: 'US Preventive Services Task Force, Davidson, K. W., Barry, M. J., Mangione, C. M., Cabana, M., Caughey, A. B., Davis, E. M., Donahue, K. E., Doubeni, C. A., Krist, A. H., Kubik, M., Li, L., Ogedegbe, G., Owens, D. K., Pbert, L., Silverstein, M., Stevermer, J., Tseng, C. W., & Wong, J. B. (2021). Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA, 325(19), 1965–1977. https://doi.org/10.1001/jama.2021.6238'
Definition |
    None
Guidance |
    Do not count digital rectal exams (DRE), fecal occult blood tests (FOBTs) performed in an office setting or performed on a sample collected via DRE.

    Please note the measure may include screenings performed outside the age range of patients referenced in the initial population. Screenings that occur prior to the measurement period are valid to meet measure criteria.

    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 46-75 years of age by the end of the measurement period with 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 with a diagnosis or past history of total colectomy or colorectal cancer.

    Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period.

    Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria:
    - Advanced illness with two outpatient encounters during the measurement period or the year prior
    - OR advanced illness with one inpatient encounter during the measurement period or the year prior
    - OR taking dementia medications during the measurement period or the year prior

    Exclude patients receiving palliative care for any part of the measurement period.
Numerator |
    Patients with one or more screenings for colorectal cancer. Appropriate screenings are defined by any one of the following criteria:
    - Fecal occult blood test (FOBT) during the measurement period
    - Stool DNA (sDNA) with FIT test during the measurement period or the two years prior to the measurement period
    - Flexible sigmoidoscopy during the measurement period or the four years prior to the measurement period
    - CT Colonography during the measurement period or the four years prior to the measurement period
    - Colonoscopy during the measurement period or the nine years prior to the measurement period
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

    - -     AgeInYearsAt(date from
              end of "Measurement Period"
            )in Interval[46, 75]
              and exists AdultOutpatientEncounters."Qualifying Encounters"

- - Denominator

    - -     "Initial Population"

- - Denominator Exclusions

    - -     Hospice."Has Hospice Services"
              or exists "Malignant Neoplasm"
              or exists "Total Colectomy Performed"
              or AIFrailLTCF."Is Age 66 or Older with Advanced Illness and Frailty"
              or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home"
              or PalliativeCare."Has Palliative Care in the Measurement Period"

- - Numerator

    - -     exists "Fecal Occult Blood Test Performed"
              or exists "Stool DNA with FIT Test Performed"
              or exists "Flexible Sigmoidoscopy Performed"
              or exists "CT Colonography Performed"
              or exists "Colonoscopy Performed"

- - Numerator Exclusions

    - -     None

- - Denominator Exceptions

    - -     None

- - Stratification 1

    - -     AgeInYearsAt(date from
              end of "Measurement Period"
            )in Interval[46, 49]

- - Stratification 2

    - -     AgeInYearsAt(date from
              end of "Measurement Period"
            )in Interval[50, 75]

### Definitions

- - AdultOutpatientEncounters.Qualifying Encounters

    - -     ( ["Encounter, Performed": "Office Visit"]
              union ["Encounter, Performed": "Annual Wellness Visit"]
              union ["Encounter, Performed": "Preventive Care Services Established Office Visit, 18 and Up"]
              union ["Encounter, Performed": "Preventive Care Services Initial Office Visit, 18 and Up"]
              union ["Encounter, Performed": "Home Healthcare Services"]
              union ["Encounter, Performed": "Online Assessments"]
              union ["Encounter, Performed": "Telephone Visits"] ) ValidEncounter
              where ValidEncounter.relevantPeriod during day of "Measurement Period"

  - AIFrailLTCF.Has Criteria Indicating Frailty

    - -     exists ( ["Device, Order": "Frailty Device"] FrailtyDeviceOrder
                where FrailtyDeviceOrder.authorDatetime during day of "Measurement Period"
            )
              or exists ( ["Assessment, Performed": "Medical equipment used"] EquipmentUsed
                  where EquipmentUsed.result in "Frailty Device"
                    and Global."NormalizeInterval" ( EquipmentUsed.relevantDatetime, EquipmentUsed.relevantPeriod ) ends during day of "Measurement Period"
              )
              or exists ( ["Diagnosis": "Frailty Diagnosis"] FrailtyDiagnosis
                  where FrailtyDiagnosis.prevalencePeriod overlaps "Measurement Period"
              )
              or exists ( ["Encounter, Performed": "Frailty Encounter"] FrailtyEncounter
                  where FrailtyEncounter.relevantPeriod overlaps "Measurement Period"
              )
              or exists ( ["Symptom": "Frailty Symptom"] FrailtySymptom
                  where FrailtySymptom.prevalencePeriod overlaps "Measurement Period"
              )

  - AIFrailLTCF.Has Dementia Medications in Year Before or During Measurement Period

    - -     exists (["Medication, Active": "Dementia Medications"] DementiaMedication
              where Global."NormalizeInterval" ( DementiaMedication.relevantDatetime, DementiaMedication.relevantPeriod ) overlaps Interval[start of "Measurement Period" - 1 year,
              end of "Measurement Period"])

  - AIFrailLTCF.Has Inpatient Encounter with Advanced Illness

    - -     exists( ["Encounter, Performed": "Acute Inpatient"] InpatientEncounter
              where exists ( InpatientEncounter.diagnoses Diagnosis
                  where Diagnosis.code in "Advanced Illness"
              )
                and InpatientEncounter.relevantPeriod starts during day of Interval[start of "Measurement Period" - 1 year,
                end of "Measurement Period"])

  - AIFrailLTCF.Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service

    - -     exists (
            from
              "Outpatient Encounters with Advanced Illness" OutpatientEncounter1,
              "Outpatient Encounters with Advanced Illness" OutpatientEncounter2
              where OutpatientEncounter2.relevantPeriod ends 1 day or more after day of
              end of OutpatientEncounter1.relevantPeriod
              return OutpatientEncounter1
              )

  - AIFrailLTCF.Is Age 66 or Older Living Long Term in a Nursing Home

    - -     ( AgeInYearsAt(date from
                end of "Measurement Period"
              )>= 66
            )
              and ( ( Last(["Assessment, Performed": "Housing status"] HousingStatus
                    where Global."NormalizeInterval"(HousingStatus.relevantDatetime, HousingStatus.relevantPeriod)ends on or before
                    end of "Measurement Period"
                    sort by
                    end of Global."NormalizeInterval"(relevantDatetime, relevantPeriod)asc
                )) LastHousingStatus
                  where LastHousingStatus.result ~ "Lives in a nursing home (finding)"
              ) is not null

  - AIFrailLTCF.Is Age 66 or Older with Advanced Illness and Frailty

    - -     ( AgeInYearsAt(date from
                end of "Measurement Period"
              )>= 66
                and "Has Criteria Indicating Frailty"
                and ( "Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service"
                    or "Has Inpatient Encounter with Advanced Illness"
                    or "Has Dementia Medications in Year Before or During Measurement Period"
                )
            )

  - AIFrailLTCF.Outpatient Encounters with Advanced Illness

    - -     ( ["Encounter, Performed": "Outpatient"]
              union ["Encounter, Performed": "Observation"]
              union ["Encounter, Performed": "Emergency Department Evaluation and Management Visit"]
              union ["Encounter, Performed": "Nonacute Inpatient"] ) OutpatientEncounter
              where exists ( OutpatientEncounter.diagnoses Diagnosis
                  where Diagnosis.code in "Advanced Illness"
              )
                and OutpatientEncounter.relevantPeriod starts during day of Interval[start of "Measurement Period" - 1 year,
                end of "Measurement Period"]

  - Colonoscopy Performed

    - -     ["Procedure, Performed": "Colonoscopy"] Colonoscopy
              where Global."NormalizeInterval" ( Colonoscopy.relevantDatetime, Colonoscopy.relevantPeriod ) ends during day of Interval[start of "Measurement Period" - 9 years,
              end of "Measurement Period"]

  - CT Colonography Performed

    - -     ["Diagnostic Study, Performed": "CT Colonography"] Colonography
              where Global."NormalizeInterval" ( Colonography.relevantDatetime, Colonography.relevantPeriod ) ends during day of Interval[start of "Measurement Period" - 4 years,
              end of "Measurement Period"]

  - Denominator

    - -     "Initial Population"

  - Denominator Exclusions

    - -     Hospice."Has Hospice Services"
              or exists "Malignant Neoplasm"
              or exists "Total Colectomy Performed"
              or AIFrailLTCF."Is Age 66 or Older with Advanced Illness and Frailty"
              or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home"
              or PalliativeCare."Has Palliative Care in the Measurement Period"

  - Fecal Occult Blood Test Performed

    - -     ["Laboratory Test, Performed": "Fecal Occult Blood Test (FOBT)"] FecalOccultResult
              where FecalOccultResult.result is not null
                and Global."LatestOf" ( FecalOccultResult.relevantDatetime, FecalOccultResult.relevantPeriod ) during day of "Measurement Period"

  - Flexible Sigmoidoscopy Performed

    - -     ["Procedure, Performed": "Flexible Sigmoidoscopy"] FlexibleSigmoidoscopy
              where Global."NormalizeInterval" ( FlexibleSigmoidoscopy.relevantDatetime, FlexibleSigmoidoscopy.relevantPeriod ) ends during day of Interval[start of "Measurement Period" - 4 years,
              end of "Measurement Period"]

  - 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

    - -     AgeInYearsAt(date from
              end of "Measurement Period"
            )in Interval[46, 75]
              and exists AdultOutpatientEncounters."Qualifying Encounters"

  - Malignant Neoplasm

    - -     ["Diagnosis": "Malignant Neoplasm of Colon"] ColorectalCancer
              where ColorectalCancer.prevalencePeriod starts on or before day of
              end of "Measurement Period"

  - Numerator

    - -     exists "Fecal Occult Blood Test Performed"
              or exists "Stool DNA with FIT Test Performed"
              or exists "Flexible Sigmoidoscopy Performed"
              or exists "CT Colonography Performed"
              or exists "Colonoscopy Performed"

  - PalliativeCare.Has 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 day of "Measurement Period"
            )
              or exists ( ["Diagnosis": "Palliative Care Diagnosis"] PalliativeDiagnosis
                  where PalliativeDiagnosis.prevalencePeriod overlaps day of "Measurement Period"
              )
              or exists ( ["Encounter, Performed": "Palliative Care Encounter"] PalliativeEncounter
                  where PalliativeEncounter.relevantPeriod overlaps day of "Measurement Period"
              )
              or exists ( ["Intervention, Performed": "Palliative Care Intervention"] PalliativeIntervention
                  where Global."NormalizeInterval" ( PalliativeIntervention.relevantDatetime, PalliativeIntervention.relevantPeriod ) overlaps day of "Measurement Period"
              )

  - 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"]

  - Stool DNA with FIT Test Performed

    - -     ["Laboratory Test, Performed": "sDNA FIT Test"] sDNATest
              where sDNATest.result is not null
                and Global."LatestOf" ( sDNATest.relevantDatetime, sDNATest.relevantPeriod ) during day of Interval[start of "Measurement Period" - 2 years,
                end of "Measurement Period"]

  - Stratification 1

    - -     AgeInYearsAt(date from
              end of "Measurement Period"
            )in Interval[46, 49]

  - Stratification 2

    - -     AgeInYearsAt(date from
              end of "Measurement Period"
            )in Interval[50, 75]

  - Total Colectomy Performed

    - -     ["Procedure, Performed": "Total Colectomy"] Colectomy
              where Global."NormalizeInterval" ( Colectomy.relevantDatetime, Colectomy.relevantPeriod ) ends on or before day of
              end of "Measurement Period"

### Functions

- - Global.HasEnd(period Interval<DateTime>)

    - -     not (
              end of period is null
                or
                end of period = maximum DateTime
            )

  - Global.Latest(period Interval<DateTime>)

    - -     if ( HasEnd(period)) then
            end of period
              else start of period

  - Global.LatestOf(pointInTime DateTime, period Interval<DateTime>)

    - -     Latest(NormalizeInterval(pointInTime, period))

  - 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 "Discharge to healthcare facility for hospice care (procedure)" ("SNOMEDCT Code (428371000124100)")
- code "Discharge to home for hospice care (procedure)" ("SNOMEDCT Code (428361000124107)")
- 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 "Housing status" ("LOINC Code (71802-3)")
- code "Lives in a nursing home (finding)" ("SNOMEDCT Code (160734000)")
- code "Medical equipment used" ("LOINC Code (98181-1)")
- code "Yes (qualifier value)" ("SNOMEDCT Code (373066001)")
- valueset "Acute Inpatient" (2.16.840.1.113883.3.464.1003.101.12.1083)
- valueset "Advanced Illness" (2.16.840.1.113883.3.464.1003.110.12.1082)
- valueset "Annual Wellness Visit" (2.16.840.1.113883.3.526.3.1240)
- valueset "Colonoscopy" (2.16.840.1.113883.3.464.1003.108.12.1020)
- valueset "CT Colonography" (2.16.840.1.113883.3.464.1003.108.12.1038)
- valueset "Dementia Medications" (2.16.840.1.113883.3.464.1003.196.12.1510)
- valueset "Emergency Department Evaluation and Management Visit" (2.16.840.1.113883.3.464.1003.101.12.1010)
- valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
- valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
- valueset "Fecal Occult Blood Test (FOBT)" (2.16.840.1.113883.3.464.1003.198.12.1011)
- valueset "Flexible Sigmoidoscopy" (2.16.840.1.113883.3.464.1003.198.12.1010)
- valueset "Frailty Device" (2.16.840.1.113883.3.464.1003.118.12.1300)
- valueset "Frailty Diagnosis" (2.16.840.1.113883.3.464.1003.113.12.1074)
- valueset "Frailty Encounter" (2.16.840.1.113883.3.464.1003.101.12.1088)
- valueset "Frailty Symptom" (2.16.840.1.113883.3.464.1003.113.12.1075)
- valueset "Home Healthcare Services" (2.16.840.1.113883.3.464.1003.101.12.1016)
- valueset "Hospice Care Ambulatory" (2.16.840.1.113883.3.526.3.1584)
- 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 "Malignant Neoplasm of Colon" (2.16.840.1.113883.3.464.1003.108.12.1001)
- valueset "Nonacute Inpatient" (2.16.840.1.113883.3.464.1003.101.12.1084)
- valueset "Observation" (2.16.840.1.113883.3.464.1003.101.12.1086)
- valueset "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001)
- valueset "ONC Administrative Sex" (2.16.840.1.113762.1.4.1)
- valueset "Online Assessments" (2.16.840.1.113883.3.464.1003.101.12.1089)
- valueset "Outpatient" (2.16.840.1.113883.3.464.1003.101.12.1087)
- valueset "Palliative Care Diagnosis" (2.16.840.1.113883.3.464.1003.1167)
- 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 "sDNA FIT Test" (2.16.840.1.113883.3.464.1003.108.12.1039)
- valueset "Telephone Visits" (2.16.840.1.113883.3.464.1003.101.12.1080)
- valueset "Total Colectomy" (2.16.840.1.113883.3.464.1003.198.12.1019)

### 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)"
- "Assessment, Performed: Housing status" using "Housing status (LOINC Code 71802-3)"
- "Assessment, Performed: Medical equipment used" using "Medical equipment used (LOINC Code 98181-1)"
- "Device, Order: Frailty Device" using "Frailty Device (2.16.840.1.113883.3.464.1003.118.12.1300)"
- "Diagnosis: Frailty Diagnosis" using "Frailty Diagnosis (2.16.840.1.113883.3.464.1003.113.12.1074)"
- "Diagnosis: Hospice Diagnosis" using "Hospice Diagnosis (2.16.840.1.113883.3.464.1003.1165)"
- "Diagnosis: Malignant Neoplasm of Colon" using "Malignant Neoplasm of Colon (2.16.840.1.113883.3.464.1003.108.12.1001)"
- "Diagnosis: Palliative Care Diagnosis" using "Palliative Care Diagnosis (2.16.840.1.113883.3.464.1003.1167)"
- "Diagnostic Study, Performed: CT Colonography" using "CT Colonography (2.16.840.1.113883.3.464.1003.108.12.1038)"
- "Encounter, Performed: Acute Inpatient" using "Acute Inpatient (2.16.840.1.113883.3.464.1003.101.12.1083)"
- "Encounter, Performed: Annual Wellness Visit" using "Annual Wellness Visit (2.16.840.1.113883.3.526.3.1240)"
- "Encounter, Performed: Emergency Department Evaluation and Management Visit" using "Emergency Department Evaluation and Management Visit (2.16.840.1.113883.3.464.1003.101.12.1010)"
- "Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
- "Encounter, Performed: Frailty Encounter" using "Frailty Encounter (2.16.840.1.113883.3.464.1003.101.12.1088)"
- "Encounter, Performed: Home Healthcare Services" using "Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016)"
- "Encounter, Performed: Hospice Encounter" using "Hospice Encounter (2.16.840.1.113883.3.464.1003.1003)"
- "Encounter, Performed: Nonacute Inpatient" using "Nonacute Inpatient (2.16.840.1.113883.3.464.1003.101.12.1084)"
- "Encounter, Performed: Observation" using "Observation (2.16.840.1.113883.3.464.1003.101.12.1086)"
- "Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)"
- "Encounter, Performed: Online Assessments" using "Online Assessments (2.16.840.1.113883.3.464.1003.101.12.1089)"
- "Encounter, Performed: Outpatient" using "Outpatient (2.16.840.1.113883.3.464.1003.101.12.1087)"
- "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)"
- "Laboratory Test, Performed: Fecal Occult Blood Test (FOBT)" using "Fecal Occult Blood Test (FOBT) (2.16.840.1.113883.3.464.1003.198.12.1011)"
- "Laboratory Test, Performed: sDNA FIT Test" using "sDNA FIT Test (2.16.840.1.113883.3.464.1003.108.12.1039)"
- "Medication, Active: Dementia Medications" using "Dementia Medications (2.16.840.1.113883.3.464.1003.196.12.1510)"
- "Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
- "Patient Characteristic Payer: Payer" using "Payer (2.16.840.1.114222.4.11.3591)"
- "Patient Characteristic Race: Race" using "Race (2.16.840.1.114222.4.11.836)"
- "Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex (2.16.840.1.113762.1.4.1)"
- "Procedure, Performed: Colonoscopy" using "Colonoscopy (2.16.840.1.113883.3.464.1003.108.12.1020)"
- "Procedure, Performed: Flexible Sigmoidoscopy" using "Flexible Sigmoidoscopy (2.16.840.1.113883.3.464.1003.198.12.1010)"
- "Procedure, Performed: Total Colectomy" using "Total Colectomy (2.16.840.1.113883.3.464.1003.198.12.1019)"
- "Symptom: Frailty Symptom" using "Frailty Symptom (2.16.840.1.113883.3.464.1003.113.12.1075)"

### 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