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Cesarean Birth

Compare Versions of: "Cesarean Birth"

The Compare function compares two years of the measure specifications found in the header of the measure's HTML. It does not include a comparison of any information in the body of the HTML, e.g., population criteria, Clinical Quality Language, or value sets.

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Measure Information 2023 Reporting Period 2024 Reporting Period
Title Cesarean Birth Cesarean Birth
CMS eCQM ID CMS334v4 CMS334v5
Short Name

PC-02

PC-02

NQF Number Not Applicable 0471e
Description

Nulliparous women with a term, singleton baby in a vertex position delivered by cesarean birth

Nulliparous women with a term, singleton baby in a vertex position delivered by cesarean birth

Initial Population

Inpatient hospitalizations for patients age >= 8 years and < 65 admitted to the hospital for inpatient acute care who undergo a delivery procedure that ends during the measurement period

Inpatient hospitalizations for patients age >= 8 years and < 65 admitted to the hospital for inpatient acute care who undergo a delivery procedure with a discharge date that ends during the measurement period

Denominator

Inpatient hospitalizations for nulliparous patients delivered of a live term singleton newborn >= 37 weeks' gestation

Note: The eCQM and chart-based measure slightly digress in the denominator logic.

eCQM:

The measure description states "Nulliparous women with a term, singleton baby in a vertex position delivered by cesarean birth". ACOG defines nulliparous as a woman with a parity of zero. The eCQM logic concludes that a patient is nulliparous when ONE of the following is true:

1. Parity equals zero

2. Gravidity equals one

3. Preterm and Term births both equal zero.

See Definition Section for more details.

Chart Based:

The chart based measure evaluates the data element "Previous Live Births". If the answer is "yes" the patient will be excluded from the denominator. If a patient had a previous stillbirth or fetal demise, the abstractor is instructed to answer "no" and the patient will remain in the denominator.

Inpatient hospitalizations for nulliparous patients who delivered a live term singleton newborn >= 37 weeks' gestation

See Guidance and Definition Sections for more details.

Denominator Exclusions Inpatient hospitalizations for patients with abnormal presentation or placenta previa during the encounter. Note that the chart-based measure excludes single stillbirth and patients with multiple gestations from the denominator. These concepts are mutually exclusive of the denominator requirement of live singleton newborn and therefore the logic does not address single stillbirth nor multiple gestation. Inpatient hospitalizations for patients with abnormal presentation, placenta previa, placenta accreta or vasa previa during the encounter
Numerator

Inpatient hospitalizations for patients who deliver by cesarean section.

Inpatient hospitalizations for patients who deliver by cesarean section

Numerator Exclusions

None

None

Denominator Exceptions

None

None

Measure Steward The Joint Commission The Joint Commission
Measure Scoring Proportion measure Proportion measure
Measure Type Outcome measure Outcome measure
Improvement Notation

Within Optimal Range. The Joint Commission does not want to encourage inappropriately low Cesarean rates that may be unsafe to patients. Acceptable PC-02 rates are 30% or lower, however there is not an established threshold for what rate may be too low. PC-06 serves as a balancing measure for PC-02 to guard against any unanticipated or unintended consequences and to identify unforeseen complications that might arise as a result of quality improvement activities and efforts for this measure. In order to identify areas for improvement, hospitals may want to review results based on specific ICD-10 codes or patient populations. Data could then be analyzed further determine specific patterns or trends to help reduce cesarean births.

Within Optimal Range. The Joint Commission does not want to encourage inappropriately low Cesarean rates that may be unsafe to patients. Acceptable PC-02 rates are 30% or lower, however there is not an established threshold for what rate may be too low. PC-06 serves as a balancing measure for PC-02 to guard against any unanticipated or unintended consequences and to identify unforeseen complications that might arise as a result of quality improvement activities and efforts for this measure. In order to identify areas for improvement, hospitals may want to review results based on specific ICD-10 codes or patient populations. Data could then be analyzed further determine specific patterns or trends to help reduce cesarean births.

Guidance

Vertex position is modeled implicitly, as the measure excludes deliveries with abnormal presentations.

Patients who do not receive prenatal care and have no documented gestational age or estimated due date are implicitly excluded from the measure, as gestational age is required to meet denominator criteria.

This measure allows for 2 approaches to determine estimated gestational age (EGA) in the following order of precedence:

1. The EGA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.*

2. The EGA is obtained from a discrete field in the electronic health record. This option is only used when the calculated EGA is not available.

Wherever gestational age is mentioned, relative to the delivery, the intent is to capture the last estimated gestational age prior to or at the time of delivery.

 

*ACOG ReVITALize Guidelines for Calculating Gestational Age:

 

Gestational Age = (280-(EDD minus Reference Date))/7

--Estimated Due Date (EDD): The best obstetrical Estimated Due Date is determined by last menstrual period if confirmed by early ultrasound or no ultrasound performed, or early ultrasound if no known lastmenstrual period or the ultrasound is not consistent with last menstrual period, or known date of fertilization (eg, assisted reproductive technology)

--Reference Date is the date on which you are trying to determine gestational age. For purposes of this eCQM, Reference Date would be the Date of Delivery.

Note however the calculation may yield a non-whole number and gestational age should be rounded off to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks.

The timing relationship of relevantDatetime 42 weeks or less before TimeOfDelivery is applied to the data elements of parity, gravida, preterm/term live births for which prenatal records may include relevant information.

The denominator includes logic to determine if the patient is nulliparous. The patient is considered nulliparous when one of the following is true:

Parity equals zero

Gravida equals one

Preterm and Term births both equal zero

Parity, preterm and term live births may be updated by the electronic health record software or by clinicians during a delivery encounter. To capture the pre-delivery value, organizations may need to create a rule or calculation to capture the number prior to the delivery start time.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

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

Vertex position is modeled implicitly, as the measure excludes deliveries with abnormal presentations.

Patients who do not receive prenatal care and have no documented gestational age or estimated due date are implicitly excluded from the measure, as gestational age is required to meet denominator criteria.

This measure allows for 3 approaches to determine gestational age (GA) in the following order of precedence:

1. The GA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.*

2. The GA is obtained from a discrete field in the electronic health record. This option is only used when the calculated GA is not available.

3. The GA is based on ICD10 or SNOMED codes indicative of weeks gestation. This option is only used when results from items #1 and #2 (see above) are not available.

Wherever gestational age is mentioned, relative to the delivery, the intent is to capture the last estimated gestational age prior to or at the time of delivery.

 

*ACOG ReVITALize Guidelines for Calculating Gestational Age:

 

Gestational Age = (280-(EDD minus Reference Date))/7

--Estimated Due Date (EDD): The best obstetrical Estimated Due Date is determined by last menstrual period if confirmed by early ultrasound or no ultrasound performed, or early ultrasound if no known last menstrual period or the ultrasound is not consistent with last menstrual period, or known date of fertilization (e.g., assisted reproductive technology)

--Reference Date is the date on which you are trying to determine gestational age. For purposes of this eCQM, Reference Date would be the Date of Delivery.

Note however the calculation may yield a non-whole number and gestational age should be rounded off to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks.

The timing relationship of relevantDatetime 42 weeks or less before TimeOfDelivery is applied to the data elements of parity, gravida, preterm/term live births for which prenatal records may include relevant information.

Note: The eCQM and chart-based measure slightly digress in the denominator and denominator exclusion logic. The chart-based measure excludes single stillbirth and patients with multiple gestations from the denominator. These concepts are mutually exclusive of the denominator requirement of live singleton newborn and therefore the logic does not address single stillbirth nor multiple gestation.

Parity, preterm and term live births may be updated by the electronic health record software or by clinicians during a delivery encounter. To capture the pre-delivery value, organizations may need to create a rule or calculation to capture the number prior to the delivery start time.

"Gravida", "PretermBirth", "TermBirth" and "Parity" results should be submitted via QRDA I as integer and not as number or quantity.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

Next Version No Version Available
Previous Version No Version Available

Header

  • Updated the NQF Number and Endorsed By fields to reflect NQF endorsement.

    Measure Section: NQF Number

    Source of Change: Measure Lead

  • Updated the NQF Number and Endorsed By fields to reflect NQF endorsement.

    Measure Section: Endorsed By

    Source of Change: Measure Lead

  • Updated grammar, wording, and/or formatting to improve readability and consistency.

    Measure Section: Description

    Source of Change: Annual Update

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Added guidance to clarify patients may now be qualified for the denominator based on gestational age diagnosis codes when neither calculated or reported gestational age is available.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Added guidance to note Gravida, Preterm Birth, Term Birth and Parity results are expected to be submitted via QRDA I as integers (and not quantities or numbers) to meet measure criteria.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Removed redundant language from the Guidance section relating to Parity, Gravidity and Preterm/Term births.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Updated Initial Population language to 'who undergo a delivery procedure with a discharge date that ends during the measurement period' to better align metadata and logic.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Removed redundant language from the Denominator section relating to Parity, Gravidity and Preterm/Term births.

    Measure Section: Denominator

    Source of Change: Measure Lead

  • Expanded placenta previa denominator exclusion to include placenta accreta and vasa previa, per technical/clinical expert recommendation and applicability to the measure.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Moved metadata language that referred to the chart abstracted measure from the Denominator and Denominator Exclusions sections to the Guidance section to reduce potential confusion.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

Logic

  • Added logic to denominator criteria to capture patients with specified weeks gestation based on diagnosis codes when neither calculated or reported gestational age is available.

    Measure Section: Denominator

    Source of Change: Measure Lead

  • Revised definition names to align with the expanded denominator exclusion of placenta accreta and vasa previa per technical/clinical expert recommendation and applicability to the measure.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Updated the version number of the PC Maternal Library to v3.0.000.

    Measure Section: Definitions

    Source of Change: Annual Update

  • Added 'EarliestOf' and 'relevantPeriod' to the Gravida, Parity, Preterm/Term Birth functions' 'where' and 'sort by' logic which will cause the 'NormalizeInterval' to be invoked, allowing for the consistent application of relevant datetime and relevant period when using 'Assessment, Performed' datatype.

    Measure Section: Functions

    Source of Change: ONC Project Tracking System (JIRA): CQM-5620

  • Removed 'Truncate.Time' function and added 'as DateTime' to Estimated Delivery Date result to simplify logic and allow hospitals to submit data as date only or as date/time.

    Measure Section: Functions

    Source of Change: Measure Lead

  • Updated the version number of the PC Maternal Library to v3.0.000.

    Measure Section: Functions

    Source of Change: Annual Update

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Added value set 37 to 42 Plus Weeks Gestation (2.16.840.1.113762.1.4.1110.68) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Abnormal Presentation (2.16.840.1.113762.1.4.1045.105): Added 13 SNOMED CT codes based on applicability of value set and/or OID. Added 7 ICD-10-CM codes (O64.8XX0, O64.8XX1, O64.8XX2, O64.8XX3, O64.8XX4, O64.8XX5, O64.8XX9) based on applicability of value set and/or OID.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set (2.16.840.1.113762.1.4.1110.37): Renamed to Placenta Previa or Accreta or Vasa Previa based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value Set Placenta Previa or Accreta or Vasa Previa (2.16.840.1.113762.1.4.1110.37): Added 5 SNOMED CT codes (199895009, 199896005, 33058001, 70129008, 79668009) based on review by technical experts, SMEs, and/or public feedback. Deleted 1 SNOMED CT code (48888007) based on terminology update. Added 9 ICD-10-CM codes (O43.213, O43.219, O69.4XX0, O69.4XX1, O69.4XX2, O69.4XX3, O69.4XX4, O69.4XX5, O69.4XX9) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Payer (2.16.840.1.114222.4.11.3591): Added 5 SOP codes (1111, 1112, 142, 344, 141) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Jan 22, 2024