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CMS Measure ID:
Version:
7
NQF Number:
421
Performance/Reporting Period
2019
Description:

Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter

Normal Parameters: Age 18 years and older BMI => 18.5 and < 25 kg/m2

Data Elements contained within the eCQM + Expand all

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent diagnoses and disorders that indicate pregnancy, type of pregnancy and termination of pregnancy.
Data Element Scope: This value set may use the Quality Data Model (QDM) category or attributes related to Diagnosis.
Inclusion Criteria: Includes only relevant concepts associated with identifying patients who were pregnant, termination of pregnancy and type of pregnancy.
Exclusion Criteria: Excludes previously conceived and past delivered pregnancies.

Constrained to codes in the Diagnosis: Pregnancy Dx value set (2.16.840.1.113883.3.600.1.1623)

QDM Datatype and Definition (QDM Version 5.3)

Diagnosis

Data elements that meet criteria using this datatype should document the Condition/Diagnosis/Problem and its corresponding value set. The onset dateTime corresponds to the implicit start dateTime of the datatype and the abatement dateTime corresponds to the implicit stop dateTime of the datatype. If the abatement dateTime is not present, then the diagnosis is considered to still be active. When this datatype is used with timing relationships, the criterion is looking for an active diagnosis for the time frame indicated by the timing relationships.

Timing: The Prevalence Period references the time from the onset date to the abatement date.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent multiple types of encounters for body mass index (BMI) assessment.
Data Element Scope: This value set may use the Quality Data Model (QDM) category or attribute related to Encounter.
Inclusion Criteria: Includes only relevant concepts associated with multiple types of encounters that enable BMI measurement.
Exclusion Criteria: No exclusions.

Constrained to codes in the Encounter, Performed: BMI Encounter Code Set value set (2.16.840.1.113883.3.600.1.1751)

QDM Datatype and Definition (QDM Version 5.3)

Encounter, Performed

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

Timing: The Relevant Period addresses:

  • startTime – the time the encounter began (admission time)
  • stopTime – the time the encounter ended (discharge time)

The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained.

The Location Period is an attribute of the attribute facility location addresses:

  • startTime - the time the patient arrived at the location;
  • stopTime - the time the patient departed from the location

 

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent identifying patients receiving palliative, comfort or hospice care.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Encounter.
Inclusion Criteria: Includes only relevant concepts associated with identifying patients receiving palliative, comfort or hospice care.
Exclusion Criteria: No exclusions.

Constrained to codes in the Encounter, Performed: Palliative care encounter value set (2.16.840.1.113883.3.600.1.1575)

QDM Datatype and Definition (QDM Version 5.3)

Encounter, Performed

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

Timing: The Relevant Period addresses:

  • startTime – the time the encounter began (admission time)
  • stopTime – the time the encounter ended (discharge time)

The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained.

The Location Period is an attribute of the attribute facility location addresses:

  • startTime - the time the patient arrived at the location;
  • stopTime - the time the patient departed from the location

 

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent interventions relevant for a follow up for a BMI above normal measurement.
Data Element Scope: This value set may use the Quality Data Model (QDM) category Intervention or Procedure.
Inclusion Criteria: Includes only relevant concepts associated with interventions relevant for a follow up when BMI is above normal measurement.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Order: Above Normal Follow-up value set (2.16.840.1.113883.3.600.1.1525)

QDM Datatype and Definition (QDM Version 5.3)

Intervention, Order

Data elements that meet criteria using this datatype should document a request to perform the intervention indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; Author dateTime

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent a follow up with a BMI below normal measurement.
Data Element Scope: This value set may use the Quality Data Model (QDM) category or attribute related to Intervention or Procedure.
Inclusion Criteria: Includes only relevant concepts associated with a follow up when BMI is below normal measurement.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Order: Below Normal Follow up value set (2.16.840.1.113883.3.600.1.1528)

QDM Datatype and Definition (QDM Version 5.3)

Intervention, Order

Data elements that meet criteria using this datatype should document a request to perform the intervention indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; Author dateTime

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent identifying patients receiving palliative, comfort or hospice care.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Intervention or Procedure.
Inclusion Criteria: Includes only relevant concepts associated with identifying patients receiving palliative, comfort or hospice care.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Order: Palliative Care value set (2.16.840.1.113883.3.600.1.1579)

QDM Datatype and Definition (QDM Version 5.3)

Intervention, Order

Data elements that meet criteria using this datatype should document a request to perform the intervention indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; Author dateTime

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent multiple types of providers and settings for weight assessment.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Intervention or Procedure.
Inclusion Criteria: Includes only relevant concepts associated with multiple providers in different settings performing weight assessments.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Order: Referrals where weight assessment may occur value set (2.16.840.1.113883.3.600.1.1527)

QDM Datatype and Definition (QDM Version 5.3)

Intervention, Order

Data elements that meet criteria using this datatype should document a request to perform the intervention indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; Author dateTime

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent clinical medications prescribed for weight loss to patients with an above normal BMI measurement.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Medication.
Inclusion Criteria: Includes only relevant concepts associated with oral drug forms prescribed for weight loss in patients with an above normal BMI measurement.
Exclusion Criteria: No exclusions.

Constrained to codes in the Medication, Order: Above Normal Medications value set (2.16.840.1.113883.3.600.1.1498)

QDM Datatype and Definition (QDM Version 5.3)

Medication, Order

Data elements that meet criteria using this datatype should document a request to a pharmacy to provide the medication indicated by the QDM category and its corresponding value set.

Timing: The Author dateTime is the time the order is signed.

Timing: The Relevant Period addresses:

  • startTime - when the first administration of the medication is expected. The first administration may be expected at the time of the order or at a specified future date (i.e., the active time for the order); such information should be identified in the medication order. If the startTime is not specified in the order, the startTime defaults to the Author dateTime (the time the order is signed).
  • stopTime - when the medication supply provided by the medication order is expected to be completed, including all fulfillments covered by the number of refills.

Note that when calculating cumulative medication duration, the stopTime may be present directly in the medication order. If the stopTime is not available, the duration in days is the difference between the Relevant Period start and stop times multiplied by (1 + the number of refills).

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent clinical medications prescribed for weight gain to patients with a below normal BMI measurement.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Medication.
Inclusion Criteria: Includes only relevant concepts associated with oral drug forms prescribed for weight gain in patients with a below normal BMI measurement.
Exclusion Criteria: No exclusions.

Constrained to codes in the Medication, Order: Below Normal Medications value set (2.16.840.1.113883.3.600.1.1499)

QDM Datatype and Definition (QDM Version 5.3)

Medication, Order

Data elements that meet criteria using this datatype should document a request to a pharmacy to provide the medication indicated by the QDM category and its corresponding value set.

Timing: The Author dateTime is the time the order is signed.

Timing: The Relevant Period addresses:

  • startTime - when the first administration of the medication is expected. The first administration may be expected at the time of the order or at a specified future date (i.e., the active time for the order); such information should be identified in the medication order. If the startTime is not specified in the order, the startTime defaults to the Author dateTime (the time the order is signed).
  • stopTime - when the medication supply provided by the medication order is expected to be completed, including all fulfillments covered by the number of refills.

Note that when calculating cumulative medication duration, the stopTime may be present directly in the medication order. If the stopTime is not available, the duration in days is the difference between the Relevant Period start and stop times multiplied by (1 + the number of refills).

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent the reason not done.
Data Element Scope: This value set may use the Quality Data Model (QDM) attribute related to Negation Rationale or Reason.
Inclusion Criteria: Includes only relevant concepts associated with medical or other reason for procedure or treatment not done.
Exclusion Criteria: No exclusions.

Constrained to codes in the Negation Rationale: Medical Or Other Reason Not Done value set (2.16.840.1.113883.3.600.1.1502)

QDM Attribute and Definition (QDM Version 5.3)

Negation Rationale

The QDM attribute, negation rationale indicates the reason that an action was not performed. Only QDM datatypes that represent actions (e.g., performed, recommended, communication, order, dispensed) allow the 'negation rationale' attribute. The intent is to indicate a justification that such action did not happen as expected. This attribute specifically does not address the presence or absence of information in a clinical record (e.g., documented absence of allergies versus lack of documentation about allergies). QDM assumes that any information expected will be in a clinical record. The situation is different when something that normally would be expected to be done is specifically not done because of a valid clinical reason (such as the patient is allergic, they are suffering from a complication, or some other rationale. In this case, the 'thing not done' is rarely documented, especially as a code, in the patient record. To express such lack of evidence, an eCQM author should use a CQL 'not exists' expression noted in the examples, and they must also capture the Negation rationale to capture a reason for the absence, i.e., the reason must be included to qualify as a negation rationale type expression. The syntax in the human readable HQMF is described in CQL examples and in the MAT User Guide. Prior versions of QDM used the syntax, 'Procedure, Performed not done.' QDM 5.5 uses the syntax, 'Procedure, not Performed' and this is then associated with either a DRC or a value set used to identify 'the expected thing,' that in this case was not done. Negation Rationale attribute value indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing.
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent whether the patient is Hispanic or not; ethnicity category defined by the Centers for Disease Control and Prevention and National Center for Health Statistics.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Patient Characteristic Ethnicity.
Inclusion Criteria: Includes only relevant concepts associated with ethnicity defined as Hispanic or Latino, or Not Hispanic or Latino.
Exclusion Criteria: No exclusions.

Constrained to codes in the Patient Characteristic Ethnicity: Ethnicity value set (2.16.840.1.114222.4.11.837)

QDM Datatype and Definition (QDM Version 5.3)

Patient Characteristic Ethnicity

Data elements that meet criteria using this datatype should document that the patient has one or more of the ethnicities indicated by the QDM category and its corresponding value set.

Timing: Ethnicity does not have a specific timing. Measures using Patient Characteristic, Ethnicity should address the most recent entry in the clinical record.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Patient Characteristic Payer.
Inclusion Criteria: Includes only relevant concepts associated with payer codes in the code system.
Exclusion Criteria: No exclusions.

Constrained to codes in the Patient Characteristic Payer: Payer value set (2.16.840.1.114222.4.11.3591)

QDM Datatype and Definition (QDM Version 5.3)

Patient Characteristic Payer

Data elements that meet criteria using this datatype should document that the patient has one or more of the payers indicated by the QDM category and its corresponding value set.

Timing: The Relevant Period addresses:

  • startTime – the first day of insurance coverage with the referenced payer
  • stopTime – the last day of insurance coverage with the referenced payer

 

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent the general race category reported by the patient - subject may have more than one; defined by the Centers for Disease Control and Prevention and National Center for Health Statistics.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Patient Characteristic Race.
Inclusion Criteria: Includes only relevant concepts associated with the following race categories: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, Other Race, White.
Exclusion Criteria: No exclusions.

Constrained to codes in the Patient Characteristic Race: Race value set (2.16.840.1.114222.4.11.836)

QDM Datatype and Definition (QDM Version 5.3)

Patient Characteristic Race

Data elements that meet criteria using this datatype should document the patient’s race.

Timing: Race does not have a specific timing. Measures using Patient Characteristic, Race should address the most recent entry in the clinical record.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent gender identity restricted to only male and female used in administrative situations requiring a restriction to these two categories.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Patient Characteristic Sex.
Inclusion Criteria: Includes relevant concepts associated with gender concepts for male and female only.
Exclusion Criteria: Excludes any gender identity that is not male or female.

Constrained to codes in the Patient Characteristic Sex: ONC Administrative Sex value set (2.16.840.1.113762.1.4.1)

QDM Datatype and Definition (QDM Version 5.3)

Patient Characteristic Sex

Data elements that meet criteria using this datatype should document that the patient's sex matches the QDM category and its corresponding value set.

Timing: Birth (administrative) sex does not have a specific timing.

Direct Reference Code

Constrained to 'Body mass index (BMI) [Ratio]' LOINC code

QDM Datatype and Definition (QDM Version 5.3)

Physical Exam, Performed

Data elements that meet criteria using this datatype should document the completion of the physical exam indicated by the QDM category and its corresponding value set.

Timing: The Relevant Period addresses:

  • startTime – the time the physical examination activity begins
  • stopTime – the time the physical examination activity ends

NOTE - timing refers to a single instance of a physical examination activity. If a measure seeks to evaluate multiple physical examination activities over a period of time, the measure developer should use CQL logic to represent the query request.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent overweight or obese patients.
Data Element Scope: This value set may use the Quality Data Model (QDM) category or attribute related to Diagnosis or Finding.
Inclusion Criteria: Includes only relevant concepts associated with identifying patients who are currently overweight or obese.
Exclusion Criteria: No exclusions.

Constrained to codes in the Reason: Overweight Or Obese value set (2.16.840.1.113762.1.4.1047.502)

QDM Attribute and Definition (QDM Version 5.3)

Reason

The thought process or justification for the datatype. In some measures, specific treatments are acceptable inclusion criteria only if a justified reason is present. Each of these measures uses a value set (often, but not exclusively, using SNOMED CT) to express acceptable justification reasons. Other measures specify reasons as justification for exclusions. Examples include patient, system, or medical-related reasons for declining to perform specific actions. Each of these measures also uses a value set to express acceptable justification reasons for declining to perform expected actions.
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent identifying underweight patients.
Data Element Scope: This value set may use the Quality Data Model (QDM) category or attribute related to Diagnosis.
Inclusion Criteria: Includes only relevant concepts associated with identifying patients who are currently underweight.
Exclusion Criteria: No exclusions.

Constrained to codes in the Reason: Underweight value set (2.16.840.1.113883.3.600.2388)

QDM Attribute and Definition (QDM Version 5.3)

Reason

The thought process or justification for the datatype. In some measures, specific treatments are acceptable inclusion criteria only if a justified reason is present. Each of these measures uses a value set (often, but not exclusively, using SNOMED CT) to express acceptable justification reasons. Other measures specify reasons as justification for exclusions. Examples include patient, system, or medical-related reasons for declining to perform specific actions. Each of these measures also uses a value set to express acceptable justification reasons for declining to perform expected actions.