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CMS Measure ID:
Version:
2
NQF Number:
None
Performance/Reporting Period
2019
Description:

Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period:

*Adults aged >= 21 years who were previously diagnosed with or currently have an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD); OR

*Adults aged >= 21 years who have ever had a fasting or direct low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial or pure hypercholesterolemia; OR

*Adults aged 40-75 years with a diagnosis of diabetes with a fasting or direct LDL-C level of 70-189 mg/dL

Data Elements contained within the eCQM + Expand all

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent an allergy to statin medications.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Allergy/Intolerance. Statin allergens as structured in RxNorm.
Inclusion Criteria: Includes only relevant concepts associated with codes that use the IN term type for statins.
Exclusion Criteria: Excludes non-statin medications.

Constrained to codes in the Adverse Event: Statin Allergen value set (2.16.840.1.113883.3.117.1.7.1.423)

QDM Datatype and Definition (QDM Version 5.3)

Adverse Event

Data elements that meet criteria using this datatype should document the Adverse Event and its corresponding value set.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent an allergy to statin medications.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Allergy/Intolerance. Statin allergens as structured in RxNorm.
Inclusion Criteria: Includes only relevant concepts associated with codes that use the IN term type for statins.
Exclusion Criteria: Excludes non-statin medications.

Constrained to codes in the Allergy Intolerance: Statin Allergen value set (2.16.840.1.113883.3.117.1.7.1.423)

QDM Datatype and Definition (QDM Version 5.3)

Allergy Intolerance

Data elements that meet criteria using this datatype should document the Allergy or intolerance and its corresponding value set.

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 a diagnosis, condition, or disorder of atherosclerosis or peripheral arterial disease (PAD).
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 conditions that indicate arterial blood flow is restricted putting patients at higher risk for heart disease.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnosis: Atherosclerosis and Peripheral Arterial Disease value set (2.16.840.1.113762.1.4.1047.21)

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 active breastfeeding.
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 lactation and the actual finding or intention of breastfeeding or nursing.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnosis: Breastfeeding value set (2.16.840.1.113762.1.4.1047.73)

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 stroke and high risk diagnoses associated with stroke, including transient ischemic attack (TIA) and generalized ischemic cerebrovascular disease, which would indicate a patient has atherosclerotic cardiovascular disease (ASCVD) in relation to a cerebrovascular event.
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 ASCVD diagnoses of cerebrovascular origin.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnosis: Cerebrovascular disease, Stroke, TIA value set (2.16.840.1.113762.1.4.1047.44)

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 identify patients who have a diagnosis of diabetes.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Diagnosis.
Inclusion Criteria: Includes only relevant concepts associated with identifying patients who have type I or type II diabetes.
Exclusion Criteria: Excludes patients who have gestational diabetes or steroid-induced diabetes.

Constrained to codes in the Diagnosis: Diabetes value set (2.16.840.1.113883.3.464.1003.103.12.1001)

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 a diagnosis of end stage renal disease.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Diagnosis.
Inclusion Criteria: Includes only relevant concepts associated with a diagnosis of end stage renal disease.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnosis: End Stage Renal Disease value set (2.16.840.1.113883.3.526.3.353)

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 hepatitis A infections.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to related to Diagnosis.
Inclusion Criteria: Includes only relevant concepts associated with hepatitis A infections. This is a grouping of ICD-10-CM and SNOMED CT codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnosis: Hepatitis A value set (2.16.840.1.113883.3.464.1003.110.12.1024)

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 acute or chronic hepatitis B infection.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Diagnosis, Active. The intent of this data element is identify patients with acute or chronic hepatitis B infection.
Inclusion Criteria: Includes only relevant concepts associated with identifying patients with acute or chronic hepatitis B infection.
Exclusion Criteria: Excludes patients with evidence of current or past acute or chronic hepatitis B infection.

Constrained to codes in the Diagnosis: Hepatitis B 1 value set (2.16.840.1.113883.3.67.1.101.1.269)

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 a diagnosis, past or present, of hypercholesterolemia.
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 diagnoses of hypercholesterolemia.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnosis: Hypercholesterolemia value set (2.16.840.1.113762.1.4.1047.100)

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 ischemic heart disease and associated diagnoses as related to atherosclerotic cardiovascular disease (ASCVD).
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 acute and chronic forms of ischemic heart disease as well as coronary occlusion, thrombosis, or rupture that can be related to ASCVD.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnosis: Ischemic heart disease or coronary occlusion, rupture, or thrombosis value set (2.16.840.1.113762.1.4.1047.46)

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 a diagnosis of liver disease.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype or attribute related to Diagnosis. The intent of this value set is to capture liver disease that would indicate that a statin medication may not be appropriate.
Inclusion Criteria: Includes only relevant concepts associated with acute and chronic liver conditions that may represent the liver is failing. Examples of conditions include concepts associated with, but are not limited to, the following: alcoholic liver damage, cirrhosis, hepatitis C and E, and liver necrosis.
Exclusion Criteria: Excludes hepatitis A and hepatitis B.

Constrained to codes in the Diagnosis: Liver Disease value set (2.16.840.1.113762.1.4.1047.42)

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 a diagnosis of myocardial infarction.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Diagnosis.
Inclusion Criteria: Includes only relevant concepts associated with a diagnosis of myocardial infarction.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnosis: Myocardial Infarction value set (2.16.840.1.113883.3.526.3.403)

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 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 a diagnosis or condition of rhabdomyolysis.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Diagnosis.
Inclusion Criteria: Includes only relevant concepts associated with the diagnosis of rhabdomyolysis.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnosis: Rhabdomyolysis value set (2.16.840.1.113762.1.4.1047.102)

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 the diagnosis of angina.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Diagnosis.
Inclusion Criteria: Includes only relevant concepts associated with stable and unstable angina, pre and post infarction angina, angina decubitus, intermediate coronary syndrome, other unspecified angina or sequelae of myocardial infarction, and other forms of angina pectoris.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnosis: Stable and Unstable Angina value set (2.16.840.1.113762.1.4.1047.47)

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 annual wellness visits.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Encounter. The intent of this data element is to identify patients who have had an annual wellness visit.
Inclusion Criteria: Includes only relevant concepts associated with encounters specific to annual wellness visits.
Exclusion Criteria: No exclusions.

Constrained to codes in the Encounter, Performed: Annual Wellness Visit value set (2.16.840.1.113883.3.526.2.1363)

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 patients who have had an office or other outpatient visit.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Encounter, Performed.
Inclusion Criteria: Includes only relevant concepts associated with comprehensive history, evaluation, and management of a patient in an office or outpatient facility. Patient can be presenting with problems that are minor to high severity. This is an extensional value set of CPT codes.
Exclusion Criteria: Excludes non-office visits, including telehealth services.

Constrained to codes in the Encounter, Performed: Office Visit value set (2.16.840.1.113883.3.464.1003.101.11.1005)

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 patients who have had an outpatient interaction at an office with a member of their medical care team.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Encounter, Performed.
Inclusion Criteria: Includes only relevant concepts associated with comprehensive history, evaluation, and management of a patient in an office or outpatient facility. Patient can be presenting with problems that are minor to high severity. This is an extensional value set of CPT and SNOMED CT codes.
Exclusion Criteria: Excludes non-office visits, including telehealth services.

Constrained to codes in the Encounter, Performed: Outpatient Consultation 1 value set (2.16.840.1.113883.3.464.1003.101.11.1040)

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 outpatient encounters.
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 evaluation and management of a new or established patient through an encounter for annual visit, preventative evaluation, follow-up, or periodic re-evaluations that would occur in the outpatient setting.
Exclusion Criteria: No exclusions.

Constrained to codes in the Encounter, Performed: Outpatient Encounters for Preventive Care value set (2.16.840.1.113762.1.4.1047.9)

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 patients over the age of 18 who have had an established preventive care office visit.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Encounter, Performed.
Inclusion Criteria: Includes only relevant concepts associated with comprehensive preventive medicine reevaluation and management of an individual over the age of 18. This is an extensional value set of CPT codes.
Exclusion Criteria: Excludes non-office visits, including telehealth services.

Constrained to codes in the Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up value set (2.16.840.1.113883.3.464.1003.101.11.1125)

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 unlisted preventive medicine services.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Encounter, Performed.
Inclusion Criteria: Includes only relevant concepts associated with unlisted preventive medicine services. This is a grouping of a CPT codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Encounter, Performed: Preventive Care Services - Other value set (2.16.840.1.113883.3.464.1003.101.12.1030)

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 patients who have received preventive medicine counseling and/or risk factor reduction interventions.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Encounter, Performed.
Inclusion Criteria: Includes only relevant concepts associated with counseling, anticipatory guidance, and risk factor reduction interventions. Preventative care and individual counseling encounters can be 15 to 60 minutes. This is a grouping of CPT codes.
Exclusion Criteria: Excludes codes for services performed in the emergency department, including critical care and observation services.

Constrained to codes in the Encounter, Performed: Preventive Care Services-Individual Counseling value set (2.16.840.1.113883.3.464.1003.101.12.1026)

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 patients over the age of 18 who have had an initial preventive care office visit.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Encounter, Performed.
Inclusion Criteria: Includes only relevant concepts associated with comprehensive preventive medicine reevaluation and management of an individual over the age of 18. This is an extensional value set of CPT codes.
Exclusion Criteria: Excludes non-office visits, including telehealth services.

Constrained to codes in the Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up value set (2.16.840.1.113883.3.464.1003.101.11.1115)

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 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 low-density lipoprotein (LDL) tests.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Laboratory Test, Performed.
Inclusion Criteria: Includes only relevant concepts associated with the calculation or measurement of LDL. This is a grouping of LOINC concepts.
Exclusion Criteria: No exclusions.

Constrained to codes in the Laboratory Test, Performed: LDL Test value set (2.16.840.1.113883.3.464.1003.198.11.1029)

QDM Datatype and Definition (QDM Version 5.3)

Laboratory Test, Performed

Data elements that meet criteria using this datatype should document the laboratory test indicated by the QDM category and its corresponding value set was performed.

Timing: The Relevant Period addresses:

  • startTime – when the laboratory test is initiated (i.e., the time the specimen collection begins)
  • stopTime – when the laboratory test is completed (i.e., the time the specimen collection ends)

Examples:

  • Initiation of a venipuncture for a fasting blood glucose to the time venipuncture for the fasting blood glucose is completed – basically a single point in time for many specimen collections
  • Initiation of a 24-hour urine collection for measured creatinine clearance until completion of the 24-hour urine collection

Note – the time that the result report is available is a separate attribute than the time of the study (specimen collection).

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent high intensity statin medications as defined by the 2013 American College of Cardiology (ACC) and the American Heart Association (AHA) guideline.
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 high intensity statin therapy medications.
Exclusion Criteria: Excludes any other intensity of statin therapy.

Constrained to codes in the Medication, Active: High intensity statin therapy value set (2.16.840.1.113762.1.4.1047.97)

QDM Datatype and Definition (QDM Version 5.3)

Medication, Active

Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set is being taken by the patient. Keep in mind that when this datatype is used with timing relationships, the criterion is looking for a medication being taken for the time frame indicated by the timing relationships.

Timing: The Relevant Period addresses:

  • startTime - when the medication is first known to be used (generally the time of entry on the medication list),
  • stopTime - when the medication is discontinued (generally, the time discontinuation is recorded on the medication list)

 

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent low intensity statin medications as defined by the 2013 American College of Cardiology (ACC) and the American Heart Association (AHA) guideline.
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 low intensity statin therapy medications.
Exclusion Criteria: Excludes any other intensity of statin therapy.

Constrained to codes in the Medication, Active: Low intensity statin therapy value set (2.16.840.1.113762.1.4.1047.107)

QDM Datatype and Definition (QDM Version 5.3)

Medication, Active

Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set is being taken by the patient. Keep in mind that when this datatype is used with timing relationships, the criterion is looking for a medication being taken for the time frame indicated by the timing relationships.

Timing: The Relevant Period addresses:

  • startTime - when the medication is first known to be used (generally the time of entry on the medication list),
  • stopTime - when the medication is discontinued (generally, the time discontinuation is recorded on the medication list)

 

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent moderate intensity statin medications as defined by the 2013 American College of Cardiology (ACC) and the American Heart Association (AHA) guideline.
Data Element Scope: This value set may use the Quality Data Model (QDM) category or attribute related to Medication.
Inclusion Criteria: Includes only relevant concepts associated with moderate intensity statin therapy medications.
Exclusion Criteria: Excludes any other intensity of statin therapy.

Constrained to codes in the Medication, Active: Moderate intensity statin therapy value set (2.16.840.1.113762.1.4.1047.98)

QDM Datatype and Definition (QDM Version 5.3)

Medication, Active

Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set is being taken by the patient. Keep in mind that when this datatype is used with timing relationships, the criterion is looking for a medication being taken for the time frame indicated by the timing relationships.

Timing: The Relevant Period addresses:

  • startTime - when the medication is first known to be used (generally the time of entry on the medication list),
  • stopTime - when the medication is discontinued (generally, the time discontinuation is recorded on the medication list)

 

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent high intensity statin medications as defined by the 2013 American College of Cardiology (ACC) and the American Heart Association (AHA) guideline.
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 high intensity statin therapy medications.
Exclusion Criteria: Excludes any other intensity of statin therapy.

Constrained to codes in the Medication, Order: High intensity statin therapy value set (2.16.840.1.113762.1.4.1047.97)

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 low intensity statin medications as defined by the 2013 American College of Cardiology (ACC) and the American Heart Association (AHA) guideline.
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 low intensity statin therapy medications.
Exclusion Criteria: Excludes any other intensity of statin therapy.

Constrained to codes in the Medication, Order: Low intensity statin therapy value set (2.16.840.1.113762.1.4.1047.107)

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 moderate intensity statin medications as defined by the 2013 American College of Cardiology (ACC) and the American Heart Association (AHA) guideline.
Data Element Scope: This value set may use the Quality Data Model (QDM) category or attribute related to Medication.
Inclusion Criteria: Includes only relevant concepts associated with moderate intensity statin therapy medications.
Exclusion Criteria: Excludes any other intensity of statin therapy.

Constrained to codes in the Medication, Order: Moderate intensity statin therapy value set (2.16.840.1.113762.1.4.1047.98)

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 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.

Value Set Description from VSAC
Clinical Focus: This value set grouping contains concepts that represent coronary artery bypass (CABG) surgical procedures.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Procedure. The intent of this data element is to identify patients who have a CABG surgical procedure.
Inclusion Criteria: Includes only relevant concepts associated with CABG surgical procedures. This is a grouping of SNOMED CT, ICD-9-CM, and ICD-10-CM codes.
Exclusion Criteria: Excludes codes that represent a CABG performed using a scope.

Constrained to codes in the Procedure, Performed: CABG Surgeries value set (2.16.840.1.113883.3.666.5.694)

QDM Datatype and Definition (QDM Version 5.3)

Procedure, Performed

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

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime -the time the procedure begins,
  • stopTime -the time the procedure is completed

NOTE:

  1. Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request.
  2. The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent carotid intervention surgical procedures.
Data Element Scope: This value set may use the Quality Data Model (QDM) category or attribute related to Procedure.
Inclusion Criteria: Includes only relevant concepts associated with representing carotid intervention surgical procedures.
Exclusion Criteria: No exclusions.

Constrained to codes in the Procedure, Performed: Carotid Intervention value set (2.16.840.1.113883.3.117.1.7.1.204)

QDM Datatype and Definition (QDM Version 5.3)

Procedure, Performed

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

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime -the time the procedure begins,
  • stopTime -the time the procedure is completed

NOTE:

  1. Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request.
  2. The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent procedures used to define percutaneous coronary intervention (PCI).
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Procedure, Performed. The intent of this data element is to identify patients who had percutaneous coronary intervention (PCI) during an episode of acute myocardial infarction.
Inclusion Criteria: Includes only relevant concepts associated with identifying patients receiving percutaneous coronary intervention (PCI). This is a grouping of ICD-10-PCS and SNOMED CT codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Procedure, Performed: PCI value set (2.16.840.1.113762.1.4.1045.67)

QDM Datatype and Definition (QDM Version 5.3)

Procedure, Performed

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

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime -the time the procedure begins,
  • stopTime -the time the procedure is completed

NOTE:

  1. Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request.
  2. The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.