Hearing Screening Prior To Hospital Discharge

Last updated: October 25, 2017

CMS Measure ID: CMS31v6
Version: 6
NQF Number: 1354
Measure Description:

This measure assesses the proportion of births that have been screened for hearing loss before hospital discharge

Initial Patient Population:

Live birth encounters at a hospital or birthing facility where the newborn was discharged with hospital stays <= 120 days that ends during the measurement period

Denominator Statement:

Denominator is equal to the Initial Population

Denominator Exclusions:

Live birth encounters where the patient expires prior to discharge and has not received hearing screening for the left or right ear

Numerator Statement:

Live birth encounters where a patient born at the facility is screened for hearing loss prior to discharge or not screened due to medical reasons

Numerator Exclusions:

Not applicable

Denominator Exceptions:

None

Measure Steward: CDC National Center on Birth Defects and Developmental Disabilities
Short Name: EHDI_1a
Previous Version: Hearing Screening Prior To Hospital Discharge
Improvement Notation:

Improvement noted as an increase in rate

Guidance:

The measurement period is one calendar year but the reporting period is jurisdictionally defined.

The Medical Reasons value set (OID 2.16.840.1.114222.4.1.214079.1.1.7) includes SNOMED codes to capture medical contraindications, surgical contraindications, and not indicated because there is a reason to withhold a certain medical procedure/treatment because it could harm a patient. A comprehensive list of codes for these conditions is not available because the judgement is often subjective. This value set is not intended to be used for other reasons a screening was not performed, such as parent refusal, technical failure, or a missed procedure.

Specifications

Release Notes

Header

  • Incremented eMeasure Version number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Removed duplicate reference to the HRSA Title V Block Grant.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Added language to provide clarity on the intent of the Medical Reasons value set and specificity regarding what is not included.

    Measure Section: Guidance

    Source of Change: JIRA (CQM-2380)

  • Updated Initial Population narrative statement by adding 'that ends' during the measurement period to better align with the measure intent and harmonize across measures.

    Measure Section: Initial Population

    Source of Change: JIRA (CQM-2520)

  • Updated Numerator narrative statement by removing the 'during the measurement period' text to better align with the measure intent and harmonize across measures.

    Measure Section: Numerator

    Source of Change: JIRA (CQM-2520)

Logic

  • Changed timing operator from 'during' to 'starts during' to harmonize with other EH eCQMs and potentially minimize missing data elements within reporting files. By using the 'starts during' operator, only the start time of the procedure is required rather than both the start and end times.

    Measure Section: Denominator Exclusions

    Source of Change: Expert Work Group Review

  • Changed timing operator from 'during' to 'starts during' to harmonize with other EH eCQMs and potentially minimize missing data elements within reporting files. By using the 'starts during' operator, only the start time of the procedure is required rather than both the start and end times.

    Measure Section: Numerator

    Source of Change: Expert Work Group Review

Value Set

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

  • Value set Newborn Hearing Screen Left (2.16.840.1.114222.4.1.214079.1.1.3): Added 1 LOINC code (73741-1).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Newborn Hearing Screen Right (2.16.840.1.114222.4.1.214079.1.1.4): Added 1 LOINC code (73744-5).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Live Birth Newborn Born in Hospital (2.16.840.1.113762.1.4.1046.6): Added 5 SNOMEDCT codes (442311008, 442327001, 442342003, 442365008, 442423001) and deleted 24 SNOMEDCT codes. Added 5 ICD10CM codes (Z38.62, Z38.63, Z38.64, Z38.65, Z38.66).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Livebirth (2.16.840.1.114222.4.1.214079.1.1.1) updated the inclusion criteria purpose statement to reflect the intent of the value set to capture live births in the hospital.

    Measure Section: QDM Data Elements

    Source of Change: Measure Lead

External Resources