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["Medication, Discharge": "ACE Inhibitor or ARB"]

Performance/Reporting Period
2020
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent angiotensin-converting enzyme (ACE) inhibitor and angiotensin-receptor blocker (ARB) therapies.
Data Element Scope: This value set may use Quality Data Model (QDM) category related to Medication.
Inclusion Criteria: Includes only relevant concepts associated with semantic clinical drugs concepts associated with component, form and strength); generic; prescribable; ACE inhibitor, ARB therapy, combination drugs such as ACEI plus diuretic, ARB plus neprilysin inhibitor (ARNI), ARB plus diuretic, ACEI plus calcium channel blocker, ARB plus calcium channel blocker, or ARB plus calcium channel blocker plus diuretic.
Exclusion Criteria: Excludes branded drugs; components or ingredients only; non-prescribable.

Constrained to codes in the Medication, Discharge: ACE Inhibitor or ARB value set (2.16.840.1.113883.3.526.3.1139)

QDM Datatype and Definition (QDM Version 5.4)

"Medication, Discharge"

Data elements that meet criteria using this datatype should document that the medications indicated by the QDM category and its corresponding value set should be taken by or given to the patient after being discharged from an inpatient encounter.

Timing: The time the discharge medication list on the discharge instruction form is authored.

QDM Attributes

authorDateTime

The time the data element was entered into the clinical software. Note, some datatypes include both Relevant Time and Author dateTime attributes. The purpose is to accommodate Author dateTime if the actual start and stop times are not available when evaluating for feasibility, and also to allow specification of a time for Negation Rationale.

negationRationale

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.

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

Last Updated: Jul 08, 2021