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"Participation"

Performance/Reporting Period
2022
QDM Datatype (QDM Version 5.5 Guidance Update):

Data elements that meet criteria using this datatype should document the type of plan or program in which the patient is expected to be enrolled. The program is identified as the Issuer (e.g., Aetna, Blue Cross Blue Shield Association, Cigna). The code attribute indicates the coverage type indicating the program in which the subject of record participates (e.g., health insurance plan policy, disease specific policy, health maintenance organization policy)

Timing:

participationPeriod addresses:

  • enrollmentStartdate - The time the patient enrolled in the program.
  • enrollmentEnddate - The time the patient’s enrollment in the program ends.
QDM Category (QDM Version 5.5 Guidance Update)

Participation

Participation represents a patient's coverage by a program such as an insurance or medical plan or a payment agreement. Such programs can include patient-centered medical home, disease-specific programs, etc.
Data Elements defined by this QDM Datatype:
QDM Attributes

participationPeriod

The time from:
  • enrollmentStartdate - The time the patient enrolled in the program.
to
  • enrollmentEndDate - The time the patient's enrollement in the program ends.

Note: participationPeriod references the QDM datatype "Participation", representing a patient's coverage by a program such as an insurance or medical plan or a payment agreement. The participationPeriod is not to be confused with the QDM participant attribute used with the "Encounter, Performed" QDM datatype.

recorder

The recorder indicates who recorded (or documented) the information (e.g., the individual or organization documenting the information). Note that HL7 FHIR modeling includes reference to asserter for concepts such as diagnosis and Allergy/Intolerance. Feedback from implementers and EHR vendors suggest that asserter fields default to the individual entering the information without clear evidence about how often clinicians change the default to theperson who reported the information. Therefore, QDM retains a recorder attribute for the referenced QDM datatypes.

The prescriber attribute references the new QDM entities (patient, care partner, practitioner, or organization) and any or all of the attributes of the respective QDM entity. For example, to reference that a physician who recorded a diagnosis is the same person who was the primary participant in an Encounter and assure the physician's specialty meets the measures requirements, the eCQM can use the Practitioner Entity and its attributes. Should the eCQM choose to reference a physician practice or a hospital, the performer can reference the Organization Entity and indicate the identifier and/or the organization type.

Last Updated: Jul 08, 2021