"Care Goal"
Unlike other QDM datatypes, the "Care Goal" datatype does not indicate a specific context of use. Instead, to meet this criterion, there must be documentation of a care goal as defined by the Care Goal QDM category and its corresponding value set.
Timing:
- relevantPeriod
- startDate – when the goal pursuit begins.
- endDate (dueDate) – the target date for the goal outcome.
- statusDate - when a goal status took effect.
Notes:
- Care Goal references dates (i.e.,days) and not dateTimes.
- The performer attribute references the US Core and FHIR R4 concept expressedBy – the individual or organization responsible for creating the goal.
Care Goal
Care Goal represents a defined target or measure to be achieved in the process of patient care, that is, an expected outcome. A typical goal is expressed as a change in status expected at a defined future time. That change can be an observation represented by other QDM categories (diagnostic tests, laboratory tests, symptoms, etc.) scheduled for some time in the future and with a particular value. A goal can be found in the plan of care (care plan), the structure used by all stakeholders, including the patient, to define the management actions for the various conditions, problems, or issues identified for the target of the plan. This structure, through which the goals and care-planning actions and processes can be organized, planned, communicated, and checked for completion, is represented in the QDM categories as a record artifact. A time/date stamp is required. Specifically, a care plan is composed of the elements:
- Problem, which is managed by other QDM standard categories (condition/diagnosis/ problem) and their related data elements.
- Procedure, which is managed by other standard categories and their related data elements.
- Note that procedures are a continuum of interventions ranging from actions patients can do for themselves to those that can be performed by others (caregivers or clinical professionals), including detailed complex surgical procedures requiring highly trained physicians, nurses, and state-of-the-art facilities.
- Goal, which is what is expected to happen.
- Outcome, which is what happened. An outcome can be shown by other QDM standard categories and their related data elements such as "Procedure, Performed", "Intervention, Performed", "Assessment, Performed", "Physical Exam, Performed".
performer
The performer is the person or organization that is responsible for the action (e.g., the individual or organization carrying out the activity). The performer references a QDM entity and any or all of the attributes of the selected QDM entity. For example, to reference that a physician who performed a procedure is the same person who was the primary participant in an Encounter and assure the physician’s specialty meets the measure’s requirements, the eCQM can reference 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.
[See Sections 2.6 and 4.2 for description of Entities]
relatedTo
An attribute that indicates one QDM data element fulfills the expectations of another QDM data element.
See Section 5.8 for examples for using relatedTo.
Note: QDM 5.6 relatedTo attribute is consistent with the FHIR element basedOn which is available for many FHIR resources addressed by the QDM datatypes added in the QDM 5.6 version. These QDM additions allow evaluation and testing during a period of FHIR transition specifically to relate actions with orders that generate them. However, measure developers should carefully determine feasibility for each use case when using the relatedTo attribute.
relevantPeriod
relevantPeriod addresses the time between the start of an action to the end of an action. Each QDM datatype using relevantPeriod defines specific definitions for the start and stop time for the action listed.
Note: negation rationale 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 and must not use relevantPeriod