["Diagnosis": "Advanced Illness"]

Performance/Reporting Period

2025

Value Set Description from VSAC

Clinical Focus: The purpose of this value set is to represent concepts for a diagnosis of advanced illnesses.
Data Element Scope: This value set may use a model element related to Diagnosis.
Inclusion Criteria: Includes concepts that represent a diagnosis of advanced illness when combined with older age and indications of frailty. Codes cover a wide range of conditions: heart failure, end stage renal disease, liver disease, emphysema, dementia and neurodegenerative disorders, metastatic and sever cancers, respiratory failure, and pulmonary fibrosis.
Exclusion Criteria: Exclude concepts that indicate pregnancy, fetal, juvenile, childhood or neonatal conditions, concepts that indicate acute, temporary, or procedure-related conditions.

Constrained to codes in the Advanced Illness value set (2.16.840.1.113883.3.464.1003.110.12.1082)

QDM Datatype and Definition

"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 prevalencePeriod references the time from the onset date to the abatement date.

eCQMs using this data element:

CMS122v13 - Diabetes: Glycemic Status Assessment Greater Than 9%

CMS125v13 - Breast Cancer Screening

CMS130v13 - Colorectal Cancer Screening

CMS131v13 - Diabetes: Eye Exam

CMS165v13 - Controlling High Blood Pressure

QDM Attributes

prevalencePeriod

prevalencePeriod is the time from onset dateTime to abatement dateTime.