Back to top
Top
CMS Measure ID:
Version:
9
NQF Number:
0
Performance/Reporting Period
2021
Description:

Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period

Data Elements contained within the eCQM + Expand all

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent durable medical equipment or devices used by frail patients.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Device.
Inclusion Criteria: Includes only relevant concepts associated with patients that use durable medical equipment or devices for frailty. This is a grouping of HCPCS codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Device, Applied: Frailty Device value set (2.16.840.1.113883.3.464.1003.118.12.1300)

QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

Device, Applied

Data elements that meet criteria using this datatype should document that the device indicated by the QDM category and its corresponding value set is in use, or impacts or alters the treatment, care plan, or encounter (e.g., an antithrombotic device has been placed on the patient's legs to prevent thromboembolism or a cardiac pacemaker is in place).


Timing:

  • relevantPeriod addresses:
    • startTime - when the device is inserted or first used.
    • stopTime - when the device is removed or last used.
    • relevantPeriod references a start and stop time for a device if the application occurred over a time interval.
  • relevant dateTime addresses the time the device is applied if it was used at a single point in time.
  • author dateTime references the time the action was recorded.
  • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

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.

See Appendix 6.1 for updated guidance regarding how to use Device, Applied

 

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent durable medical equipment or devices used by frail patients.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Device.
Inclusion Criteria: Includes only relevant concepts associated with patients that use durable medical equipment or devices for frailty. This is a grouping of HCPCS codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Device, Order: Frailty Device value set (2.16.840.1.113883.3.464.1003.118.12.1300)

QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

Device, Order

Data elements that meet criteria using this datatype should document an order for the device indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; author dateTime.

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.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts related to Advanced Illnesses.
Data Element Scope: This value set may use Quality Data Model (QDM) category related to Diagnosis.
Inclusion Criteria: Includes only relevant concepts associated with identifying patients who have an advanced illness diagnosis.
Exclusion Criteria: No exclusions.

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

QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

Diagnoses

Coded diagnoses/problems addressed during the encounter. The diagnoses attribute has three components:

  • diagnosis (code)
  • presentOnAdmissionIndicator (code)
  • rank (positive integer)

To reference an encounter diagnosis, the expression must include the diagnosis code component. The other components are optional. The expression should only include the presentOnAdmissionIndicator if it is necessary to reference present on admission and should only include the rank if it is necessary to reference principal diagnosis.

The "Encounter, Performed" diagnosis attribute is intended to capture ALL diagnoses, including the principal diagnosis, i.e., all diagnoses addressed during the encounter represented by the diagnosis (code) used in the expression.The presentOnAdmissionIndicator (code) allows the eCQM developer to include criteria about whether each specific "Encounter, Performed" diagnosis was present at the time of admission (an indicator used to evaluate patient safety and adverse events). See presentOnAdmissionIndicator attribute definition for information about using the "Encounter, Performed" diagnosis attribute.

The "Encounter, Performed" diagnosis (rank) replaces the principal diagnosis attribute. To reference a principal diagnosis, eCQM developers should express the "Encounter, Performed" diagnosis with a diagnosis (code) and a rank of 1. See definition of rank attribute.

With an "Encounter, Performed" diagnosis, there is no dependency on the timing of the diagnosis in relation to the encounter.

  • Use of the "Encounter, Performed": diagnoses attribute component and the "Diagnosis" datatype is redundant for relating the diagnosis to the "Encounter, Performed". The "Encounter, Performed": diagnoses component syntax is preferred.
  • Referencing the same diagnosis using "Encounter, Performed" (diagnoses attribute) and "Diagnosis" (datatype) should only occur if the measure must define a specified length of a prevalencePeriod, e.g.,
    • The measure must assure that the diagnoses
      • have been present for at least some defined time period before the encounter, and
      • were addressed during the "Encounter, Performed"
    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts that identify patients who have a diagnosis of diabetes.
    Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Diagnosis.
    Inclusion Criteria: Includes only relevant concepts associated with identifying patients who have type I or type II diabetes.
    Exclusion Criteria: Excludes patients who have gestational diabetes or steroid-induced diabetes.

    Constrained to codes in the Diagnosis: Diabetes value set (2.16.840.1.113883.3.464.1003.103.12.1001)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    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.

    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts that represent diagnoses of frailty.
    Data Element Scope: This value set may use Quality Data Model (QDM) category related to Diagnosis.
    Inclusion Criteria: Includes only relevant concepts associated with diagnoses that represent frailty. This is a grouping of ICD10CM and SNOMEDCT codes.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Diagnosis: Frailty Diagnosis value set (2.16.840.1.113883.3.464.1003.113.12.1074)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    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.

    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts related to acute inpatient visits.
    Data Element Scope: This value set may use Quality Data Model (QDM) datatype related to Encounter, Performed.
    Inclusion Criteria: Includes only relevant concepts associated with comprehensive history, evaluation, and management of a patient in an acute inpatient setting. This is a grouping value set of CPT and SNOMED codes.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: Acute Inpatient value set (2.16.840.1.113883.3.464.1003.101.12.1083)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Encounter, Performed

    Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

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

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • 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.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: This value set grouping contains concepts that represent annual wellness visits.
    Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Encounter. The intent of this data element is to identify patients who have had an annual wellness visit.
    Inclusion Criteria: Includes only relevant concepts associated with encounters specific to annual wellness visits.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: Annual Wellness Visit value set (2.16.840.1.113883.3.526.3.1240)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Encounter, Performed

    Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

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

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • 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.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts that represent patients living in assisted living, domiciliary care or rest homes who have had an interaction with a member of their medical team.
    Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Encounter, Performed.
    Inclusion Criteria: Includes only relevant concepts associated with services provided to new and established patients living in assisted living, domiciliary care or rest home. This is a grouping value set of CPT codes.
    Exclusion Criteria: Excludes visits in settings other than assisted living, domiciliary care or rest homes.

    Constrained to codes in the Encounter, Performed: Care Services in Long-Term Residential Facility value set (2.16.840.1.113883.3.464.1003.101.12.1014)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Encounter, Performed

    Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

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

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • 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.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts related to an ED visit.
    Data Element Scope: This value set may use Quality Data Model (QDM) datatype related to Encounter, Performed.
    Inclusion Criteria: Includes only relevant concepts associated with comprehensive history, evaluation, and management of a patient in an ED. This is a grouping value set of CPT and SNOMED codes.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: ED value set (2.16.840.1.113883.3.464.1003.101.12.1085)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Encounter, Performed

    Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

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

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • 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.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts that represent the most common inpatient encounter types.
    Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Encounter. The intent of this data element is to identify patients who have had an inpatient encounter.
    Inclusion Criteria: Includes only relevant concepts associated with SNOMED CT codes representing inpatient encounter.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: Encounter Inpatient value set (2.16.840.1.113883.3.666.5.307)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Encounter, Performed

    Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

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

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • 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.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts that represent nursing care services provided to frail patients.
    Data Element Scope: This value set may use Quality Data Model (QDM) datatype related to Encounter, Performed.
    Inclusion Criteria: Includes only relevant concepts associated with nursing care and home care services provided to frail patients. This is a grouping of CPT, HCPCS, and SNOMEDCT codes.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: Frailty Encounter value set (2.16.840.1.113883.3.464.1003.101.12.1088)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Encounter, Performed

    Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

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

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • 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.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts that represent patients who have had a home health visit by a provider for the evaluation or management of a new or existing patient.
    Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Encounter, Performed.
    Inclusion Criteria: Includes only relevant concepts associated with home visits for the evaluation and management of a new or established patient. This is a grouping value set of CPT and SNOMED CT codes.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: Home Healthcare Services value set (2.16.840.1.113883.3.464.1003.101.12.1016)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Encounter, Performed

    Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

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

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • 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.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts related to nonacute inpatient visits.
    Data Element Scope: This value set may use Quality Data Model (QDM) datatype related to Encounter, Performed.
    Inclusion Criteria: Includes only relevant concepts associated with comprehensive history, evaluation, and management of a patient in a nonacute inpatient setting. This is a grouping value set of CPT and SNOMED codes.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: Nonacute Inpatient value set (2.16.840.1.113883.3.464.1003.101.12.1084)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Encounter, Performed

    Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

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

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • 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.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts that represent patients who have had an interaction with a member of their medical team on admission to a nursing facility.
    Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Encounter, Performed.
    Inclusion Criteria: Includes only relevant concepts associated with services provided to new and established patients in a nursing facility (skilled, intermediate and long-term care facilities).
    Exclusion Criteria: Excludes visits in settings other than a nursing facility.

    Constrained to codes in the Encounter, Performed: Nursing Facility Visit value set (2.16.840.1.113883.3.464.1003.101.12.1012)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Encounter, Performed

    Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

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

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • 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.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts related to observation visits.
    Data Element Scope: This value set may use Quality Data Model (QDM) datatype related to Encounter, Performed.
    Inclusion Criteria: Includes only relevant concepts associated with comprehensive history, evaluation, and management of a patient in an observation care setting. This is a grouping value set of CPT codes.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: Observation value set (2.16.840.1.113883.3.464.1003.101.12.1086)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Encounter, Performed

    Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

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

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • 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.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts that represent patients who have had an office or other outpatient visit.
    Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Encounter, Performed.
    Inclusion Criteria: Includes only relevant concepts associated with comprehensive history, evaluation, and management of a patient in an office or outpatient facility. Patient can be presenting with problems that are minor to high severity. This is a grouping value set of CPT codes.
    Exclusion Criteria: Excludes non-office visits, including telehealth services.

    Constrained to codes in the Encounter, Performed: Office Visit value set (2.16.840.1.113883.3.464.1003.101.12.1001)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Encounter, Performed

    Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

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

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • 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.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts related to outpatient visits.
    Data Element Scope: This value set may use Quality Data Model (QDM) datatype related to Encounter, Performed.
    Inclusion Criteria: Includes only relevant concepts associated with comprehensive history, evaluation, and management of a patient in an outpatient setting. This is a grouping value set of CPT and HCPCS codes.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: Outpatient value set (2.16.840.1.113883.3.464.1003.101.12.1087)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Encounter, Performed

    Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

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

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • 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.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts that represent patients over the age of 18 who have had an established preventive care office visit.
    Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Encounter, Performed.
    Inclusion Criteria: Includes only relevant concepts associated with comprehensive preventive medicine reevaluation and management of an individual the age of 18 years or over. This is a grouping value set of CPT codes.
    Exclusion Criteria: Excludes non-office visits, including telehealth services.

    Constrained to codes in the Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up value set (2.16.840.1.113883.3.464.1003.101.12.1025)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Encounter, Performed

    Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

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

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • 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.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts that represent patients over the age of 18 who have had an initial preventive care office visit.
    Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Encounter, Performed.
    Inclusion Criteria: Includes only relevant concepts associated with comprehensive preventive medicine reevaluation and management of an individual the age of 18 years or over. This is a grouping value set of CPT codes.
    Exclusion Criteria: Excludes non-office visits, including telehealth services.

    Constrained to codes in the Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up value set (2.16.840.1.113883.3.464.1003.101.12.1023)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Encounter, Performed

    Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

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

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • 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.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts that represent patients receiving hospice care outside of a hospital or long term care facility.
    Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Procedure, Order or Intervention, Order. The intent of this value set is to identify all patients receiving hospice care outside of a hospital or long term care facility.
    Inclusion Criteria: Includes only relevant concepts associated with hospice care concepts.
    Exclusion Criteria: Excludes concepts for palliative care or comfort measures.

    Constrained to codes in the Intervention, Order: Hospice care ambulatory value set (2.16.840.1.113762.1.4.1108.15)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Intervention, Order

    Data elements that meet criteria using this datatype should document a request to perform the intervention indicated by the QDM category and its corresponding value set.

    Timing: The time the order is signed; author dateTime.

    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.

    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts that represent patients receiving hospice care outside of a hospital or long term care facility.
    Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Procedure, Order or Intervention, Order. The intent of this value set is to identify all patients receiving hospice care outside of a hospital or long term care facility.
    Inclusion Criteria: Includes only relevant concepts associated with hospice care concepts.
    Exclusion Criteria: Excludes concepts for palliative care or comfort measures.

    Constrained to codes in the Intervention, Performed: Hospice care ambulatory value set (2.16.840.1.113762.1.4.1108.15)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Intervention, Performed

    Data elements that meet criteria using this datatype should document the completion of the intervention indicated by the QDM category and its corresponding value set.

    Timing:

    • relevant dateTime references the time the intervention is performed when the intervention occurs at a single point in time.
    • relevantPeriod references a start and stop time for an intervention that occurs over a time interval. relevantPeriod addresses:
      • startTime - The time the intervention begins.
      • stopTime - The time the intervention ends.
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

    Notes:

    • Timing refers to a single instance of an intervention. If a measure seeks to evaluate multiple interventions over a period of time, the measure developer should use CQL logic to represent the query request.
    • 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.
       
    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts that represent hemoglobin A1c laboratory tests.
    Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Laboratory Test.
    Inclusion Criteria: Includes only relevant concepts associated with identifying hemoglobin A1c laboratory tests.
    Exclusion Criteria: Excludes codes that identify hemoglobin A1c laboratory tests that use the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) protocol and Japanese Diabetes Society (JDS)/Japanese Society of Clinical Chemistry (JSCC) protocol.

    Constrained to codes in the Laboratory Test, Performed: HbA1c Laboratory Test value set (2.16.840.1.113883.3.464.1003.198.12.1013)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Laboratory Test, Performed

    Data elements that meet criteria using this datatype should document the laboratory test indicated by the QDM category and its corresponding value set was performed.

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

    Timing:

    • relevant dateTime references the time the laboratory test is performed when the laboratory test occurs at a single point in time.
    • relevantPeriod references a start and stop time for a laboratory test that occurs over a time interval. relevantPeriod addresses:
      • startTime - The time the laboratory test begins.
      • stopTime - The time the laboratory test ends.
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

    Examples:

    • Initiation of a venipuncture for a fasting blood glucose to the time venipuncture for the fasting blood glucose is completed – use relevant dateTime to reference this single point in time for many specimen collections
    • Initiation of a 24-hour urine collection for measured creatinine clearance until completion of the 24-hour urine collection – use relevantPeriod to reference the start to stop time for this event.

    Notes:

    • The time that the result report is available is a separate attribute than the time of the study (specimen collection).
    • 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.
    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts that represent dementia medications.
    Data Element Scope: This value set may use Quality Data Model (QDM) datatype related to Medication, Ordered.
    Inclusion Criteria: Includes semantic clinical drugs (includes component, form and strength); generic; prescribable. Includes dementia medications. This is a grouping of RXNORM codes.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Medication, Active: Dementia Medications value set (2.16.840.1.113883.3.464.1003.196.12.1510)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Medication, Active

    Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set is being taken by the patient. Keep in mind that when this datatype is used with timing relationships, the criterion is looking for a medication being taken for the time frame indicated by the timing relationships.

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

    Timing:

    • relevant dateTime references the time the medication is active on the medication record if it was given or taken at a single point in time.
    • relevantPeriod references a start and stop time for an active medication on the medication record that is given or taken over a time interval:
    • The relevantPeriod addresses:
      • startTime - when the medication is first known to be used (generally the time of entry on the medication list).
      • stopTime - when the medication is no longer active.

    In the original QDM 5.5 publication, stopTime stated: when the medication is discontinued (generally, the time discontinuation is recorded on the medication list). See Appendix 6.3 for clarification regarding definition of "Medication, Active" relevantPeriod stopTime.

    Direct Reference Code

    Constrained to 'Birth date' LOINC code

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Patient Characteristic, Birthdate

    The "Patient Characteristic Birthdate" should document the patient’s date of birth.

    Timing: The "Patient Characteristic, Birthdate" is a single point in time representing the date and time of birth. It does not have a start and stop time.

    Note: "Patient Characteristic Birthdate" is fixed to LOINC code 21112-8 (Birth date) and therefore cannot be further qualified with a value set.

    Value Set Description from VSAC
    Clinical Focus: n/a Data Element Scope: n/a Inclusion Criteria: n/a Exclusion Criteria: n/a

    Constrained to codes in the Patient Characteristic, Ethnicity: Ethnicity value set (2.16.840.1.114222.4.11.837)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Patient Characteristic, Ethnicity

    Data elements that meet criteria using this datatype should document that the patient has one or more of the ethnicities indicated by the QDM category and its corresponding value set.

    Timing: Ethnicity does not have a specific timing. Measures using "Patient Characteristic, Ethnicity" should address the most recent entry in the clinical record.

    Value Set Description from VSAC
    Clinical Focus: Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system
    Data Element Scope: @code in CCDA r2.1 template Planned Coverage [act: identifier urn:oid:2.16.840.1.113883.10.20.22.4.129 (open)] DYNAMIC
    Inclusion Criteria: All codes in the code system
    Exclusion Criteria: none

    Constrained to codes in the Patient Characteristic, Payer: Payer value set (2.16.840.1.114222.4.11.3591)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Patient Characteristic, Payer

    Data elements that meet criteria using this datatype should document that the patient has one or more of the payers indicated by the QDM category and its corresponding value set.

    Timing:

    The relevantPeriod addresses:

    • startTime – the first day of insurance coverage with the referenced payer.
    • stopTime – the last day of insurance coverage with the referenced payer.
    Value Set Description from VSAC
    Clinical Focus: n/a Data Element Scope: n/a Inclusion Criteria: n/a Exclusion Criteria: n/a

    Constrained to codes in the Patient Characteristic, Race: Race value set (2.16.840.1.114222.4.11.836)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Patient Characteristic, Race

    Data elements that meet criteria using this datatype should document the patient’s race.

    Timing: Race does not have a specific timing. Measures using "Patient Characteristic, Race" should address the most recent entry in the clinical record.

    Value Set Description from VSAC
    Clinical Focus: Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.
    Data Element Scope: Gender
    Inclusion Criteria: Male and Female only.
    Exclusion Criteria: Any gender identity that is not male or female.

    Constrained to codes in the Patient Characteristic, Sex: ONC Administrative Sex value set (2.16.840.1.113762.1.4.1)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Patient Characteristic, Sex

    Data elements that meet criteria using this datatype should document that the patient's sex matches the QDM category and its corresponding value set.

    Timing: Birth (administrative) sex does not have a specific timing.

    Value Set Description from VSAC
    Clinical Focus: This value set contains concepts that represent frailty symptoms.
    Data Element Scope: This value set may use Quality Data Model (QDM) datatype related to Symptom.
    Inclusion Criteria: Includes only relevant concepts associated with frailty symptoms. This is a grouping of ICD10CM and SNOMEDCT codes.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Symptom: Frailty Symptom value set (2.16.840.1.113883.3.464.1003.113.12.1075)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    Symptom

    Data elements that meet criteria using this datatype should document the symptom and its corresponding value set.

    Timing:

    • The prevalencePeriod references the time from the onset date to the abatement date.
    • 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 null, then the symptom is considered to still be active. When this datatype is used with timing relationships, the criterion is looking for whether the symptom was active for the time frame indicated by the timing relationships.