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CMS Measure ID: CMS506v7    Performance/Reporting Period: 2025    NQF Number: 3316e
Description:

Proportion of inpatient hospitalizations for patients 18 years of age and older prescribed, or continued on, two or more opioids or an opioid and benzodiazepine concurrently at discharge

Data Elements and coded QDM Attributes contained within the eCQM

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Value Set Description from VSAC
Clinical Focus: The purpose of this value set is to represent concepts of pain related to cancer.
Data Element Scope: This value set may use a model element related to diagnosis.
Inclusion Criteria: Includes concepts that represent concepts of pain related to cancer.
Exclusion Criteria: Excludes concepts that do not represent cancer with pain.

Constrained to codes in the Cancer Related Pain value set (2.16.840.1.113762.1.4.1111.180)

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.

Value Set Description from VSAC
Clinical Focus: The purpose of this value set is to group concepts that indicate an opioid use disorder.
Data Element Scope: This value set may use a model element related to condition.
Inclusion Criteria: Includes concepts that represent an conditions for opioid use disorders.
Exclusion Criteria: No exclusions.

Constrained to codes in the Opioid Use Disorder value set (2.16.840.1.113762.1.4.1111.171)

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.

Value Set Description from VSAC
Clinical Focus: The purpose of this value set is to represent concepts for conditions used to identify sickle cell disease with and without crisis.
Data Element Scope: This value set may use the data element Diagnosis/Condition.
Inclusion Criteria: Includes concepts that represent a conditions for sickle cell disease.
Exclusion Criteria: Excludes hemoglobin diseases not identified as sickle cell.

Constrained to codes in the Sickle Cell Disease with and without Crisis value set (2.16.840.1.113762.1.4.1111.175)

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.

Value Set Description from VSAC
Clinical Focus: The purpose of this value set is to represent concepts for encounters in the emergency department (ED).
Data Element Scope: This value set may use a model element related to Encounter.
Inclusion Criteria: Includes concepts that represent an encounter ocurring in the emergency department (ED).
Exclusion Criteria: Excludes concepts that represent services not performed in the emergency department, including critical care and observation services.

Constrained to codes in the Emergency Department Visit value set (2.16.840.1.113883.3.117.1.7.1.292)

QDM Datatype and Definition

"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 5.6 addresses that concept using the diagnosis rank=1.

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: The purpose of this value set is to represent concepts of inpatient hospitalization encounters.
Data Element Scope: This value set may use a model element related to Encounter.
Inclusion Criteria: Includes concepts that represent an encounter for inpatient hospitalizations.
Exclusion Criteria: No exclusions.

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

QDM Datatype and Definition

"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 5.6 addresses that concept using the diagnosis rank=1.

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: The purpose of this value set is to represent concepts for encounters for observation.
Data Element Scope: This value set may use a model element related to Encounter.
Inclusion Criteria: Includes concepts that represent an encounter for observation in the inpatient or outpatient setting.
Exclusion Criteria: No exclusions.

Constrained to codes in the Observation Services value set (2.16.840.1.113762.1.4.1111.143)

QDM Datatype and Definition

"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 5.6 addresses that concept using the diagnosis rank=1.

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: The purpose of this value set is to represent concepts of an intervention or procedure to identify patients receiving palliative, comfort or hospice care.
Data Element Scope: This value set may use a model element related to Intervention or Procedure.
Inclusion Criteria: Includes concepts that identify an intervention or procedure for palliative, comfort or hospice care.
Exclusion Criteria: No exclusions.

Constrained to codes in the Palliative or Hospice Care value set (2.16.840.1.113883.3.600.1.1579)

QDM Datatype and Definition

"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: The purpose of this value set is to group concepts that indicate an opioid medication assisted treatment (MAT).
Data Element Scope: This value set may use a model element related to intervention.
Inclusion Criteria: Includes concepts that represent interventions for opioid use disorder treatment.
Exclusion Criteria: No exclusions.

Constrained to codes in the Opioid Medication Assisted Treatment (MAT) value set (2.16.840.1.113762.1.4.1111.177)

QDM Datatype and Definition

"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: The purpose of this value set is to represent concepts of an intervention or procedure to identify patients receiving palliative, comfort or hospice care.
Data Element Scope: This value set may use a model element related to Intervention or Procedure.
Inclusion Criteria: Includes concepts that identify an intervention or procedure for palliative, comfort or hospice care.
Exclusion Criteria: No exclusions.

Constrained to codes in the Palliative or Hospice Care value set (2.16.840.1.113883.3.600.1.1579)

QDM Datatype and Definition

"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: The purpose of this value set is to group concepts that represent medications for opioid use disorders.
Data Element Scope: This value set may use a model element related to medication.
Inclusion Criteria: Includes concepts that represent medications used for opioid use disorders.
Exclusion Criteria: No exclusions.

Constrained to codes in the Medications for Opioid Use Disorder (MOUD) value set (2.16.840.1.113762.1.4.1046.269)

QDM Datatype and Definition

"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.

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.
Value Set Description from VSAC
Clinical Focus: The purpose of this value set is to group Schedules II, III and IV opioid medications.
Data Element Scope: This value set may use a model element related to Medication.
Inclusion Criteria: Includes concepts that identify medications of Schedules II, III and IV opioid medications.
Exclusion Criteria: Excludes concepts that represent schedule I and V, unscheduled, nonprescribable, non-human, and inactive opioid medications.

Constrained to codes in the Schedule II, III and IV Opioid Medications value set (2.16.840.1.113762.1.4.1046.241)

QDM Datatype and Definition

"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.

Note: the QDM "Medication, Discharge" datatype includes the supply attribute since some EHRs populate some medications on the medications discharge list provided to the patient from prescriptions written at discharge. Therefore, such newly prescribed medications may include the supply prescribed. Other medications on the discharge medication list will not have supply information since they represent medications for which the patient already has a supply at home or those the patient may purchase without prescription (i.e., over-the-counter). Thus, measure developers need to address data availability and feasibility when using the supply attribute with "Medication, Discharge".

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

The "Medication, Discharge" QDM datatype includes two performers or actors - prescriber and recorder. The list of medications a patient should take after hospital discharge may come from two sources. The first source originates from medications ordered from a community pharmacy directly from the clinical software (e.g., eprescribing). That source will include the prescriber. The second method of providing content for the discharge medication list is via entry of medications known to be present in the home or over-the-counter substances, neither of which result in a prescription. The individual entering these latter medications is the recorder. Hence, content in the discharge medication list may include both performers.

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: The purpose of this value set is to represent concepts for medications that are Schedule IV benzodiazepine medication.
Data Element Scope: This value set may use a model element related to Medication.
Inclusion Criteria: Includes concepts that identify a medication for benzodiazepines.
Exclusion Criteria: No exclusions.

Constrained to codes in the Schedule IV Benzodiazepines value set (2.16.840.1.113762.1.4.1125.1)

QDM Datatype and Definition

"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.

Note: the QDM "Medication, Discharge" datatype includes the supply attribute since some EHRs populate some medications on the medications discharge list provided to the patient from prescriptions written at discharge. Therefore, such newly prescribed medications may include the supply prescribed. Other medications on the discharge medication list will not have supply information since they represent medications for which the patient already has a supply at home or those the patient may purchase without prescription (i.e., over-the-counter). Thus, measure developers need to address data availability and feasibility when using the supply attribute with "Medication, Discharge".

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

The "Medication, Discharge" QDM datatype includes two performers or actors - prescriber and recorder. The list of medications a patient should take after hospital discharge may come from two sources. The first source originates from medications ordered from a community pharmacy directly from the clinical software (e.g., eprescribing). That source will include the prescriber. The second method of providing content for the discharge medication list is via entry of medications known to be present in the home or over-the-counter substances, neither of which result in a prescription. The individual entering these latter medications is the recorder. Hence, content in the discharge medication list may include both performers.

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: The purpose of this value set is to group concepts that represent medications for opioid use disorders.
Data Element Scope: This value set may use a model element related to medication.
Inclusion Criteria: Includes concepts that represent medications used for opioid use disorders.
Exclusion Criteria: No exclusions.

Constrained to codes in the Medications for Opioid Use Disorder (MOUD) value set (2.16.840.1.113762.1.4.1046.269)

QDM Datatype and Definition

"Medication, Order"

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

Timing:

  • relevantPeriod addresses the time referenced in the dosage instruction indicating when the medication administration should start and end.
  • author dateTime references the date and time the medication order (prescription) is authored.

Notes:

  • The medication order (prescription) is unlikely to indicate a relevantPeriod, the time period for which the ordered supply is to be administered/taken including all refills. Therefore, to determine the number of days covered by a single dispensing event, use the daysSupplied attribute and the relevant dateTime of the event to determine when the ordered medication will run out. If daysSupplied is not available, derive it from the supply (quantity of medication ordered) divided by the dosage (amount of medication to be taken at a single administration) times the frequency (number of units per time period – e.g., per day):
    daysSupplied = supply / (dosage x frequency)
    And multiply the daysSupplied per dispensing event multiplied by one plus the number of refills to determine the total daysSupplied ordered.
    daysSupplied x (1 + #refills)
    Starting with the relevant dateTime add the total daysSupplied (including refills) to determine when the ordered medication quantity will run out.
  • 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.

Refer to Special Cases in Section 4.1.16 for scenarios to consider in calculating cumulative medication duration.

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 Ethnicity value set (2.16.840.1.114222.4.11.837)

QDM Datatype and Definition

"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 payer 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 Payer Type value set (2.16.840.1.114222.4.11.3591)

QDM Datatype and Definition

"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 Race value set (2.16.840.1.114222.4.11.836)

QDM Datatype and Definition

"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 ONC Administrative Sex value set (2.16.840.1.113762.1.4.1)

QDM Datatype and Definition

"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.