Severe Obstetric Complications 3.0.000

Patients with severe obstetric complications that occur during the inpatient delivery hospitalization

Measure specifications are in the Public Domain.

LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2023 World Health Organization. All Rights Reserved.

These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.

This measure will be stratified by race/ethnicity and payer after measure submission

The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov).
Pre-existing conditions and variables must be present on admission. Please note that present on admission codes may be extracted from billing/claims data that was entered by coding staff (Leonard, Kennedy, Carmichael, Lyell, & Main, 2020; Main, Leonard, & Menard, 2020).
- Anemia (includes sickle cell disease)
- Asthma 
- Autoimmune Disease
- Bariatric Surgery
- Bleeding Disorder
- Cardiac Disease
- Economic Housing Instability
- Gastrointestinal Disease 
- Gestational Diabetes
- HIV
- Hypertension
- Long-term Anticoagulant Use
- Maternal Age (derived from birthdate)
- Mental Health Disorder
- Morbid Obesity
- Multiple Pregnancy	
- Neuromuscular Disease
- Obstetric VTE
- Other Pre-eclampsia
- Placenta Previa
- Placental Abruption
- Placental Accreta Spectrum
- Pre-existing Diabetes 
- Preterm Birth
- Previous Cesarean 
- Pulmonary Hypertension
- Renal Disease 
- Severe Pre-eclampsia
- Substance Abuse
- Thyrotoxicosis 

Lab and Physical Exam Results:
Report the first resulted value 24 hours prior to start of encounter and before time of delivery in UCUM units specified:
- Heart rate: {beats}/min
- Systolic blood pressure: mm[Hg]
- Hematocrit: %
- White blood cell count: 10*3/uL 


Note regarding submission of risk variable data: The risk variable definitions are included in the specifications and risk variable data should be sent with eCQM data in the QRDA1 file. Specific risk variable templates are not needed in the QRDA1 files.

Two hospital-level measure scores are calculated as a risk-adjusted proportion reported as a rate per 10,000 delivery hospitalizations:

1. All Severe Obstetric Complications (SOC).
     ((Num1 – NumExcl) / (Den-DenExcl)) * 10,000

2. SOC excluding encounters where transfusion was the only SOC.
     ((Num2 – NumExcl) / (Den-DenExcl)) * 10,000

Num1: Number of delivery encounters with SOC
Num2: Number of delivery encounters with SOC excluding encounters where transfusion was the only SOC
NumExcl: Delivery encounters with blood transfusion or hysterectomy with Placenta Percreta or Placenta Increta
Den: Delivery encounters with > or = 20 weeks gestation completed
DenExcl: Delivery encounters for patients with a COVID diagnosis and COVID-related respiratory condition or a COVID diagnosis and COVID-related respiratory procedure

The United States (US) experiences higher rates of maternal morbidity and mortality than most other developed countries. These rates have continued to trend upward in recent decades (CDC, 2021). Research indicates that the overall rate of severe maternal morbidity (SMM) increased by almost 200% between 1993 and 2014 to 144 per 10,000 delivery hospitalizations (CDC, 2021), with more than 25,000 women per year experiencing obstetric complications (U.S. Department of Health and Human Services, 2020). Recent maternal mortality data from 2018 reveal that 658 women in the US died from maternal causes, resulting in a rate of 17.4 deaths per 100,000 live births, with 77% of the deaths attributed to direct obstetric causes like hemorrhage, preeclampsia, obstetric embolism, and other complications (Hoyert & Minino, 2018). 144 per 10,000 women hospitalized for delivery have experienced SMM, including hemorrhage, embolism, hypertension, stroke, and other serious complications (CDC, 2021). Racial and ethnic disparities exist: Black women and Hispanic women are at a significantly higher risk for developing these complications than are Non-Hispanic White women (Leonard, Main, Scott, Profit, & Carmichael, 2019). Increasing rates of SMM are resulting in increased healthcare costs, longer hospitalization stays and impacts on a woman's health (Callaghan, Creanga, & Kuklina, 2012).

There is limited national evaluation of hospitals' performance on maternal morbidity and mortality although SMM is widely used at the population level. SMM is linked to maternal mortality, varies significantly among hospitals, and has significant racial/ethnic and urban/rural disparities. SMM is a cost driver for both Medicaid and commercial plans. This measure is important as it will assist in the discovery and understanding of SMM patterns that can lead to improvements in the safety and quality of maternal care necessary to reduce SMM rates.

Healthy People 2030 Measure (MICH-05): Reduce severe maternal complications identified during delivery hospitalizations (U.S. Department of Health and Human Services, n.d.).

The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine recommend identifying potential cases of severe maternal morbidity for further review, with a focus on outcomes and complications, and consider this an important step toward promoting safe obstetric care (American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine, Kilpatrick, & Ecker, 2016).

Improvement noted as a decrease in the rate

Reference Type: CITATION

Reference Text: 'American College of Obstetricians and Gynecologists. (2014). Revitalize: Obstetrics Data Definitions Version 1.0. American College of Obstetricians and Gynecologists. Revitalize: Obstetrics Data Definitions Version 1.0 - Search (bing.com)'

Reference Type: CITATION

Reference Text: 'American College of Obstetricians and Gynecologists, & Society for Maternal-Fetal Medicine. (2018). Obstetric Care Consensus No. 7: Placenta Accreta Spectrum. Obstetrics & Gynecology, 132(6), e259–e275. https://doi.org/10.1097/AOG.0000000000002983'

Reference Type: CITATION

Reference Text: 'American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine, Kilpatrick, S. K., & Ecker, J. L. (2016). Severe Maternal Morbidity: Screening and review. American Journal of Obstetrics and Gynecology, 215(3), B17–B22. https://doi.org/10.1016/j.ajog.2016.07.050'

Reference Type: CITATION

Reference Text: 'Callaghan, W. M., Creanga, A. A., & Kuklina, E. V. (2012). Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstetrics and Gynecology, 120(5), 1029–1036. https://doi.org/10.1097/aog.0b013e31826d60c5'

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention. (2021, February 2). Severe maternal morbidity in the United States. Division of Reproductive Health. Retrieved December 14, 2022, from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html'

Reference Type: CITATION

Reference Text: 'Hoyert, D. L., & Minino, A. M. (2020). Maternal Mortality in the United States: Changes in coding, publication, and data release, 2018. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 69(2), 1–18.'

Reference Type: CITATION

Reference Text: 'Leonard, S. A., Kennedy, C. J., Carmichael, S. L., Lyell, D. J., & Main, E. K. (2020). An expanded obstetric comorbidity scoring system for predicting severe maternal morbidity. Obstetrics and Gynecology, 136(3), 440–449. https://doi.org/10.1097/AOG.0000000000004022'

Reference Type: CITATION

Reference Text: 'Leonard, S. A., Main, E. K., & Carmichael, S. L. (2019). The contribution of maternal characteristics and cesarean delivery to an increasing trend of severe maternal morbidity. BMC Pregnancy and Childbirth, 19(1), 16. https://doi.org/10.1186/s12884-018-2169-3'

Reference Type: CITATION

Reference Text: 'Leonard, S. A., Main, E. K., Scott, K. A., Profit, J., & Carmichael, S. L. (2019). Racial and ethnic disparities in severe maternal morbidity prevalence and trends. Annals of Epidemiology, 33, 30–36. https://doi.org/10.1016/j.annepidem.2019.02.007'

Reference Type: CITATION

Reference Text: 'Main, E. K., Leonard, S. A., & Menard, M. K. (2020). Association of Maternal Comorbidity with Severe Maternal Morbidity: A cohort study of California mothers delivering between 1997 and 2014. Annals of Internal Medicine, 173(11 Suppl), S11–S18. https://doi.org/10.7326/M19-3253'

Reference Type: CITATION

Reference Text: 'U.S. Department of Health and Human Services. (n.d.). Reduce severe maternal complications identified during delivery hospitalizations - MICH 05. Retrieved December 14, 2022, from https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/reduce-severe-maternal-complications-identified-during-delivery-hospitalizations-mich-05'

Reference Type: CITATION

Reference Text: 'U.S. Department of Health and Human Services. (2020). The Surgeon General's Call to Action to Improve Maternal Health. Retrieved December 15, 2022, from https://www.hhs.gov/sites/default/files/call-to-action-maternal-health.pdf'

For this measure, specifications are modeled after the nationally available and adopted CDC definition for Severe Maternal Morbidity (SMM) with the addition of maternal mortality. At times, we may refer to the CDC indicators of morbidity as SMM, but the outcome of the measure, which includes morbidity and mortality, is referred to as Severe Obstetric Complications (SOC).

In the case of multiple births, map the first delivery date/time (Baby A) as the delivery date/time for the encounter.

This measure allows for 3 approaches to determine gestational age (GA) in the following order of precedence:

1. The GA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.*
2. The GA is obtained from a discrete field in the electronic health record. This option is only used when the calculated GA is not available.
3. The GA is based on ICD10 or SNOMED codes indicative of weeks gestation. This option is only used when results from items #1 and #2 (see above) are not available.

Wherever gestational age is mentioned, relative to the delivery, the intent is to capture the last estimated gestational age prior to or at the time of delivery.

*ACOG ReVITALize Guidelines for Calculating Gestational Age (ACOG, 2014):

Gestational Age = (280-(Estimated Due Date minus Reference Date))/7

--Estimated Due Date (EDD): The best obstetrical EDD is determined by last menstrual period if confirmed by early ultrasound or no ultrasound performed, or early ultrasound if no known last menstrual period or the ultrasound is not consistent with last menstrual period, or known date of fertilization (e.g., assisted reproductive technology)
--Reference Date is the date on which you are trying to determine gestational age. For purposes of this eCQM, Reference Date would be the Date of Delivery.

Note however the calculation may yield a non-whole number and gestational age should be rounded down to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

Inpatient hospitalizations for patients age >= 8 years and < 65 admitted to the hospital for inpatient acute care who undergo a delivery procedure with a discharge date that ends during the measurement period

Inpatient hospitalizations for patients delivering stillborn or live birth with >= 20 weeks, 0 days gestation completed

Inpatient hospitalizations for patients with confirmed diagnosis of COVID with COVID-related respiratory condition or patients with confirmed diagnosis of COVID with COVID-related respiratory procedure during the encounter

Two numerator populations are defined for this measure:

1. All Severe Obstetric Complications (SOC).
2. SOC excluding encounters where transfusion was the only SOC.

Inpatient hospitalizations for patients with severe obstetric complications (not present on admission that occur during the current delivery encounter) including the following: 
- Severe maternal morbidity diagnoses (see list below)
- Severe maternal morbidity procedures (see list below)
- Discharge disposition of expired
Please note that present on admission codes may be extracted from billing/claims data that was entered by coding staff.

Severe Maternal Morbidity Diagnoses:
- Cardiac
	          Acute heart failure 
	          Acute myocardial infarction
	          Aortic aneurysm
	          Cardiac arrest/ventricular fibrillation
	          Heart failure/arrest during procedure or surgery
- Hemorrhage
	          Disseminated intravascular coagulation
	          Shock
- Renal
                  Acute renal failure
- Respiratory
	          Adult respiratory distress syndrome
	          Pulmonary edema
- Sepsis
- Other OB
	          Air and thrombotic embolism
	          Amniotic fluid embolism
	          Eclampsia
	          Severe anesthesia complications
- Other Medical
	          Puerperal cerebrovascular disorder
	          Sickle cell disease with crisis


Severe Maternal Morbidity Procedures:
- Blood transfusion
- Conversion of cardiac rhythm
- Hysterectomy
- Temporary tracheostomy
- Ventilation

Inpatient hospitalizations with blood transfusion or hysterectomy with a diagnosis of placenta percreta or placenta increta and no additional severe obstetrical complications.

For every patient evaluated by this measure also identify payer, race, ethnicity, sex, variable calculated gestational age, SOC diagnosis details, and SOC procedure details

Population Criteria 1

Initial Population

PCMaternal."Delivery Encounter with Age Range"

Denominator

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation"

Denominator Exclusions

"Delivery Encounters with COVID and Respiratory Condition or Procedure"

Numerator

"Delivery Encounters with Severe Obstetric Complications"

Numerator Exclusions

"SOC with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC"

- Denominator Exceptions
  - None
- Stratification
  - None

Population Criteria 2

Initial Population

PCMaternal."Delivery Encounter with Age Range"

Denominator

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation"

Denominator Exclusions

"Delivery Encounters with COVID and Respiratory Condition or Procedure"

Numerator

"Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only"

Numerator Exclusions

"SOC Excluding Blood Transfusions Only with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC"

- Denominator Exceptions
  - None
- Stratification
  - None

Cardiac Conversion, Tracheostomy or Ventilation Procedures

["Procedure, Performed": "Conversion of Cardiac Rhythm"]
  union ["Procedure, Performed": "Tracheostomy"]
  union ["Procedure, Performed": "Ventilation"]

Delivery Encounters At Greater than or Equal to 20 Weeks Gestation

"Delivery Encounters with Calculated Gestational Age Greater than or Equal to 20 Weeks"
  union "Delivery Encounters with Estimated Gestational Age Assessment Greater than or Equal to 20 Weeks"
  union "Delivery Encounters with Gestational Age Greater than or Equal to 20 Weeks Based on Coding"

Delivery Encounters with Blood Transfusion

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  with ["Procedure, Performed": "Blood Transfusion"] BloodTransfusion
    such that Global."NormalizeInterval" ( BloodTransfusion.relevantDatetime, BloodTransfusion.relevantPeriod ) starts during day of PCMaternal."HospitalizationWithEDOBTriageObservation" ( TwentyWeeksPlusEncounter )

Delivery Encounters with Calculated Gestational Age Greater than or Equal to 20 Weeks

PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
  where PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ) >= 20

Delivery Encounters with Cardiac Conversion, Tracheostomy or Ventilation Procedures

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  with "Cardiac Conversion, Tracheostomy or Ventilation Procedures" ConvTrachVentProcedures
    such that Global."NormalizeInterval" ( ConvTrachVentProcedures.relevantDatetime, ConvTrachVentProcedures.relevantPeriod ) starts during day of PCMaternal."HospitalizationWithEDOBTriageObservation" ( TwentyWeeksPlusEncounter )

Delivery Encounters with COVID and Respiratory Condition or Procedure

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
      where EncounterDiagnoses.code in "COVID 19 Confirmed"
  )
    and ( exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
          where EncounterDiagnoses.code in "Respiratory Conditions Related to COVID 19"
            or exists ( ["Procedure, Performed": "Respiratory Support Procedures Related to COVID 19"] COVIDRespiratoryProcedure
                where Global."NormalizeInterval" ( COVIDRespiratoryProcedure.relevantDatetime, COVIDRespiratoryProcedure.relevantPeriod ) starts during day of PCMaternal."HospitalizationWithEDOBTriageObservation" ( TwentyWeeksPlusEncounter )
            )
      )
    )

Delivery Encounters with Estimated Gestational Age Assessment Greater than or Equal to 20 Weeks

PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
  where PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ) is null
    and ( PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter ) >= 20 weeks )

Delivery Encounters with Expiration

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where TwentyWeeksPlusEncounter.dischargeDisposition in "Patient Expired"

Delivery Encounters with Gestational Age Greater than or Equal to 20 Weeks Based on Coding

PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
  let CGA: PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ),
  EGA: PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter )
  where CGA is null
    and EGA is null
    and exists ( DeliveryEncounter.diagnoses EncounterDiagnoses
        where EncounterDiagnoses.code in "20 to 42 Plus Weeks Gestation"
    )

Delivery Encounters with Hysterectomy

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  with ["Procedure, Performed": "Hysterectomy"] Hysterectomy
    such that Global."NormalizeInterval" ( Hysterectomy.relevantDatetime, Hysterectomy.relevantPeriod ) starts during day of PCMaternal."HospitalizationWithEDOBTriageObservation" ( TwentyWeeksPlusEncounter )

Delivery Encounters with Severe Obstetric Complications

"Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion"
  union "Delivery Encounters with Expiration"
  union "Delivery Encounters with Blood Transfusion"

Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsNoOrUTD"(TwentyWeeksPlusEncounter).code in "Severe Maternal Morbidity Diagnoses"
    or exists ( ["Procedure, Performed": "Severe Maternal Morbidity Procedures"] SMMProcedures
        where Global."NormalizeInterval" ( SMMProcedures.relevantDatetime, SMMProcedures.relevantPeriod ) starts during day of PCMaternal."HospitalizationWithEDOBTriageObservation" ( TwentyWeeksPlusEncounter )
    )

Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions

"Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion"
  union "Delivery Encounters with Expiration"

Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only

"Delivery Encounters with Severe Obstetric Complications"
  intersect "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions"

Denominator

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation"

Denominator Exclusion

"Delivery Encounters with COVID and Respiratory Condition or Procedure"

Initial Population

PCMaternal."Delivery Encounter with Age Range"

Global.Inpatient Encounter

["Encounter, Performed": "Encounter Inpatient"] EncounterInpatient
  where EncounterInpatient.relevantPeriod ends during day of "Measurement Period"

Numerator 1 Delivery Encounters with Severe Obstetric Complications
- - "Delivery Encounters with Severe Obstetric Complications"

Numerator 2 Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only
- - "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only"

Numerator Exclusion 1 SOC with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC
- - "SOC with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC"

Numerator Exclusion 2 SOC Excluding Blood Transfusions Only with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC
- - "SOC Excluding Blood Transfusions Only with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC"

PCMaternal.Delivery Encounter with Age Range

"Encounter with Age Range" EncounterWithAge
  with ["Procedure, Performed": "Delivery Procedures"] DeliveryProcedure
    such that Global."NormalizeInterval" ( DeliveryProcedure.relevantDatetime, DeliveryProcedure.relevantPeriod ) starts during "HospitalizationWithEDOBTriageObservation"(EncounterWithAge)

PCMaternal.Encounter with Age Range

Global."Inpatient Encounter" InpatientEncounter
  where AgeInYearsAt(date from start of InpatientEncounter.relevantPeriod) >= 8
    and AgeInYearsAt(date from start of InpatientEncounter.relevantPeriod) < 65

PCMaternal.Variable Calculated Gestational Age

//This definition establishes a variable of CGA (Calculated Gestational Age).  CGA is a supplemental data element to store the calculated gestational age result from the "CalculatedGestationalAge" function.  The data element enables the capturing and saving of the CGA for data analysis post data receipt. Hospitals do not need to submit any additional data to comply with this definition.  

"Delivery Encounter with Age Range" DeliveryEncounter
  let CGA: "CalculatedGestationalAge"(DeliveryEncounter)
  return { DeliveryEncounter, CGA }

Risk Variable Anemia

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Anemia"

Risk Variable Asthma

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Acute or Persistent Asthma"

Risk Variable Autoimmune Disease

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Autoimmune Disease"

Risk Variable Bariatric Surgery

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Bariatric Surgery"

Risk Variable Bleeding Disorder

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Bleeding Disorder"

Risk Variable Cardiac Disease

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Cardiac Disease"

Risk Variable Economic Housing Instability

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Economic Housing Instability"

Risk Variable Gastrointestinal Disease

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Gastrointestinal Disease"

Risk Variable Gestational Diabetes

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Gestational Diabetes"

Risk Variable HIV

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "HIV in Pregnancy Childbirth and Puerperium"

Risk Variable Hypertension

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Hypertension"

Risk Variable Lab and Physical Exam Results

{
// First physical exams:  Report heart rate as {beats}/min, systolic blood pressure as mm[Hg]
  
  FirstHeartRate: "FirstPhysicalExamWithEncounterId"(["Physical Exam, Performed": "Heart rate"]),
  FirstSystolicBloodPressure: "FirstPhysicalExamWithEncounterId"(["Physical Exam, Performed": "Systolic blood pressure"]),
// First lab tests:  Report hematocrit as %, white blood cell count as 10*3/uL
  
  FirstHematocritLab: "FirstLabTestWithEncounterId"(["Laboratory Test, Performed": "Hematocrit Lab Test"]),
  FirstWhiteBloodCellCount: "FirstLabTestWithEncounterId"(["Laboratory Test, Performed": "White Blood Cells Count Lab Test"])
}

Risk Variable Long Term Anticoagulant Use

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Long Term Anticoagulant Use"

Risk Variable Maternal Age

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  let MaternalAge: AgeInYearsAt(date from start of TwentyWeeksPlusEncounter.relevantPeriod)
  return { TwentyWeeksPlusEncounter, MaternalAge }

Risk Variable Mental Health Disorder

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Mental Health Disorder"

Risk Variable Morbid Obesity

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Morbid or Severe Obesity"

Risk Variable Multiple Pregnancy

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Multiple Pregnancy"

Risk Variable Neuromuscular

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Neuromuscular Disease"

Risk Variable Obstetrical VTE

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Venous Thromboembolism in Pregnancy"

Risk Variable Other Preeclampsia

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Mild or Moderate Preeclampsia"

Risk Variable Placenta Previa

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Placenta Previa"

Risk Variable Placental Abruption

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Placental Abruption"

Risk Variable Placental Accreta Spectrum

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Placenta Accreta"
    or "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Placenta Increta or Percreta"

Risk Variable Preexisting Diabetes

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Preexisting Diabetes"

Risk Variable Preterm Birth

//CGA = Calculated Gestational Age.  EGA = Estimated Gestational Age.

( PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
    let CGA: PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ),
    EGA: PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter )
    where CGA in Interval[20, 36]
      or ( CGA is null
          and ( EGA >= 20 weeks
              and EGA <= 36 weeks
          )
      )
)
  union ( PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
      let CGA: PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ),
      EGA: PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter )
      where CGA is null
        and EGA is null
        and "POAIsYesOrExempt"(DeliveryEncounter).code in "Preterm Birth"
  )

Risk Variable Previous Cesarean

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Previous Cesarean"

Risk Variable Pulmonary Hypertension

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Pulmonary Hypertension"

Risk Variable Renal Disease

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Renal Disease"

Risk Variable Severe Preeclampsia

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Severe Preeclampsia"

Risk Variable Substance Abuse

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Substance Abuse"

Risk Variable Thyrotoxicosis

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Thyrotoxicosis"

SDE Delivery Encounters with Severe Obstetric Complication Diagnosis

( "Delivery Encounters with Severe Obstetric Complications"
  except "SOC with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC" ) Encounter
  where "POAIsNoOrUTD"(Encounter).code in "Severe Maternal Morbidity Diagnoses"

SDE Delivery Encounters with Severe Obstetric Complication Procedures

( "Delivery Encounters with Severe Obstetric Complications"
  except "SOC with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC" ) Encounter
  where exists ( ["Procedure, Performed": "Severe Maternal Morbidity Procedures"]
    union ["Procedure, Performed": "Blood Transfusion"] ) SMMProcedures
    where Global."NormalizeInterval" ( SMMProcedures.relevantDatetime, SMMProcedures.relevantPeriod ) starts during day of PCMaternal."HospitalizationWithEDOBTriageObservation" ( Encounter )

SDE Ethnicity

["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

["Patient Characteristic Payer": "Payer Type"]

SDE Race
- - ["Patient Characteristic Race": "Race"]

SDE Sex

["Patient Characteristic Sex": "ONC Administrative Sex"]

SDE SOC Diagnoses Detail

"SDE Delivery Encounters with Severe Obstetric Complication Diagnosis" Encounter
  let complication: "POAIsNoOrUTD"(Encounter)
  return {
    id: Encounter.id,
    code: Encounter.code,
    complications: complication C
      where C.code in "Severe Maternal Morbidity Diagnoses"
      return {
        code: C,
        SOCDxCategory: "SOCDxCategory"(C)
      }
  }

SDE SOC Procedure Detail

"SDE Delivery Encounters with Severe Obstetric Complication Procedures" Encounter
  let procedure: "SOCProcedures"(Encounter)
  return {
    id: Encounter.id,
    code: Encounter.code,
    procedures: procedure P
      return {
        code: P,
        SOCProcedureCategory: "SOCProcedureCategory"(P)
      }
  }

SDE Variable Calculated Gestational Age

//This definition establishes a variable of CGA (Calculated Gestational Age).  CGA is a supplemental data element to store the calculated gestational age result from the "CalculatedGestationalAge" function.  The data element enables the capturing and saving of the CGA for data analysis post data receipt. Hospitals do not need to submit any additional data to comply with this definition. 

PCMaternal."Variable Calculated Gestational Age"

SOC Excluding Blood Transfusions Only with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC

( "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only" SOCExcludingTransfusion
    where exists ( SOCExcludingTransfusion.diagnoses EncounterDiagnoses
        where EncounterDiagnoses.code in "Placenta Increta or Percreta"
    )
      and ( exists "Delivery Encounters with Blood Transfusion"
          or exists "Delivery Encounters with Hysterectomy"
      )
)
//The following logic keeps encounter in the numerator if there is an additional SOC besides Blood Transfusion or Hysterectomy
  
  except ( ( "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only" SOCExcludingTransfusion
        where ( "POAIsNoOrUTD"(SOCExcludingTransfusion).code in "Severe Maternal Morbidity Diagnoses" )
    )
      union "Delivery Encounters with Cardiac Conversion, Tracheostomy or Ventilation Procedures"
      union "Delivery Encounters with Expiration"
  )

SOC with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC

( "Delivery Encounters with Severe Obstetric Complications" SOCEncounter
    where exists ( SOCEncounter.diagnoses EncounterDiagnoses
        where EncounterDiagnoses.code in "Placenta Increta or Percreta"
    )
      and ( exists "Delivery Encounters with Blood Transfusion"
          or exists "Delivery Encounters with Hysterectomy"
      )
)
//The following logic keeps encounter in the numerator if there is an additional SOC besides Blood Transfusion or Hysterectomy
  
  except ( ( "Delivery Encounters with Severe Obstetric Complications" SOCEncounter
        where ( "POAIsNoOrUTD"(SOCEncounter).code in "Severe Maternal Morbidity Diagnoses" )
    )
      union "Delivery Encounters with Cardiac Conversion, Tracheostomy or Ventilation Procedures"
      union "Delivery Encounters with Expiration"
  )

FirstLabTestWithEncounterId(LabList List<QDM.PositiveLaboratoryTestPerformed>)

//(first resulted value 24 hours prior to start of encounter and before time of delivery)

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  let FirstLab: First(LabList Lab
      where Lab.result is not null
        and Lab.resultDatetime during Interval[start of PCMaternal."HospitalizationWithEDOBTriageObservation"(TwentyWeeksPlusEncounter) - 1440 minutes, PCMaternal."LastTimeOfDelivery"(TwentyWeeksPlusEncounter))
      sort by resultDatetime
  )
  return {
    EncounterId: TwentyWeeksPlusEncounter.id,
    FirstResult: FirstLab.result as Quantity,
    Timing: FirstLab.resultDatetime
  }

FirstPhysicalExamWithEncounterId(ExamList List<QDM.PositivePhysicalExamPerformed>)

//(first resulted value 24 hours prior to start of encounter and before time of delivery)

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  let FirstExam: First(ExamList Exam
      where Exam.result is not null
        and Global."EarliestOf"(Exam.relevantDatetime, Exam.relevantPeriod) during Interval[start of PCMaternal."HospitalizationWithEDOBTriageObservation"(TwentyWeeksPlusEncounter) - 1440 minutes, PCMaternal."LastTimeOfDelivery"(TwentyWeeksPlusEncounter))
      sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
  )
  return {
    EncounterId: TwentyWeeksPlusEncounter.id,
    FirstResult: FirstExam.result as Quantity,
    Timing: Global."EarliestOf" ( FirstExam.relevantDatetime, FirstExam.relevantPeriod )
  }

Global.Earliest(period Interval<DateTime>)

if ( HasStart(period)) then start of period 
  else 
end of period

Global.EarliestOf(pointInTime DateTime, period Interval<DateTime>)
- - Earliest(NormalizeInterval(pointInTime, period))

Global.HasStart(period Interval<DateTime>)

not ( start of period is null
    or start of period = minimum DateTime
)

Global.NormalizeInterval(pointInTime DateTime, period Interval<DateTime>)

if pointInTime is not null then Interval[pointInTime, pointInTime]
  else if period is not null then period 
  else null as Interval<DateTime>

PCMaternal.CalculatedGestationalAge(Encounter "Encounter, Performed")

// Age = (280-(Estimated Delivery Date minus Reference Date/Delivery Date))/7

( 280 - ( difference in days between "LastTimeOfDelivery"(Encounter) and "LastEstimatedDeliveryDate"(Encounter) ) ) div 7

PCMaternal.HospitalizationWithEDOBTriageObservation(Encounter "Encounter, Performed")

//HospitalizationWithEDOBTriageObservation returns the total interval from the start of any immediately prior emergency department visit or OB Triage visit through the observation visit to the discharge of the given encounter.
Encounter Visit
  let ObsVisit: Last(["Encounter, Performed": "Observation Services"] LastObs
      where LastObs.relevantPeriod ends 1 hour or less on or before start of Visit.relevantPeriod
      sort by 
      end of relevantPeriod
  ),
  VisitStart: Coalesce(start of ObsVisit.relevantPeriod, start of Visit.relevantPeriod),
  EDOBTriageVisit: Last(["Encounter, Performed": "ED Visit and OB Triage"] LastEDOBTriage
      where LastEDOBTriage.relevantPeriod ends 1 hour or less on or before VisitStart
      sort by 
      end of relevantPeriod
  )
  return Interval[Coalesce(start of EDOBTriageVisit.relevantPeriod, VisitStart), 
  end of Visit.relevantPeriod]

PCMaternal.LastEstimatedDeliveryDate(Encounter "Encounter, Performed")

//This function identifies the last time the Estimated Delivery Date was assessed 42 weeks or less prior to or on delivery and stores the result of that assessment.  
Last(["Assessment, Performed": "Delivery date Estimated"] EstimatedDateOfDelivery
    where Global."EarliestOf"(EstimatedDateOfDelivery.relevantDatetime, EstimatedDateOfDelivery.relevantPeriod)42 weeks or less before or on "LastTimeOfDelivery"(Encounter)
      and EstimatedDateOfDelivery.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as DateTime

PCMaternal.LastEstimatedGestationalAge(Encounter "Encounter, Performed")

Last(["Assessment, Performed": "Estimated Gestational Age at Delivery"] EstimatedGestationalAge
    let EGATiming: Global."EarliestOf"(EstimatedGestationalAge.relevantDatetime, EstimatedGestationalAge.relevantPeriod)
    where(EGATiming 24 hours or less before or on "LastTimeOfDelivery"(Encounter)
        and EstimatedGestationalAge.result is not null
    )
      or(EGATiming same day as "LastTimeOfDelivery"(Encounter)
          and EGATiming during "HospitalizationWithEDOBTriageObservation"(Encounter)
          and EstimatedGestationalAge.result is not null
      )
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

PCMaternal.LastTimeOfDelivery(Encounter "Encounter, Performed")

Last(["Assessment, Performed": "Date and time of obstetric delivery"] TimeOfDelivery
    where Global."EarliestOf"(TimeOfDelivery.relevantDatetime, TimeOfDelivery.relevantPeriod)during "HospitalizationWithEDOBTriageObservation"(Encounter)
      and TimeOfDelivery.result as DateTime during "HospitalizationWithEDOBTriageObservation"(Encounter)
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as DateTime

POAIsNoOrUTD(Encounter "Encounter, Performed")

Encounter.diagnoses EncounterDiagnoses
  where EncounterDiagnoses.presentOnAdmissionIndicator in "Present on Admission is No or Unable To Determine"
  return EncounterDiagnoses.code

POAIsYesOrExempt(Encounter "Encounter, Performed")

Encounter.diagnoses EncounterDiagnoses
  where EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
  return EncounterDiagnoses.code

SOCDxCategory(Dx Code)

case
  when Dx.code in "Acute Heart Failure" then 'Acute Heart Failure'
  when Dx.code in "Acute Myocardial Infarction" then 'Acute Myocardial Infarction'
  when Dx.code in "Acute Renal Failure" then 'Acute Renal Failure'
  when Dx.code in "Acute Respiratory Distress Syndrome" then 'Acute Respiratory Distress Syndrome'
  when Dx.code in "Air and Thrombotic Embolism" then 'Air and Thrombotic Embolism'
  when Dx.code in "Amniotic Fluid Embolism" then 'Amniotic Fluid Embolism'
  when Dx.code in "Aortic Aneurysm" then 'Aortic Aneurysm'
  when Dx.code in "Cardiac Arrest Ventricular Fibrillation" then 'Cardiac Arrest Ventricular Fibrillation'
  when Dx.code in "Disseminated Intravascular Coagulation" then 'Disseminated Intravascular Coagulation'
  when Dx.code in "Eclampsia" then 'Eclampsia'
  when Dx.code in "Heart Failure Cardiac Arrest Related to Procedure or Surgery" then 'Heart Failure Cardiac Arrest Related to Procedure or Surgery'
  when Dx.code in "Puerperal Cerebrovascular Disorder" then 'Puerperal Cerebrovascular Disorder'
  when Dx.code in "Pulmonary Edema" then 'Pulmonary Edema'
  when Dx.code in "Sepsis" then 'Sepsis'
  when Dx.code in "Severe Anesthesia Complications" then 'Severe Anesthesia Complications'
  when Dx.code in "Shock" then 'Shock'
  when Dx.code in "Sickle Cell Disease with Crisis" then 'Sickle Cell Disease with Crisis' 
  else null end

SOCProcedureCategory(Procedure "Procedure, Performed")

case
  when Procedure.code in "Blood Transfusion" then 'Blood Transfusion'
  when Procedure.code in "Conversion of Cardiac Rhythm" then 'Conversion of cardiac rhythm'
  when Procedure.code in "Hysterectomy" then 'Hysterectomy'
  when Procedure.code in "Tracheostomy" then 'Tracheostomy'
  when Procedure.code in "Ventilation" then 'Ventilation' 
  else null end

SOCProcedures(Encounter "Encounter, Performed")

( ["Procedure, Performed": "Severe Maternal Morbidity Procedures"]
  union ["Procedure, Performed": "Blood Transfusion"] ) SMMProcedures
  where Global."NormalizeInterval" ( SMMProcedures.relevantDatetime, SMMProcedures.relevantPeriod ) starts during day of PCMaternal."HospitalizationWithEDOBTriageObservation" ( Encounter )

code "Date and time of obstetric delivery" ("LOINC Code (93857-1)")
code "Delivery date Estimated" ("LOINC Code (11778-8)")
code "Heart rate" ("LOINC Code (8867-4)")
code "Systolic blood pressure" ("LOINC Code (8480-6)")
valueset "20 to 42 Plus Weeks Gestation" (2.16.840.1.113762.1.4.1110.67)
valueset "Acute Heart Failure" (2.16.840.1.113762.1.4.1029.233)
valueset "Acute Myocardial Infarction" (2.16.840.1.113883.3.666.5.623)
valueset "Acute or Persistent Asthma" (2.16.840.1.113883.3.117.1.7.1.271)
valueset "Acute Renal Failure" (2.16.840.1.113762.1.4.1110.53)
valueset "Acute Respiratory Distress Syndrome" (2.16.840.1.113762.1.4.1029.214)
valueset "Air and Thrombotic Embolism" (2.16.840.1.113762.1.4.1029.243)
valueset "Amniotic Fluid Embolism" (2.16.840.1.113762.1.4.1029.217)
valueset "Anemia" (2.16.840.1.113762.1.4.1029.323)
valueset "Aortic Aneurysm" (2.16.840.1.113762.1.4.1029.219)
valueset "Autoimmune Disease" (2.16.840.1.113762.1.4.1029.311)
valueset "Bariatric Surgery" (2.16.840.1.113762.1.4.1029.317)
valueset "Bleeding Disorder" (2.16.840.1.113762.1.4.1029.287)
valueset "Blood Transfusion" (2.16.840.1.113762.1.4.1029.213)
valueset "Cardiac Arrest Ventricular Fibrillation" (2.16.840.1.113762.1.4.1029.221)
valueset "Cardiac Disease" (2.16.840.1.113762.1.4.1029.341)
valueset "Conversion of Cardiac Rhythm" (2.16.840.1.113762.1.4.1029.357)
valueset "COVID 19 Confirmed" (2.16.840.1.113762.1.4.1029.373)
valueset "Delivery Procedures" (2.16.840.1.113762.1.4.1045.59)
valueset "Disseminated Intravascular Coagulation" (2.16.840.1.113762.1.4.1029.223)
valueset "Eclampsia" (2.16.840.1.113762.1.4.1029.225)
valueset "Economic Housing Instability" (2.16.840.1.113762.1.4.1029.292)
valueset "ED Visit and OB Triage" (2.16.840.1.113762.1.4.1029.369)
valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
valueset "Estimated Gestational Age at Delivery" (2.16.840.1.113762.1.4.1045.26)
valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
valueset "Gastrointestinal Disease" (2.16.840.1.113762.1.4.1029.338)
valueset "Gestational Diabetes" (2.16.840.1.113762.1.4.1029.269)
valueset "Heart Failure Cardiac Arrest Related to Procedure or Surgery" (2.16.840.1.113762.1.4.1029.227)
valueset "Hematocrit Lab Test" (2.16.840.1.113762.1.4.1045.114)
valueset "HIV in Pregnancy Childbirth and Puerperium" (2.16.840.1.113762.1.4.1029.272)
valueset "Hypertension" (2.16.840.1.113762.1.4.1029.332)
valueset "Hysterectomy" (2.16.840.1.113762.1.4.1029.358)
valueset "Long Term Anticoagulant Use" (2.16.840.1.113762.1.4.1029.366)
valueset "Mental Health Disorder" (2.16.840.1.113762.1.4.1029.314)
valueset "Mild or Moderate Preeclampsia" (2.16.840.1.113762.1.4.1029.329)
valueset "Morbid or Severe Obesity" (2.16.840.1.113762.1.4.1029.290)
valueset "Multiple Pregnancy" (2.16.840.1.113762.1.4.1029.284)
valueset "Neuromuscular Disease" (2.16.840.1.113762.1.4.1029.308)
valueset "Observation Services" (2.16.840.1.113762.1.4.1111.143)
valueset "ONC Administrative Sex" (2.16.840.1.113762.1.4.1)
valueset "Patient Expired" (2.16.840.1.113883.3.117.1.7.1.309)
valueset "Payer Type" (2.16.840.1.114222.4.11.3591)
valueset "Placenta Accreta" (2.16.840.1.113762.1.4.1029.302)
valueset "Placenta Increta or Percreta" (2.16.840.1.113762.1.4.1029.388)
valueset "Placenta Previa" (2.16.840.1.113762.1.4.1110.78)
valueset "Placental Abruption" (2.16.840.1.113762.1.4.1029.305)
valueset "Preexisting Diabetes" (2.16.840.1.113762.1.4.1029.275)
valueset "Present on Admission is No or Unable To Determine" (2.16.840.1.113762.1.4.1029.370)
valueset "Present On Admission is Yes or Exempt" (2.16.840.1.113762.1.4.1110.63)
valueset "Preterm Birth" (2.16.840.1.113762.1.4.1029.299)
valueset "Previous Cesarean" (2.16.840.1.113762.1.4.1029.278)
valueset "Puerperal Cerebrovascular Disorder" (2.16.840.1.113762.1.4.1029.229)
valueset "Pulmonary Edema" (2.16.840.1.113762.1.4.1029.231)
valueset "Pulmonary Hypertension" (2.16.840.1.113762.1.4.1029.281)
valueset "Race" (2.16.840.1.114222.4.11.836)
valueset "Renal Disease" (2.16.840.1.113762.1.4.1029.335)
valueset "Respiratory Conditions Related to COVID 19" (2.16.840.1.113762.1.4.1029.376)
valueset "Respiratory Support Procedures Related to COVID 19" (2.16.840.1.113762.1.4.1029.379)
valueset "Sepsis" (2.16.840.1.113762.1.4.1029.237)
valueset "Severe Anesthesia Complications" (2.16.840.1.113762.1.4.1029.235)
valueset "Severe Maternal Morbidity Diagnoses" (2.16.840.1.113762.1.4.1029.255)
valueset "Severe Maternal Morbidity Procedures" (2.16.840.1.113762.1.4.1029.256)
valueset "Severe Preeclampsia" (2.16.840.1.113762.1.4.1029.327)
valueset "Shock" (2.16.840.1.113762.1.4.1029.239)
valueset "Sickle Cell Disease with Crisis" (2.16.840.1.113762.1.4.1029.241)
valueset "Substance Abuse" (2.16.840.1.113762.1.4.1029.320)
valueset "Thyrotoxicosis" (2.16.840.1.113762.1.4.1029.296)
valueset "Tracheostomy" (2.16.840.1.113762.1.4.1029.359)
valueset "Venous Thromboembolism in Pregnancy" (2.16.840.1.113762.1.4.1029.363)
valueset "Ventilation" (2.16.840.1.113762.1.4.1029.360)
valueset "White Blood Cells Count Lab Test" (2.16.840.1.113762.1.4.1045.129)

"Assessment, Performed: Date and time of obstetric delivery" using "Date and time of obstetric delivery (LOINC Code 93857-1)"
"Assessment, Performed: Delivery date Estimated" using "Delivery date Estimated (LOINC Code 11778-8)"
"Assessment, Performed: Estimated Gestational Age at Delivery" using "Estimated Gestational Age at Delivery (2.16.840.1.113762.1.4.1045.26)"
"Encounter, Performed: ED Visit and OB Triage" using "ED Visit and OB Triage (2.16.840.1.113762.1.4.1029.369)"
"Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
"Encounter, Performed: Observation Services" using "Observation Services (2.16.840.1.113762.1.4.1111.143)"
"Laboratory Test, Performed: Hematocrit Lab Test" using "Hematocrit Lab Test (2.16.840.1.113762.1.4.1045.114)"
"Laboratory Test, Performed: White Blood Cells Count Lab Test" using "White Blood Cells Count Lab Test (2.16.840.1.113762.1.4.1045.129)"
"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
"Patient Characteristic Payer: Payer Type" using "Payer Type (2.16.840.1.114222.4.11.3591)"
"Patient Characteristic Race: Race" using "Race (2.16.840.1.114222.4.11.836)"
"Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex (2.16.840.1.113762.1.4.1)"
"Physical Exam, Performed: Heart rate" using "Heart rate (LOINC Code 8867-4)"
"Physical Exam, Performed: Systolic blood pressure" using "Systolic blood pressure (LOINC Code 8480-6)"
"Procedure, Performed: Blood Transfusion" using "Blood Transfusion (2.16.840.1.113762.1.4.1029.213)"
"Procedure, Performed: Conversion of Cardiac Rhythm" using "Conversion of Cardiac Rhythm (2.16.840.1.113762.1.4.1029.357)"
"Procedure, Performed: Delivery Procedures" using "Delivery Procedures (2.16.840.1.113762.1.4.1045.59)"
"Procedure, Performed: Hysterectomy" using "Hysterectomy (2.16.840.1.113762.1.4.1029.358)"
"Procedure, Performed: Respiratory Support Procedures Related to COVID 19" using "Respiratory Support Procedures Related to COVID 19 (2.16.840.1.113762.1.4.1029.379)"
"Procedure, Performed: Severe Maternal Morbidity Procedures" using "Severe Maternal Morbidity Procedures (2.16.840.1.113762.1.4.1029.256)"
"Procedure, Performed: Tracheostomy" using "Tracheostomy (2.16.840.1.113762.1.4.1029.359)"
"Procedure, Performed: Ventilation" using "Ventilation (2.16.840.1.113762.1.4.1029.360)"

["Patient Characteristic Ethnicity": "Ethnicity"]

"SDE Delivery Encounters with Severe Obstetric Complication Diagnosis" Encounter
  let complication: "POAIsNoOrUTD"(Encounter)
  return {
    id: Encounter.id,
    code: Encounter.code,
    complications: complication C
      where C.code in "Severe Maternal Morbidity Diagnoses"
      return {
        code: C,
        SOCDxCategory: "SOCDxCategory"(C)
      }
  }

"SDE Delivery Encounters with Severe Obstetric Complication Procedures" Encounter
  let procedure: "SOCProcedures"(Encounter)
  return {
    id: Encounter.id,
    code: Encounter.code,
    procedures: procedure P
      return {
        code: P,
        SOCProcedureCategory: "SOCProcedureCategory"(P)
      }
  }

["Patient Characteristic Payer": "Payer Type"]

```
["Patient Characteristic Race": "Race"]
```

["Patient Characteristic Sex": "ONC Administrative Sex"]

//This definition establishes a variable of CGA (Calculated Gestational Age).  CGA is a supplemental data element to store the calculated gestational age result from the "CalculatedGestationalAge" function.  The data element enables the capturing and saving of the CGA for data analysis post data receipt. Hospitals do not need to submit any additional data to comply with this definition. 

PCMaternal."Variable Calculated Gestational Age"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Anemia"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Acute or Persistent Asthma"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Autoimmune Disease"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Bariatric Surgery"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Bleeding Disorder"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Cardiac Disease"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Economic Housing Instability"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Gastrointestinal Disease"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Gestational Diabetes"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "HIV in Pregnancy Childbirth and Puerperium"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Hypertension"

{
// First physical exams:  Report heart rate as {beats}/min, systolic blood pressure as mm[Hg]
  
  FirstHeartRate: "FirstPhysicalExamWithEncounterId"(["Physical Exam, Performed": "Heart rate"]),
  FirstSystolicBloodPressure: "FirstPhysicalExamWithEncounterId"(["Physical Exam, Performed": "Systolic blood pressure"]),
// First lab tests:  Report hematocrit as %, white blood cell count as 10*3/uL
  
  FirstHematocritLab: "FirstLabTestWithEncounterId"(["Laboratory Test, Performed": "Hematocrit Lab Test"]),
  FirstWhiteBloodCellCount: "FirstLabTestWithEncounterId"(["Laboratory Test, Performed": "White Blood Cells Count Lab Test"])
}

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Long Term Anticoagulant Use"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  let MaternalAge: AgeInYearsAt(date from start of TwentyWeeksPlusEncounter.relevantPeriod)
  return { TwentyWeeksPlusEncounter, MaternalAge }

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Mental Health Disorder"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Morbid or Severe Obesity"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Multiple Pregnancy"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Neuromuscular Disease"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Venous Thromboembolism in Pregnancy"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Mild or Moderate Preeclampsia"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Placenta Previa"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Placental Abruption"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Placenta Accreta"
    or "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Placenta Increta or Percreta"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Preexisting Diabetes"

//CGA = Calculated Gestational Age.  EGA = Estimated Gestational Age.

( PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
    let CGA: PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ),
    EGA: PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter )
    where CGA in Interval[20, 36]
      or ( CGA is null
          and ( EGA >= 20 weeks
              and EGA <= 36 weeks
          )
      )
)
  union ( PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
      let CGA: PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ),
      EGA: PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter )
      where CGA is null
        and EGA is null
        and "POAIsYesOrExempt"(DeliveryEncounter).code in "Preterm Birth"
  )

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Previous Cesarean"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Pulmonary Hypertension"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Renal Disease"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Severe Preeclampsia"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Substance Abuse"

"Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
  where "POAIsYesOrExempt"(TwentyWeeksPlusEncounter).code in "Thyrotoxicosis"

Perinatal Care Maternal

Severe Obstetric Complications

Table of Contents

Population Criteria

Definitions

Functions

Terminology

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables