Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)

( ["Encounter, Performed": "Office Visit"]
  union ["Encounter, Performed": "Annual Wellness Visit"]
  union ["Encounter, Performed": "Preventive Care Services - Established Office Visit, 18 and Up"]
  union ["Encounter, Performed": "Preventive Care Services-Initial Office Visit, 18 and Up"]
  union ["Encounter, Performed": "Home Healthcare Services"] ) ValidEncounter
  where ValidEncounter.relevantPeriod during "Measurement Period"

exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
    where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 65
      and "Has Criteria Indicating Frailty"
      and ( exists "Two Outpatient Encounters with Advanced Illness on Different Dates of Service"
          or exists ( "Inpatient Encounter with Advanced Illness" )
          or exists "Dementia Medications In Year Before or During Measurement Period"
      )
)

["Medication, Active": "Dementia Medications"] DementiaMed
	where Global."NormalizeInterval"(DementiaMed.relevantDatetime, DementiaMed.relevantPeriod) overlaps Interval[( start of "Measurement Period" - 1 year ), 
	end of "Measurement Period"]

exists ( ["Device, Order": "Frailty Device"] FrailtyDeviceOrder
    where FrailtyDeviceOrder.authorDatetime during "Measurement Period"
)
  or exists ( ["Device, Applied": "Frailty Device"] FrailtyDeviceApplied
      where Global."NormalizeInterval" ( FrailtyDeviceApplied.relevantDatetime, FrailtyDeviceApplied.relevantPeriod ) overlaps "Measurement Period"
  )
  or exists ( ["Diagnosis": "Frailty Diagnosis"] FrailtyDiagnosis
      where FrailtyDiagnosis.prevalencePeriod overlaps "Measurement Period"
  )
  or exists ( ["Encounter, Performed": "Frailty Encounter"] FrailtyEncounter
      where FrailtyEncounter.relevantPeriod overlaps "Measurement Period"
  )
  or exists ( ["Symptom": "Frailty Symptom"] FrailtySymptom
      where FrailtySymptom.prevalencePeriod overlaps "Measurement Period"
  )

"Max Long Term Care Period Length" > 90

["Encounter, Performed": "Acute Inpatient"] InpatientEncounter
  where exists ( InpatientEncounter.diagnoses Diagnosis
      where Diagnosis.code in "Advanced Illness"
  )
    and InpatientEncounter.relevantPeriod starts 2 years or less on or before 
    end of "Measurement Period"

from 
"Long Term Care Overlapping Periods" LTCPeriod1,
"Long Term Care Overlapping Periods" LTCPeriod2
where end of LTCPeriod1 within 1 day of start of LTCPeriod2
return Interval[start of LTCPeriod1, end of LTCPeriod2]

collapse("Long Term Care Periods During Measurement Period")

( ["Encounter, Performed": "Care Services in Long-Term Residential Facility"]
  union ["Encounter, Performed": "Nursing Facility Visit"] ) LongTermFacilityEncounter
  where LongTermFacilityEncounter.relevantPeriod overlaps "Measurement Period"
  return LongTermFacilityEncounter.relevantPeriod
    intersect "Measurement Period"

Max((collapse("Long Term Care Overlapping Periods"
      union "Long Term Care Adjacent Periods"
  ))LTCPeriods
    return duration in days of LTCPeriods
)

( ["Encounter, Performed": "Outpatient"]
  union ["Encounter, Performed": "Observation"]
  union ["Encounter, Performed": "Emergency Department Visit"]
  union ["Encounter, Performed": "Nonacute Inpatient"] ) OutpatientEncounter
  where exists ( OutpatientEncounter.diagnoses Diagnosis
      where Diagnosis.code in "Advanced Illness"
  )
    and OutpatientEncounter.relevantPeriod starts 2 years or less on or before 
    end of "Measurement Period"

from
  "Outpatient Encounters with Advanced Illness" OutpatientEncounter1,
  "Outpatient Encounters with Advanced Illness" OutpatientEncounter2
  where OutpatientEncounter2.relevantPeriod ends 1 day or more after day of 
  end of OutpatientEncounter1.relevantPeriod
  return OutpatientEncounter1

"Initial Population"

Hospice."Has Hospice"
  or FrailtyLTI."Advanced Illness and Frailty Exclusion Not Including Over Age 80"
  or ( exists ["Patient Characteristic Birthdate": "Birth date"] BirthDate
      where ( Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 65 )
        and FrailtyLTI."Has Long Term Care Periods Longer Than 90 Consecutive Days"
        or PalliativeCare."Palliative Care in the Measurement Period"
  )

"Most Recent HbA1c".result > 9 '%'

"Most Recent HbA1c" is not null
  and "Most Recent HbA1c".result is null

not exists ( ["Laboratory Test, Performed": "HbA1c Laboratory Test"] NoHbA1c
    where Global."LatestOf" ( NoHbA1c.relevantDatetime, NoHbA1c.relevantPeriod ) during "Measurement Period"
)

exists ( ["Encounter, Performed": "Encounter Inpatient"] DischargeHospice
    where ( DischargeHospice.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
        or DischargeHospice.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
    )
      and DischargeHospice.relevantPeriod ends during "Measurement Period"
)
  or exists ( ["Intervention, Order": "Hospice care ambulatory"] HospiceOrder
      where HospiceOrder.authorDatetime during "Measurement Period"
  )
  or exists ( ["Intervention, Performed": "Hospice care ambulatory"] HospicePerformed
      where Global."NormalizeInterval" ( HospicePerformed.relevantDatetime, HospicePerformed.relevantPeriod ) overlaps "Measurement Period"
  )

exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
    where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) in Interval[18, 75 )
)
  and exists ( AdultOutpatientEncounters."Qualifying Encounters"
      union "Telehealth Services"
  )
  and exists ( ["Diagnosis": "Diabetes"] Diabetes
      where Diabetes.prevalencePeriod overlaps "Measurement Period"
  )

Last(["Laboratory Test, Performed": "HbA1c Laboratory Test"] RecentHbA1c
    where Global."LatestOf"(RecentHbA1c.relevantDatetime, RecentHbA1c.relevantPeriod)during "Measurement Period"
    sort by start of Global."NormalizeInterval"(relevantDatetime, relevantPeriod)
)

"Has Most Recent HbA1c Without Result"
  or "Has Most Recent Elevated HbA1c"
  or "Has No Record Of HbA1c"

exists ( ["Assessment, Performed": "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"] PalliativeAssessment
    where Global."NormalizeInterval"(PalliativeAssessment.relevantDatetime, PalliativeAssessment.relevantPeriod) overlaps "Measurement Period"
)
  or exists ( ["Encounter, Performed": "Palliative Care Encounter"] PalliativeEncounter
      where PalliativeEncounter.relevantPeriod overlaps "Measurement Period"
  )
  or exists ( ["Intervention, Performed": "Palliative Care Intervention"] PalliativeIntervention
      where Global."NormalizeInterval"(PalliativeIntervention.relevantDatetime, PalliativeIntervention.relevantPeriod) overlaps "Measurement Period"
  )

["Patient Characteristic Ethnicity": "Ethnicity"]

["Patient Characteristic Payer": "Payer"]

["Patient Characteristic Race": "Race"]

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

["Encounter, Performed": "Telephone Visits"] TelehealthEncounter
  where TelehealthEncounter.relevantPeriod during "Measurement Period"

years between ToDate(BirthDateTime)and ToDate(AsOf)

not ( 
  end of period is null
    or 
    end of period = maximum DateTime
)

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

Latest(NormalizeInterval(pointInTime, period))

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

DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezoneoffset from Value)