Follow-Up Care for Children Prescribed ADHD Medication (ADD)

CMD."CumulativeDuration" ( "ADHD Medications Taken on IPSD or During Continuation and Maintenance Phase" )

( ( ["Medication, Order": "Atomoxetine"]
  union ["Medication, Order": "Clonidine"]
  union ["Medication, Order": "Dexmethylphenidate"]
  union ["Medication, Order": "Dextroamphetamine"]
  union ["Medication, Order": "Lisdexamfetamine"]
  union ["Medication, Order": "methamphetamine hydrochloride 5 MG Oral Tablet"]
  union ["Medication, Order": "Methylphenidate"]
  union ["Medication, Order": "Guanfacine Medications"] ) ADHDMedications
  where Coalesce(ADHDMedications.relevantPeriod.low, ADHDMedications.authorDatetime) during "Intake Period" ) ADHDMedicationOrder
  without ( ["Medication, Active": "Atomoxetine"]
    union ["Medication, Active": "Clonidine"]
    union ["Medication, Active": "Dexmethylphenidate"]
    union ["Medication, Active": "Dextroamphetamine"]
    union ["Medication, Active": "Lisdexamfetamine"]
    union ["Medication, Active": "methamphetamine hydrochloride 5 MG Oral Tablet"]
    union ["Medication, Active": "Methylphenidate"]
    union ["Medication, Active": "Guanfacine Medications"] ) ActiveADHDMedication
    such that Global."ToDateInterval" ( Global."NormalizeInterval" ( ActiveADHDMedication.relevantDatetime, ActiveADHDMedication.relevantPeriod ) ) overlaps Interval[date from Coalesce(ADHDMedicationOrder.relevantPeriod.low, ADHDMedicationOrder.authorDatetime) - 120 days, date from Coalesce(ADHDMedicationOrder.relevantPeriod.low, ADHDMedicationOrder.authorDatetime) )
  sort by Coalesce(relevantPeriod.low, authorDatetime) asc

( ( CMD."RolloutIntervals" ( ( ["Medication, Order": "Atomoxetine"] AtomoxetineMed
      return all {
        period: CMD."MedicationOrderPeriod" ( AtomoxetineMed ),
        periodStart: start of CMD."MedicationOrderPeriod" ( AtomoxetineMed )
      }
      sort by periodStart
  ).period )
)
  union ( CMD."RolloutIntervals" ( ( ["Medication, Order": "Clonidine"] ClonidineMed
        return all {
          period: CMD."MedicationOrderPeriod" ( ClonidineMed ),
          periodStart: start of CMD."MedicationOrderPeriod" ( ClonidineMed )
        }
        sort by periodStart
    ).period )
  )
  union ( CMD."RolloutIntervals" ( ( ["Medication, Order": "Dexmethylphenidate"] DexmethylphenidateMed
        return all {
          period: CMD."MedicationOrderPeriod" ( DexmethylphenidateMed ),
          periodStart: start of CMD."MedicationOrderPeriod" ( DexmethylphenidateMed )
        }
        sort by periodStart
    ).period )
  )
  union ( CMD."RolloutIntervals" ( ( ["Medication, Order": "Dextroamphetamine"] DextroamphetamineMed
        return all {
          period: CMD."MedicationOrderPeriod" ( DextroamphetamineMed ),
          periodStart: start of CMD."MedicationOrderPeriod" ( DextroamphetamineMed )
        }
        sort by periodStart
    ).period )
  )
  union ( CMD."RolloutIntervals" ( ( ["Medication, Order": "Lisdexamfetamine"] LisdexamfetamineMed
        return all {
          period: CMD."MedicationOrderPeriod" ( LisdexamfetamineMed ),
          periodStart: start of CMD."MedicationOrderPeriod" ( LisdexamfetamineMed )
        }
        sort by periodStart
    ).period )
  )
  union ( CMD."RolloutIntervals" ( ( ["Medication, Order": "Methylphenidate"] MethylphenidateMed
        return all {
          period: CMD."MedicationOrderPeriod" ( MethylphenidateMed ),
          periodStart: start of CMD."MedicationOrderPeriod" ( MethylphenidateMed )
        }
        sort by periodStart
    ).period )
  )
  union ( CMD."RolloutIntervals" ( ( ["Medication, Order": "Guanfacine Medications"] GuanfacineMed
        return all {
          period: CMD."MedicationOrderPeriod" ( GuanfacineMed ),
          periodStart: start of CMD."MedicationOrderPeriod" ( GuanfacineMed )
        }
        sort by periodStart
    ).period )
  )
  union ( CMD."RolloutIntervals" ( ( ["Medication, Order": "methamphetamine hydrochloride 5 MG Oral Tablet"] MethamphetamineMed
        return all {
          period: CMD."MedicationOrderPeriod" ( MethamphetamineMed ),
          periodStart: start of CMD."MedicationOrderPeriod" ( MethamphetamineMed )
        }
        sort by periodStart
    ).period )
  ) ) ADHDMedication
  let IPSDAndContinuationMaintenancePhase: Interval["IPSD", "IPSD" + 300 days]
  return all ADHDMedication
    intersect IPSDAndContinuationMaintenancePhase

"Initial Population 1"

"Initial Population 2"

Hospice."Has Hospice Services"
  or exists ( "Narcolepsy Exclusion" )

"Qualifying Numerator Encounter" ValidNumeratorEncounter
  where Global."ToDateInterval" ( ValidNumeratorEncounter.relevantPeriod ) starts during day of Interval["IPSD" + 31 days, "IPSD" + 300 days]
  return date from start of ValidNumeratorEncounter.relevantPeriod

"Qualifying Numerator Encounter" ValidNumeratorEncounter
  where Global."ToDateInterval" ( ValidNumeratorEncounter.relevantPeriod ) starts 30 days or less after day of "IPSD"

First("ADHD Medication Prescribed During Intake Period and Not Previously on ADHD Medication")

"ADHD Cumulative Medication Duration" >= 210

exists ( ["Encounter, Performed": "Encounter Inpatient"] InpatientEncounter
    where ( InpatientEncounter.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
        or InpatientEncounter.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
    )
      and InpatientEncounter.relevantPeriod ends during day of "Measurement Period"
)
  or exists ( ["Encounter, Performed": "Hospice Encounter"] HospiceEncounter
      where HospiceEncounter.relevantPeriod overlaps day of "Measurement Period"
  )
  or exists ( ["Assessment, Performed": "Hospice care [Minimum Data Set]"] HospiceAssessment
      where HospiceAssessment.result ~ "Yes (qualifier value)"
        and Global."NormalizeInterval" ( HospiceAssessment.relevantDatetime, HospiceAssessment.relevantPeriod ) overlaps day of "Measurement Period"
  )
  or exists ( ["Intervention, Order": "Hospice Care Ambulatory"] HospiceOrder
      where HospiceOrder.authorDatetime during day of "Measurement Period"
  )
  or exists ( ["Intervention, Performed": "Hospice Care Ambulatory"] HospicePerformed
      where Global."NormalizeInterval" ( HospicePerformed.relevantDatetime, HospicePerformed.relevantPeriod ) overlaps day of "Measurement Period"
  )
or exists ( ["Diagnosis": "Hospice Diagnosis"] HospiceCareDiagnosis
      where HospiceCareDiagnosis.prevalencePeriod overlaps day of "Measurement Period"
  )

AgeInYearsAt(date from start of "Intake Period") >= 6
  and AgeInYearsAt(date from 
    end of "Intake Period"
  ) <= 12
  and exists "Qualifying Encounter"
  and "First ADHD Medication Prescribed During Intake Period" is not null
  and not exists "Inpatient Stay with Qualifying Diagnosis During Initiation Phase"

AgeInYearsAt(date from start of "Intake Period") >= 6
  and AgeInYearsAt(date from 
    end of "Intake Period"
  ) <= 12
  and exists "Qualifying Encounter"
  and "First ADHD Medication Prescribed During Intake Period" is not null
  and "Has ADHD Cumulative Medication Duration Greater Than or Equal to 210 Days"
  and not exists "Inpatient Stay with Qualifying Diagnosis During Continuation and Maintenance Phase"

( ["Encounter, Performed": "Encounter Inpatient"] InpatientStay
    where exists ( InpatientStay.diagnoses EncounterDiagnoses
        where ( EncounterDiagnoses.rank = 1
            and EncounterDiagnoses.code in "Mental Behavioral and Neurodevelopmental Disorders"
        )
    )
)

"Inpatient Stay with Qualifying Diagnosis" InpatientStay
  where Global."ToDateInterval" ( InpatientStay.relevantPeriod ) starts 300 days or less after day of "IPSD"

"Inpatient Stay with Qualifying Diagnosis" InpatientStay
  where Global."ToDateInterval" ( InpatientStay.relevantPeriod ) starts 30 days or less after day of "IPSD"

Interval["March 1 of Year Prior to Measurement Period", "Last Calendar Day of February of Measurement Period"]

date from Coalesce("First ADHD Medication Prescribed During Intake Period".relevantPeriod.low, "First ADHD Medication Prescribed During Intake Period".authorDatetime)

( DateTime(year from start of "Measurement Period", 3, 1, 23, 59, 59, 0, 0) ) - 1 day

DateTime((year from start of "Measurement Period" - 1), 3, 1, 0, 0, 0, 0, 0)

["Diagnosis": "Narcolepsy"] Narcolepsy
  where Narcolepsy.prevalencePeriod starts on or before end "Measurement Period"

exists ( "Encounter During Initiation Phase" )

exists ( "Encounter During Initiation Phase" )
  and ( ( "Two or More Encounters 31 to 300 Days into Continuation and Maintenance Phase" )
      or ( exists ( "Encounter 31 to 300 Days into Continuation and Maintenance Phase" Encounter1
            with "Virtual Encounter 31 to 300 Days into Continuation and Maintenance Phase" Encounter2
              such that Encounter1 is not null
                and Encounter2 is not null
                and Encounter1 !~ Encounter2
        )
      )
  )

( ["Encounter, Performed": "Office Visit"]
  union ["Encounter, Performed": "Home Healthcare Services"]
  union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"]
  union ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"] ) ValidEncounters
  where Global."ToDateInterval" ( ValidEncounters.relevantPeriod ) during day of Interval["IPSD" - 6 months, "IPSD"]

( ["Encounter, Performed": "Office Visit"]
    union ["Encounter, Performed": "Preventive Care Services Group Counseling"]
    union ["Encounter, Performed": "Behavioral Health Follow up Visit"]
    union ["Encounter, Performed": "Preventive Care Services Individual Counseling"]
    union ( ["Encounter, Performed": "Psychotherapy and Pharmacologic Management"] PsychPharmManagement
        where exists ( PsychPharmManagement.facilityLocations Location
            where Location.code in "Ambulatory"
        )
    )
    union ["Encounter, Performed": "Outpatient Consultation"]
    union ["Encounter, Performed": "Home Healthcare Services"]
    union ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"]
    union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"]
    union ["Encounter, Performed": "Psych Visit Diagnostic Evaluation"]
    union ["Encounter, Performed": "Psych Visit Psychotherapy"]
    union ["Encounter, Performed": "Telephone Visits"]
)

["Patient Characteristic Ethnicity": "Ethnicity"]

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

["Patient Characteristic Race": "Race"]

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

Count("Encounter 31 to 300 Days into Continuation and Maintenance Phase") >= 2

["Encounter, Performed": "Virtual Encounter"] VirtualEnc
  where Global."ToDateInterval" ( VirtualEnc.relevantPeriod ) starts during day of Interval["IPSD" + 31 days, "IPSD" + 300 days]
  return date from start of VirtualEnc.relevantPeriod

case
  when Frequency ~ "Once daily (qualifier value)" then 1.0
  when Frequency ~ "Twice a day (qualifier value)" then 2.0
  when Frequency ~ "Three times daily (qualifier value)" then 3.0
  when Frequency ~ "Four times daily (qualifier value)" then 4.0
  when Frequency ~ "Every twenty four hours (qualifier value)" then 1.0
  when Frequency ~ "Every twelve hours (qualifier value)" then 2.0
  when Frequency ~ "Every thirty six hours (qualifier value)" then 0.67
  when Frequency ~ "Every eight hours (qualifier value)" then 3.0
  when Frequency ~ "Every four hours (qualifier value)" then 6.0
  when Frequency ~ "Every six hours (qualifier value)" then 4.0
  when Frequency ~ "Every seventy two hours (qualifier value)" then 0.33
  when Frequency ~ "Every forty eight hours (qualifier value)" then 0.5
  when Frequency ~ "Every eight to twelve hours (qualifier value)" then 3.0
  when Frequency ~ "Every six to eight hours (qualifier value)" then 4.0
  when Frequency ~ "Every three to four hours (qualifier value)" then 8.0
  when Frequency ~ "Every three to six hours (qualifier value)" then 8.0
  when Frequency ~ "Every two to four hours (qualifier value)" then 12.0
  when Frequency ~ "One to four times a day (qualifier value)" then 4.0
  when Frequency ~ "One to three times a day (qualifier value)" then 3.0
  when Frequency ~ "One to two times a day (qualifier value)" then 2.0
  when Frequency ~ "Two to four times a day (qualifier value)" then 4.0
  else null
end

if Intervals is not null then ( Sum((collapse Intervals per day)X
      return all(difference in days between start of X and 
        end of X
      )+ 1
  )
) 
  else null

MedOrder Order
  let startDate: date from Coalesce(Order.relevantPeriod.low, Order.authorDatetime),
  totalDaysSupplied: Coalesce(Order.daysSupplied, Order.supply.value /(Order.dosage.value * ToDaily(Order.frequency))) * ( 1 + Coalesce(Order.refills, 0) )
  return if startDate is null then null 
    else if totalDaysSupplied is not null then Interval[startDate, startDate + Quantity { value: totalDaysSupplied - 1, unit: 'day' }]
    else if Order.relevantPeriod.high is not null then Interval[startDate, date from end of Order.relevantPeriod]
    else null

case Frequency.unit
    when 'h' then (24.0 / Frequency.value)
    when 'min' then (24.0 / Frequency.value) * 60
    when 's' then (24.0 / Frequency.value) * 60 * 60
    when 'd' then (24.0 / Frequency.value) / 24
    when 'wk' then (24.0 / Frequency.value) / (24 * 7)
    when 'mo' then (24.0 / Frequency.value) / (24 * 30) /* assuming 30 days in month */
    when 'a' then (24.0 / Frequency.value) / (24 * 365) /* assuming 365 days in year */
    when 'hour' then (24.0 / Frequency.value)
    when 'minute' then (24.0 / Frequency.value) * 60
    when 'second' then (24.0 / Frequency.value) * 60 * 60
    when 'day' then (24.0 / Frequency.value) / 24
    when 'week' then (24.0 / Frequency.value) / (24 * 7)
    when 'month' then (24.0 / Frequency.value) / (24 * 30) /* assuming 30 days in month */
    when 'year' then (24.0 / Frequency.value) / (24 * 365) /* assuming 365 days in year */
    when 'hours' then (24.0 / Frequency.value)
    when 'minutes' then (24.0 / Frequency.value) * 60
    when 'seconds' then (24.0 / Frequency.value) * 60 * 60
    when 'days' then (24.0 / Frequency.value) / 24
    when 'weeks' then (24.0 / Frequency.value) / (24 * 7)
    when 'months' then (24.0 / Frequency.value) / (24 * 30) /* assuming 30 days in month */
    when 'years' then (24.0 / Frequency.value) / (24 * 365) /* assuming 365 days in year */
    else null
  end

intervals I aggregate all R starting ( null as List<Interval<Date>>): R
  union ( { I X
      let S: Max({ 
        end of Last(R)+ 1 day, start of X }
      ),
      E: S + Quantity { value: Coalesce(duration in days of X, 0), unit: 'day' }
      return Interval[S, E]}
  )

case
  when Frequency is Quantity then QuantityToDaily(Frequency as Quantity)
  else CodeToDaily(Frequency as Code)
end

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

Interval[date from start of period, date from end of period]