eCQM Title

Chlamydia Screening for Women

eCQM Identifier (Measure Authoring Tool)

153

eCQM Version Number

10.0.000

NQF Number

Not Applicable

GUID

c9930664-be3d-4ffe-ae4a-5cf4933ecb89

Measurement Period

January 1, 20XX through December 31, 20XX

Measure Steward

National Committee for Quality Assurance

Measure Developer

National Committee for Quality Assurance

Endorsed By

None

Description

Percentage of women 16-24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement period

This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2020 National Committee for Quality Assurance. All Rights Reserved.

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2020 American Medical Association. LOINC(R) copyright 2004-2020 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2020 International Health Terminology Standards Development Organisation. ICD-10 copyright 2020 World Health Organization. All Rights Reserved.

Disclaimer

The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.
 
Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Measure Scoring

Proportion

Measure Type

Process

Stratification

Report a total score, and each of the following strata:
Stratum 1: Patients age 16-20 
Stratum 2: Patients age 21-24

Risk Adjustment

None

Rate Aggregation

None

Rationale

Chlamydia trachomatis is the most common sexually transmitted bacterial infection in the U.S., resulting in roughly 1.7 million cases (Centers for Disease Control and Prevention, 2019). Chlamydia infections are often asymptomatic, but, if left untreated, can lead to serious and irreversible complications (U.S. Preventive Services Task Force, 2014; Centers for Disease Control and Prevention, 2019). 

Women are particularly vulnerable when infected with chlamydia. Left untreated, chlamydia can cause pelvic inflammatory disease (PID), which can lead to chronic pelvic pain or infertility. Pregnant women may also transmit the infection to their infant, potentially resulting in neonatal pneumonia (Centers for Disease Control and Prevention, 2019).

Clinical Recommendation Statement

U.S. Preventive Services Task Force (2014) recommends screening for chlamydia in sexually active females aged 24 years or younger and in older women who are at increased risk for infection (B recommendation)

Improvement Notation

Higher score indicates better quality

Reference

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention (CDC). (2019). Sexually Transmitted Disease Surveillance 2018. Atlanta: U.S. Department of Health and Human Services.'

Reference

Reference Type: CITATION

Reference Text: 'LeFevre, M. L., & U.S. Preventive Services Task Force. (2014). Screening for Chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 161(12), 902–910. https://doi.org/10.7326/M14-1981'

Definition

None

Guidance

Codes to identify sexually active women include codes for: pregnancy, sexually transmitted infections, contraceptives or contraceptive devices, and infertility treatments.

The denominator exclusion does not apply to patients who qualify for the initial population (IP) based on services other than the pregnancy test alone. These other services include services for sexually transmitted infections, contraceptives or contraceptive devices and infertility treatments. For example, a patient who has both a pregnancy test and a chlamydia diagnosis, either of which would qualify them for the IP, would not be eligible for this denominator exclusion.

Patient self-report for procedures as well as diagnostic studies should be recorded in 'Procedure, Performed' template or 'Diagnostic Study, Performed' template in QRDA-1. Patient self-report is not allowed for laboratory tests.

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

Transmission Format

TBD

Initial Population

Women 16 to 24 years of age who are sexually active and who had a visit in the measurement period

Denominator

Equals Initial Population

Denominator Exclusions

Women who are only eligible for the initial population due to a pregnancy test and who had an order for an x-ray or for a specified medication within 7 days of the pregnancy test.

Exclude patients who are in hospice care for any part of the measurement period.

Numerator

Women with at least one chlamydia test during the measurement period

Numerator Exclusions

Not Applicable

Denominator Exceptions

None

Supplemental Data Elements

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Population Criteria
Definitions
Functions
Terminology
Data Criteria (QDM Data Elements)
Supplemental Data Elements
Risk Adjustment Variables

Population Criteria

Initial Population

exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
    where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) in Interval[16, 24 )
)
  and exists ( ["Patient Characteristic Sex": "Female"] )
  and exists ( "Qualifying Encounters" )
  and ( exists ( "Assessments Identifying Sexual Activity" )
      or exists ( "Diagnoses Identifying Sexual Activity" )
      or exists ( "Active Contraceptive Medications" )
      or exists ( "Ordered Contraceptive Medications" )
      or exists ( "Laboratory Tests Identifying Sexual Activity" )
      or exists ( "Diagnostic Studies Identifying Sexual Activity" )
      or exists ( "Procedures Identifying Sexual Activity" )
  )

- Denominator
  - "Initial Population"

Denominator Exclusions

Hospice."Has Hospice"
  or ( exists ( "Pregnancy Test Exclusion" )
      and not exists ( "Diagnoses Identifying Sexual Activity" )
      and not exists ( "Active Contraceptive Medications" )
      and not exists ( "Laboratory Tests Identifying Sexual Activity But Not Pregnancy" )
      and not exists ( "Procedures Identifying Sexual Activity" )
      and not exists ( "Assessments Identifying Sexual Activity" )
      and not exists ( "Ordered Contraceptive Medications" )
      and not exists ( "Diagnostic Studies Identifying Sexual Activity" )
  )

Numerator

exists ( ["Laboratory Test, Performed": "Chlamydia Screening"] ChlamydiaTest
    where Global."LatestOf" ( ChlamydiaTest.relevantDatetime, ChlamydiaTest.relevantPeriod ) during "Measurement Period"
      and ChlamydiaTest.result is not null
)

- Numerator Exclusions
  - None

- Denominator Exceptions
  - None

Stratification 1

exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
    where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) in Interval[16, 21 )
)

Stratification 2

exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
    where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) in Interval[21, 24 )
)

Definitions

Active Contraceptive Medications

["Medication, Active": "Contraceptive Medications"] ActiveContraceptives
  where ActiveContraceptives.relevantPeriod overlaps "Measurement Period"

Assessments Identifying Sexual Activity

( ["Assessment, Performed": "Sexually Active"] SexualActivityAssessment
    where SexualActivityAssessment.result ~ "Yes (qualifier value)"
      and Global."NormalizeInterval" ( SexualActivityAssessment.relevantDatetime, SexualActivityAssessment.relevantPeriod ) before 
      end of "Measurement Period"
)

Denominator
- - "Initial Population"

Denominator Exclusions

Hospice."Has Hospice"
  or ( exists ( "Pregnancy Test Exclusion" )
      and not exists ( "Diagnoses Identifying Sexual Activity" )
      and not exists ( "Active Contraceptive Medications" )
      and not exists ( "Laboratory Tests Identifying Sexual Activity But Not Pregnancy" )
      and not exists ( "Procedures Identifying Sexual Activity" )
      and not exists ( "Assessments Identifying Sexual Activity" )
      and not exists ( "Ordered Contraceptive Medications" )
      and not exists ( "Diagnostic Studies Identifying Sexual Activity" )
  )

Diagnoses Identifying Sexual Activity

( ( ["Diagnosis": "Diagnoses Used to Indicate Sexual Activity"]
    union ["Diagnosis": "HIV"]
    union ["Diagnosis": "Complications of Pregnancy, Childbirth and the Puerperium"] ) SexualActivityDiagnosis
    where SexualActivityDiagnosis.prevalencePeriod overlaps "Measurement Period"
)

Diagnostic Studies Identifying Sexual Activity

["Diagnostic Study, Order": "Diagnostic Studies During Pregnancy"] SexualActivityDiagnostics
  where SexualActivityDiagnostics.authorDatetime during "Measurement Period"

Hospice.Has Hospice

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"
  )

Initial Population

exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
    where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) in Interval[16, 24 )
)
  and exists ( ["Patient Characteristic Sex": "Female"] )
  and exists ( "Qualifying Encounters" )
  and ( exists ( "Assessments Identifying Sexual Activity" )
      or exists ( "Diagnoses Identifying Sexual Activity" )
      or exists ( "Active Contraceptive Medications" )
      or exists ( "Ordered Contraceptive Medications" )
      or exists ( "Laboratory Tests Identifying Sexual Activity" )
      or exists ( "Diagnostic Studies Identifying Sexual Activity" )
      or exists ( "Procedures Identifying Sexual Activity" )
  )

Laboratory Tests Identifying Sexual Activity

( ["Laboratory Test, Order": "Pregnancy Test"]
  union "Laboratory Tests Identifying Sexual Activity But Not Pregnancy" ) AllLabOrders
  where AllLabOrders.authorDatetime during "Measurement Period"

Laboratory Tests Identifying Sexual Activity But Not Pregnancy

( ["Laboratory Test, Order": "Pap Test"]
  union ["Laboratory Test, Order": "Lab Tests During Pregnancy"]
  union ["Laboratory Test, Order": "Lab Tests for Sexually Transmitted Infections"] ) LabOrders
  where LabOrders.authorDatetime during "Measurement Period"

Numerator

exists ( ["Laboratory Test, Performed": "Chlamydia Screening"] ChlamydiaTest
    where Global."LatestOf" ( ChlamydiaTest.relevantDatetime, ChlamydiaTest.relevantPeriod ) during "Measurement Period"
      and ChlamydiaTest.result is not null
)

Ordered Contraceptive Medications

["Medication, Order": "Contraceptive Medications"] OrderedContraceptives
  where OrderedContraceptives.authorDatetime during "Measurement Period"

Pregnancy Test Exclusion

( ["Laboratory Test, Order": "Pregnancy Test"] PregnancyTest
    with ["Diagnostic Study, Order": "X-Ray Study (all inclusive)"] XrayOrder
      such that XrayOrder.authorDatetime occurs 7 days or less on or after day of PregnancyTest.authorDatetime
    where PregnancyTest.authorDatetime during "Measurement Period"
)
  union ( ["Laboratory Test, Order": "Pregnancy Test"] PregnancyTestOrder
      with ["Medication, Order": "Isotretinoin"] AccutaneOrder
        such that AccutaneOrder.authorDatetime occurs 7 days or less on or after day of PregnancyTestOrder.authorDatetime
      where PregnancyTestOrder.authorDatetime during "Measurement Period"
  )

Procedures Identifying Sexual Activity

["Procedure, Performed": "Procedures Used to Indicate Sexual Activity"] ProceduresForSexualActivity
  where Global."NormalizeInterval" ( ProceduresForSexualActivity.relevantDatetime, ProceduresForSexualActivity.relevantPeriod ) during "Measurement Period"

Qualifying Encounters

( ["Encounter, Performed": "Office 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": "Preventive Care Services, Initial Office Visit, 0 to 17"]
  union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"]
  union ["Encounter, Performed": "Home Healthcare Services"]
  union ["Encounter, Performed": "Telephone Visits"]
  union ["Encounter, Performed": "Online Assessments"] ) ValidEncounter
  where ValidEncounter.relevantPeriod during "Measurement Period"

SDE Ethnicity

["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

["Patient Characteristic Payer": "Payer"]

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

SDE Sex

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

Stratification 1

exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
    where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) in Interval[16, 21 )
)

Stratification 2

exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
    where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) in Interval[21, 24 )
)

Functions

Global.CalendarAgeInYearsAt(BirthDateTime DateTime, AsOf DateTime)
- - years between ToDate(BirthDateTime)and ToDate(AsOf)

Global.HasEnd(period Interval<DateTime>)

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

Global.Latest(period Interval<DateTime>)

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

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

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>

Global.ToDate(Value DateTime)

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

Terminology

code "Birth date" ("LOINC Code (21112-8)")
code "Discharge to healthcare facility for hospice care (procedure)" ("SNOMEDCT Code (428371000124100)")
code "Discharge to home for hospice care (procedure)" ("SNOMEDCT Code (428361000124107)")
code "Yes (qualifier value)" ("SNOMEDCT Code (373066001)")
valueset "Chlamydia Screening" (2.16.840.1.113883.3.464.1003.110.12.1052)
valueset "Complications of Pregnancy, Childbirth and the Puerperium" (2.16.840.1.113883.3.464.1003.111.12.1012)
valueset "Contraceptive Medications" (2.16.840.1.113883.3.464.1003.196.12.1080)
valueset "Diagnoses Used to Indicate Sexual Activity" (2.16.840.1.113883.3.464.1003.111.12.1018)
valueset "Diagnostic Studies During Pregnancy" (2.16.840.1.113883.3.464.1003.111.12.1008)
valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
valueset "Female" (2.16.840.1.113883.3.560.100.2)
valueset "HIV" (2.16.840.1.113883.3.464.1003.120.12.1003)
valueset "Home Healthcare Services" (2.16.840.1.113883.3.464.1003.101.12.1016)
valueset "Hospice care ambulatory" (2.16.840.1.113762.1.4.1108.15)
valueset "Isotretinoin" (2.16.840.1.113883.3.464.1003.196.12.1143)
valueset "Lab Tests During Pregnancy" (2.16.840.1.113883.3.464.1003.111.12.1007)
valueset "Lab Tests for Sexually Transmitted Infections" (2.16.840.1.113883.3.464.1003.110.12.1051)
valueset "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001)
valueset "ONC Administrative Sex" (2.16.840.1.113762.1.4.1)
valueset "Online Assessments" (2.16.840.1.113883.3.464.1003.101.12.1089)
valueset "Pap Test" (2.16.840.1.113883.3.464.1003.108.12.1017)
valueset "Payer" (2.16.840.1.114222.4.11.3591)
valueset "Pregnancy Test" (2.16.840.1.113883.3.464.1003.111.12.1011)
valueset "Preventive Care Services - Established Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1025)
valueset "Preventive Care Services, Initial Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1022)
valueset "Preventive Care Services-Initial Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1023)
valueset "Preventive Care, Established Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1024)
valueset "Procedures Used to Indicate Sexual Activity" (2.16.840.1.113883.3.464.1003.111.12.1017)
valueset "Race" (2.16.840.1.114222.4.11.836)
valueset "Sexually Active" (2.16.840.1.113883.3.464.1003.121.12.1040)
valueset "Telephone Visits" (2.16.840.1.113883.3.464.1003.101.12.1080)
valueset "X-Ray Study (all inclusive)" (2.16.840.1.113883.3.464.1003.198.12.1034)

Data Criteria (QDM Data Elements)

"Assessment, Performed: Sexually Active" using "Sexually Active (2.16.840.1.113883.3.464.1003.121.12.1040)"
"Diagnosis: Complications of Pregnancy, Childbirth and the Puerperium" using "Complications of Pregnancy, Childbirth and the Puerperium (2.16.840.1.113883.3.464.1003.111.12.1012)"
"Diagnosis: Diagnoses Used to Indicate Sexual Activity" using "Diagnoses Used to Indicate Sexual Activity (2.16.840.1.113883.3.464.1003.111.12.1018)"
"Diagnosis: HIV" using "HIV (2.16.840.1.113883.3.464.1003.120.12.1003)"
"Diagnostic Study, Order: Diagnostic Studies During Pregnancy" using "Diagnostic Studies During Pregnancy (2.16.840.1.113883.3.464.1003.111.12.1008)"
"Diagnostic Study, Order: X-Ray Study (all inclusive)" using "X-Ray Study (all inclusive) (2.16.840.1.113883.3.464.1003.198.12.1034)"
"Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
"Encounter, Performed: Home Healthcare Services" using "Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016)"
"Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)"
"Encounter, Performed: Online Assessments" using "Online Assessments (2.16.840.1.113883.3.464.1003.101.12.1089)"
"Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up" using "Preventive Care Services - Established Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1025)"
"Encounter, Performed: Preventive Care Services, Initial Office Visit, 0 to 17" using "Preventive Care Services, Initial Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1022)"
"Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up" using "Preventive Care Services-Initial Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1023)"
"Encounter, Performed: Preventive Care, Established Office Visit, 0 to 17" using "Preventive Care, Established Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1024)"
"Encounter, Performed: Telephone Visits" using "Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080)"
"Intervention, Order: Hospice care ambulatory" using "Hospice care ambulatory (2.16.840.1.113762.1.4.1108.15)"
"Intervention, Performed: Hospice care ambulatory" using "Hospice care ambulatory (2.16.840.1.113762.1.4.1108.15)"
"Laboratory Test, Order: Lab Tests During Pregnancy" using "Lab Tests During Pregnancy (2.16.840.1.113883.3.464.1003.111.12.1007)"
"Laboratory Test, Order: Lab Tests for Sexually Transmitted Infections" using "Lab Tests for Sexually Transmitted Infections (2.16.840.1.113883.3.464.1003.110.12.1051)"
"Laboratory Test, Order: Pap Test" using "Pap Test (2.16.840.1.113883.3.464.1003.108.12.1017)"
"Laboratory Test, Order: Pregnancy Test" using "Pregnancy Test (2.16.840.1.113883.3.464.1003.111.12.1011)"
"Laboratory Test, Performed: Chlamydia Screening" using "Chlamydia Screening (2.16.840.1.113883.3.464.1003.110.12.1052)"
"Medication, Active: Contraceptive Medications" using "Contraceptive Medications (2.16.840.1.113883.3.464.1003.196.12.1080)"
"Medication, Order: Contraceptive Medications" using "Contraceptive Medications (2.16.840.1.113883.3.464.1003.196.12.1080)"
"Medication, Order: Isotretinoin" using "Isotretinoin (2.16.840.1.113883.3.464.1003.196.12.1143)"
"Patient Characteristic Birthdate: Birth date" using "Birth date (LOINC Code 21112-8)"
"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
"Patient Characteristic Payer: Payer" using "Payer (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: Female" using "Female (2.16.840.1.113883.3.560.100.2)"
"Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex (2.16.840.1.113762.1.4.1)"
"Procedure, Performed: Procedures Used to Indicate Sexual Activity" using "Procedures Used to Indicate Sexual Activity (2.16.840.1.113883.3.464.1003.111.12.1017)"

Supplemental Data Elements

SDE Ethnicity

["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

["Patient Characteristic Payer": "Payer"]

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

SDE Sex

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

Risk Adjustment Variables

None

Measure Set

None