eCQM Title | Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture |
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eCQM Identifier (Measure Authoring Tool) | 249 | eCQM Version number | 2.4.000 |
NQF Number | Not Applicable | GUID | a3ce125d-c238-42ce-862e-dba0055dfc66 |
Measurement Period | January 1, 20XX through December 31, 20XX | ||
Measure Steward | Centers for Medicare & Medicaid Services (CMS) | ||
Measure Developer | National Committee for Quality Assurance | ||
Endorsed By | None | ||
Description | |||
Copyright | |||
Disclaimer | |||
Measure Scoring | Proportion | ||
Measure Type | Process | ||
Stratification | |||
Risk Adjustment | |||
Rate Aggregation | |||
Rationale | |||
Clinical Recommendation Statement | |||
Improvement Notation | |||
Reference | |||
Reference | |||
Reference | |||
Definition | |||
Guidance | |||
Transmission Format | |||
Initial Population | |||
Denominator | |||
Denominator Exclusions | |||
Numerator | |||
Numerator Exclusions | |||
Denominator Exceptions | |||
Supplemental Data Elements |
exists ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global."CalendarAgeInYearsAt"(BirthDate.birthDatetime, start of "Measurement Period")>= 50 and Global."CalendarAgeInYearsAt"(BirthDate.birthDatetime, start of "Measurement Period")< 64 and exists ( ["Patient Characteristic Sex": "Female"] ) and exists "Qualifying Encounter"
"Initial Population"
"Has Age Dependent Combination Risk Factors" or exists "Osteoporosis Before Measurement Period" or exists "Independent Risk Factors Applicable Any Time" or exists "Independent Risk Factors Before Measurement Period"
exists ["Diagnostic Study, Order": "DXA (Dual energy Xray Absorptiometry) Scan"] DXA where DXA.authorDatetime during "Measurement Period"
"Combination Risk Factors Applicable Any Time" union "Osteoporotic Fracture From Patient History" union "Parent History of Hip Fracture Assessment" union "Osteopenia Before Measurement Period" union "First Tobacco Use Screening Indicating Current Smoker" union "First Average Number of Drinks Assessments Indicating More Than Two Per Day" union "First BMI Exam in Measurement Period Less Than or Equal to 20 kg m2" union ["Patient Characteristic Race": "White"]
( ["Diagnosis": "Rheumatoid Arthritis"] union ["Diagnosis": "Hyperthyroidism"] union ["Diagnosis": "Malabsorption Syndromes"] union ["Diagnosis": "Chronic Liver Disease"] union ["Diagnosis": "Chronic Malnutrition"] ) CombinationRiskDiagnosis where CombinationRiskDiagnosis.prevalencePeriod starts before end "Measurement Period"
/*Identifies the months in the year containing 28 days for determining number of days the medication is prescribed*/ { 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28 }
/*Identifies the months in the year containing 29 days for determining the number of days a medication prescribed*/ { 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29 }
/*Identifies the months in the year containing 30 days for determining the number of days a medication is prescribed*/ { 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 }
/*Identifies the months in the year containing 31 days for determining the number of days a medication is prescribed*/ { 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 }
/*Identifies the number of months in a calendar year to determine the number of days a medication is prescribed*/ { 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 }
"Initial Population"
"Has Age Dependent Combination Risk Factors" or exists "Osteoporosis Before Measurement Period" or exists "Independent Risk Factors Applicable Any Time" or exists "Independent Risk Factors Before Measurement Period"
{ First(["Assessment, Performed": "Average Number of Drinks per Drinking Day"] AverageDrinks where AverageDrinks.authorDatetime during "Measurement Period" and AverageDrinks.result > 2 '{drinks}/d' sort by authorDatetime )}
{ First(["Physical Exam, Performed": "BMI Ratio"] BMI where BMI.relevantPeriod during "Measurement Period" and BMI.result is not null sort by start of relevantPeriod )}
"First BMI Exam in Measurement Period" FirstBMI where FirstBMI.result <= 20 'kg/m2'
{ First(["Assessment, Performed": "Tobacco Use Screening"] TobaccoScreen where TobaccoScreen.result in "Current Tobacco Smoker" and TobaccoScreen.authorDatetime during "Measurement Period" sort by authorDatetime )}
["Medication, Active": "Glucocorticoids (oral only)"] Glucocorticoid where Glucocorticoid.relevantPeriod starts before end of "Measurement Period"
"Glucocorticoid Medication Active" MedicationGlucocorticoid let dosesPerDay: "DosesPerDay"(MedicationGlucocorticoid.frequency), dailyDosage: "GetMedicationDailyDose"(MedicationGlucocorticoid.dosage, dosesPerDay), medPeriod: MedicationGlucocorticoid.relevantPeriod intersect Interval[start of MedicationGlucocorticoid.relevantPeriod, end of "Measurement Period"] return Tuple { code: MedicationGlucocorticoid.code, daysInPeriod: Timing."DaysInPeriod"(medPeriod), dailyDosage: dailyDosage }
( distinct(flatten("Glucocorticoids Daily Dosage Per Medication" GlucocorticoidsDailyDosage return all GlucocorticoidsDailyDosage.daysInPeriod ) )) Day return { medicationDay: Day, totalDailyDosage: Sum("Glucocorticoids Daily Dosage Per Medication" GlucocorticoidsDailyDosagePerDay where Day in GlucocorticoidsDailyDosagePerDay.daysInPeriod return all GlucocorticoidsDailyDosagePerDay.dailyDosage ) }
Count("Glucocorticoids Dosage Per Day" GlucocorticoidsDosage where GlucocorticoidsDosage.totalDailyDosage >= 5 'mg/d' )>= 90
singleton from ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate let Age: Global."CalendarAgeInYearsAt"(BirthDate.birthDatetime, start of "Measurement Period"), NumberOfRiskFactors: Count("Age Dependent Combination Risk Factors")+ ( if "Glucocorticoids Greater Than 5 MG per Day for 90 or More Days" then 1 else 0 ) return ( ( Age between 50 and 54 and NumberOfRiskFactors >= 4 ) or ( Age between 55 and 59 and NumberOfRiskFactors >= 3 ) or ( Age between 60 and 63 and NumberOfRiskFactors >= 2 ) ) )
( ["Diagnosis": "Type 1 Diabetes"] union ["Diagnosis": "End Stage Renal Disease"] union ["Diagnosis": "Osteogenesis Imperfecta"] union ["Diagnosis": "Ankylosing Spondylitis"] union ["Diagnosis": "Psoriatic Arthritis"] union ["Diagnosis": "Ehlers Danlos Syndrome"] union ["Diagnosis": "Cushings Syndrome"] union ["Diagnosis": "Marfan's Syndrome"] union ["Diagnosis": "Hyperparathyroidism"] union ["Diagnosis": "Lupus"] ) IndependentRiskDiagnosis where IndependentRiskDiagnosis.prevalencePeriod starts before end "Measurement Period"
(( ["Procedure, Performed": "Gastric Bypass Surgery"] union ["Medication, Active": "Aromatase Inhibitors"] union ["Medication, Order": "Aromatase Inhibitors"] ) GastricBypassOrAromataseInhibitor where GastricBypassOrAromataseInhibitor.relevantPeriod starts before start "Measurement Period") union "Osteoporosis Fracture Probability Assessment"
exists ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global."CalendarAgeInYearsAt"(BirthDate.birthDatetime, start of "Measurement Period")>= 50 and Global."CalendarAgeInYearsAt"(BirthDate.birthDatetime, start of "Measurement Period")< 64 and exists ( ["Patient Characteristic Sex": "Female"] ) and exists "Qualifying Encounter"
exists ["Diagnostic Study, Order": "DXA (Dual energy Xray Absorptiometry) Scan"] DXA where DXA.authorDatetime during "Measurement Period"
["Diagnosis": "Osteopenia"] OsteopeniaDiagnosis where OsteopeniaDiagnosis.prevalencePeriod starts before start "Measurement Period"
["Diagnosis": "Osteoporosis"] OsteoporosisDiagnosis where OsteoporosisDiagnosis.prevalencePeriod overlaps before "Measurement Period"
["Assessment, Performed": "Major osteoporotic fracture 10-year probability [Likelihood] Fracture Risk Assessment"] ProbabilityAssessment where ProbabilityAssessment.result >= 8.4 '%' and ProbabilityAssessment.authorDatetime before start of "Measurement Period"
( ["Diagnosis": "Osteoporotic Fractures"] PathologicalFracture where PathologicalFracture.prevalencePeriod starts before start "Measurement Period" )
["Assessment, Performed": "History of hip fracture in parent"] ParentFractureHistory where ParentFractureHistory.authorDatetime before start of "Measurement Period"
( ["Encounter, Performed": "Office Visit"] union ["Encounter, Performed": "Preventive Care Services - Established Office Visit, 18 and Up"] union ["Encounter, Performed": "Preventive Care Services - Other"] union ["Encounter, Performed": "Preventive Care Services-Initial Office Visit, 18 and Up"] union ["Encounter, Performed": "Outpatient Consultation"] ) ValidEncounter where ValidEncounter.relevantPeriod during "Measurement Period"
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
/*Calculates the number of days of a prescription relevant period*/ ( case when mo in { 1, 3, 5, 7, 8, 10, 12 } then "Months Containing 31 Days" when mo = 2 then if "IsLeapYear"(yr)then "Months Containing 29 Days" else "Months Containing 28 Days" else "Months Containing 30 Days" end ) D return DateTime(yr, mo, D)
/*Calculates the number of days of a prescription and if the prescription is within the measurement period*/ case when start of period is null or end of period is null then null when start of period same year as end of period then case when month from start of period = month from end of period then ( "DaysInMonth"(year from start of period, month from start of period)) DaysMonth where DaysMonth same day or after start of period and DaysMonth same day or before end of period else ( "DaysInYear"(year from start of period)) DaysYear where DaysYear same day or after start of period and DaysYear same day or before end of period end when difference in years between start of period and end of period = 1 then ( ( "DaysInYear"(year from start of period)) DaysYear where DaysYear same day or after start of period and DaysYear same day or before end of period ) union ( ( "DaysInYear"(year from end of period )) DaysYear where DaysYear same day or after start of period and DaysYear same day or before end of period ) else null end
/*Lists are flattened to a single list*/ flatten ( MonthsInYear Mo return "DaysInMonth"(yr, Mo) )
/*Determines if year is a leap year*/ ( yr mod 4 = 0 and yr mod 100 != 0 ) or yr mod 400 = 0
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 0.34 when frequency ~ "Every forty eight hours (qualifier value)" then 0.5 when frequency ~ "Every eight to twelve hours (qualifier value)" then 2.0 when frequency ~ "Every six to eight hours (qualifier value)" then 3.0 when frequency ~ "Every three to four hours (qualifier value)" then 6.0 when frequency ~ "Every three to six hours (qualifier value)" then 4.0 when frequency ~ "Every two to four hours (qualifier value)" then 6.0 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
dosage * Quantity { value: dosesPerDay, unit: '/d' }
years between ToDate(BirthDateTime)and ToDate(AsOf)
DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezone from Value)
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
Measure Set |