Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture

• • Age Dependent Combination Risk Factors

    • • "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 in Measurement Period Less Than or Equal to 20 kg m2"
          union ["Patient Characteristic Race": "White"]

       

  • Combination Risk Factors Applicable Any Time

    • • ( ["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"

       

  • Denominator

    • • "Initial Population"

       

  • Denominator Exclusions

    • • "Has Age Dependent Combination Risk Factors"
          or "Has Osteoporosis Before Measurement Period"
          or "Has Independent Risk Factors Applicable Any Time"
          or "Has Independent Risk Factors Before Measurement Period"

       

  • First Average Number of Drinks Assessments Indicating More Than Two Per Day

    • • { First(["Assessment, Performed": "Average Number of Drinks per Drinking Day"] AverageDrinks
            where AverageDrinks.relevantDatetime during "Measurement Period"
              and AverageDrinks.result > 2 '{drinks}/d'
            sort by relevantDatetime
        )}

       

  • First BMI in Measurement Period

    • • { First(["Physical Exam, Performed": "BMI Ratio"] BMI
            where BMI.relevantDatetime during "Measurement Period"
              and BMI.result is not null
            sort by relevantDatetime
        )}

       

  • First BMI in Measurement Period Less Than or Equal to 20 kg m2

    • • "First BMI in Measurement Period" FirstBMI
          where FirstBMI.result <= 20 'kg/m2'

       

  • First Tobacco Use Screening Indicating Current Smoker

    • • { First(["Assessment, Performed": "Tobacco Use Screening"] TobaccoScreen
            where TobaccoScreen.result in "Current Tobacco Smoker"
              and TobaccoScreen.relevantDatetime during "Measurement Period"
            sort by relevantDatetime
        )}

       

  • Glucocorticoid Medication Active

    • • ["Medication, Active": "Glucocorticoids (oral only)"] Glucocorticoid
          where Glucocorticoid.relevantPeriod starts before 
          end of "Measurement Period"

       

  • Glucocorticoids Daily Dosage Per Medication

    • • "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: expand { medPeriod } per day,
            dailyDosage: dailyDosage
          }

       

  • Glucocorticoids Dosage Per Day

    • • ( 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
            )
          }

       

  • Glucocorticoids Greater Than 5 MG per Day for 90 or More Days

    • • Count("Glucocorticoids Dosage Per Day" GlucocorticoidsDosage
            where GlucocorticoidsDosage.totalDailyDosage >= 5 'mg/d'
        )>= 90

       

  • Has Age Dependent Combination Risk Factors

    • • 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
                )
            )
        )

       

  • Has Independent Risk Factors Applicable Any Time

    • • exists ( ["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"

       

  • Has Independent Risk Factors Before Measurement Period

    • • exists ( ( ( ["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"
        )

       

  • Has Osteoporosis Before Measurement Period

    • • exists ["Diagnosis": "Osteoporosis"] OsteoporosisDiagnosis
          where OsteoporosisDiagnosis.prevalencePeriod overlaps before "Measurement Period"

       

  • Initial Population

    • • exists ["Patient Characteristic Birthdate": "Birth date"] BirthDate
          where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) in Interval[50, 64 )
            and exists ( ["Patient Characteristic Sex": "Female"] )
            and exists "Qualifying Encounter"

       

  • Numerator

    • • exists ["Diagnostic Study, Order": "DXA (Dual energy Xray Absorptiometry) Scan"] DXA
          where DXA.authorDatetime during "Measurement Period"

       

  • Osteopenia Before Measurement Period

    • • ["Diagnosis": "Osteopenia"] OsteopeniaDiagnosis
          where OsteopeniaDiagnosis.prevalencePeriod starts before start "Measurement Period"

       

  • Osteoporosis Fracture Probability Assessment

    • • ["Assessment, Performed": "Major osteoporotic fracture 10-year probability [Likelihood] Fracture Risk Assessment"] ProbabilityAssessment
          where ProbabilityAssessment.result >= 8.4 '%'
            and ProbabilityAssessment.relevantDatetime before start of "Measurement Period"

       

  • Osteoporotic Fracture From Patient History

    • • ( ["Diagnosis": "Osteoporotic Fractures"] PathologicalFracture
            where PathologicalFracture.prevalencePeriod starts before start "Measurement Period"
        )

       

  • Parent History of Hip Fracture Assessment

    • • ["Assessment, Performed": "History of hip fracture in parent"] ParentFractureHistory
          where ParentFractureHistory.relevantDatetime before start of "Measurement Period"

       

  • Qualifying Encounter

    • • ( ["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"

       

  • 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"]

       

Functions

None