eCQM Title

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

eCQM Identifier (Measure Authoring Tool)

249

eCQM Version Number

4.0.000

NQF Number

3475e

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

National Quality Forum

Description

Percentage of female patients 50 to 64 years of age without select risk factors for osteoporotic fracture who received an order for a dual-energy x-ray absorptiometry (DXA) scan during the measurement period

This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). This measure was developed under CMS Contract No. HHSM-500-2013-13011I, Task Order HHSM-500-TO0001. Mathematica and the National Committee for Quality Assurance (NCQA) supported development of this electronic measure. 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.

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

None

Risk Adjustment

None

Rate Aggregation

None

Rationale

This measure is expected to increase recording of patient risk for fracture data and decrease the amount of inappropriate DXA scans. Current osteoporosis guidelines recommend using bone measurement testing to assess osteoporosis risk in women 65 years and older. In postmenopausal women younger than age 65, guidelines recommend using a formal clinical risk assessment tool to establish a patient's risk for osteoporosis, in order to determine whether to screen a patient for osteoporosis using bone measurement testing. Clinical information, such as age, body mass index (BMI), parental hip fracture history, and smoking and alcohol use, can be used to determine a woman's fracture risk (U.S. Preventive Services Task Force [USPSTF], 2018). Additionally, there are potentially avoidable harms associated with screening for osteoporosis in general, including exposure to radiation, false positive exams, and resulting side effects from unnecessary osteoporosis medications, which add costs to an already burdened health care system (Lim, Hoeksema, & Sherin, 2009).

Clinical Recommendation Statement

USPSTF:
"The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older." This is a B recommendation. 

"The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men." This is an I statement.

"The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool." This is a B recommendation. 
"For postmenopausal women younger than 65 years who have at least 1 risk factor, a reasonable approach to determine who should be screened with bone measurement testing is to use a clinical risk assessment tool." 

"Several tools are available to assess osteoporosis risk: the Simple Calculated Osteoporosis Risk Estimate (SCORE; Merck), Osteoporosis Risk Assessment Instrument (ORAI), Osteoporosis Index of Risk (OSIRIS), and the Osteoporosis Self-Assessment Tool (OST). These tools seem to perform similarly and are moderately accurate at predicting osteoporosis. The FRAX tool (University of Sheffield), which assesses a person's 10-year risk of fracture, is also a commonly used tool."

"Because the benefits of treatment are greater in persons at higher risk of fracture, one approach is to perform bone measurement testing in postmenopausal women younger than 65 years who have a 10-year FRAX risk of major osteoporotic fracture (MOF) (without DXA) greater than that of a 65-year-old white woman without major risk factors. For example, in the United States, a 65-year-old white woman of mean height and weight without major risk factors has a 10-year FRAX risk of MOF of 8.4%."

The National Institute for Health and Clinical Excellence’s Osteoporosis Guidelines:
"Consider assessment of fracture risk:
a. in all women aged 65 years and over and all men aged 75 years and over
b. in women aged under 65 years and men aged under 75 years in the presence of risk factors, for 
example:
*previous fragility fracture
*current use or frequent/ recent use of oral or systemic glucocorticoids
*history of falls
*family history of hip fracture
*other causes of secondary osteoporosis
*low body mass index (BMI) (less than 18.5 kg/m2)
*smoking
*alcohol intake of more than 14 units per week for women and more than 21 units per week for men."

"Do not routinely assess fracture risk in people aged under 50 years unless they have major risk 
factors (for example, current or frequent/recent use of oral or systemic glucocorticoids, untreated 
premature menopause or previous fragility fracture), because they are unlikely to be at high risk."

"Estimate absolute risk when assessing risk of fracture (for example, the predicted risk of major osteoporotic or hip fracture over 10 years, expressed as a percentage."

"Use either FRAX (without a bone mineral density [BMD] value if a dual energy X-ray absorptiometry [DXA] scan has not previously been undertaken) or QFracture, within their allowed age ranges, to estimate 10-year predicted absolute fracture risk when assessing risk of fracture."

"Do not routinely measure BMD to assess fracture risk without prior assessment using FRAX 
(without a BMD value) or QFracture."

"Take into account that risk assessment tools may underestimate fracture risk in certain 
circumstances, for example if a person:
*has a history of multiple fractures
*has had previous vertebral fracture(s)
*has a high alcohol intake
*is taking high-dose oral or high-dose systemic glucocorticoids (more than 7.5 mg prednisolone 
or equivalent per day for 3 months or longer)
*has other causes of secondary osteoporosis."

Improvement Notation

Lower score indicates better quality

Reference

Reference Type: CITATION

Reference Text: 'Lim, L. S., Hoeksema, L. J., & Sherin, K. (2009). Screening for osteoporosis in the adult U.S. population: ACPM position statement on preventive practice. American Journal of Preventive Medicine, 36(4), 366-375.'

Reference

Reference Type: CITATION

Reference Text: 'National Institute for Health and Care Excellence. (2017). Osteoporosis: Assessing the risk of fragility fracture (NICE Guideline CG146). https://www.nice.org.uk/guidance/cg146/chapter/1-Guidance'

Reference

Reference Type: CITATION

Reference Text: 'U.S. Preventive Services Task Force, Curry S. J., Krist, A. H., et al. (2018). Screening for osteoporosis to prevent fractures: U.S. Preventive Services Task Force recommendation statement. JAMA, 319(24), 2521-2531.'

Definition

The measure allows for clinicians to use the Fracture Risk Assessment Tool (FRAX[R]) to calculate 10-year absolute fracture risk. The FRAX was developed by the World Health Organization in 2008 to evaluate a patient's 10-year probability of hip fracture and major osteoporotic fracture (clinical spine, forearm, hip, or shoulder fracture). It is applicable to people aged 40-90 years.

Guidance

There are two ways that a patient can be excluded from the measure:
1. The patient has a specific number of "combination" risk factors (the number of risk factors varies by age).
2. The patient has one or more of the "independent" risk factors, including a 10-year probability of major osteoporotic fracture of 8.4 percent or higher as determined by the FRAX.

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

Female patients ages 50 to 64 years with an encounter during the measurement period

Denominator

Equals Initial Population

Denominator Exclusions

Exclude patients with a combination of risk factors (as determined by age) or one of the independent risk factors

Ages: 50-54 (>=4 combination risk factors) or 1 independent risk factor
Ages: 55-59 (>=3 combination risk factors) or 1 independent risk factor
Ages: 60-64 (>=2 combination risk factors) or 1 independent risk factor

COMBINATION RISK FACTORS [The following risk factors are all combination risk factors; they are grouped by when they occur in relation to the measurement period]:

The following risk factors may occur any time in the patient's history but must be active during the measurement period:
White (race)
BMI <= 20 kg/m2 (must be the first BMI of the measurement period)
Smoker (current during the measurement period)
Alcohol consumption (> two units per day (one unit is 12 oz. of beer, 4 oz. of wine, or 1 oz. of liquor))

The following risk factor may occur any time in the patient's history and must not start during the measurement period:
Osteopenia 

The following risk factors may occur at any time in the patient's history or during the measurement period:
Rheumatoid arthritis
Hyperthyroidism
Malabsorption Syndromes: celiac disease, inflammatory bowel disease, ulcerative colitis, Crohn's disease, cystic fibrosis, malabsorption
Chronic liver disease
Chronic malnutrition
Osteoporotic fracture

The following risk factors may occur any time in the patient's history prior to the start of the measurement period but do not need to be active at the start of the measurement period:
Documentation of history of hip fracture in parent
Glucocorticoids [cumulative medication duration >= 90 days]

INDEPENDENT RISK FACTORS (The following risk factors are all independent risk factors; they are grouped by when they occur in relation to the measurement period):

The following risk factors may occur at any time in the patient's history and must not start during the measurement period:
Osteoporosis  

The following risk factors may occur at any time in the patient's history prior to the start of the measurement period, but do not need to be active during the measurement period:
Gastric bypass 
FRAX[R] ten-year probability of all major osteoporosis related fracture >= 8.4 percent
Aromatase inhibitors

The following risk factors may occur at any time in the patient's history or during the measurement period:
Type I Diabetes 
End stage renal disease
Osteogenesis imperfecta
Ankylosing spondylitis
Psoriatic arthritis
Ehlers-Danlos syndrome
Cushing's syndrome
Hyperparathyroidism
Marfan syndrome
Lupus

Numerator

Female patients who received an order for at least one DXA scan in 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[50, 64 )
    and exists ( ["Patient Characteristic Sex": "Female"] )
    and exists "Qualifying Encounter"

- 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"

Numerator

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

- Numerator Exclusions
  - None

- Denominator Exceptions
  - None

- Stratification
  - None

Definitions

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

( { "RiskFactorInPatientHistory"(["Diagnosis": "Rheumatoid Arthritis"]), "RiskFactorInPatientHistory"(["Diagnosis": "Hyperthyroidism"]), "RiskFactorInPatientHistory"(["Diagnosis": "Malabsorption Syndromes"]), "RiskFactorInPatientHistory"(["Diagnosis": "Chronic Liver Disease"]), "RiskFactorInPatientHistory"(["Diagnosis": "Chronic Malnutrition"])} )

Count of Distinct Age Dependent Combination Risk Factors
- - Count("Age Dependent Combination Risk Factors")

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 start of Global."NormalizeInterval"(AverageDrinks.relevantDatetime, AverageDrinks.relevantPeriod)during "Measurement Period"
      and AverageDrinks.result > 2 '{drinks}/d'
    sort by start of Global."NormalizeInterval"(relevantDatetime, relevantPeriod)
)}

First BMI in Measurement Period

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

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 start of Global."NormalizeInterval"(TobaccoScreen.relevantDatetime, TobaccoScreen.relevantPeriod)during "Measurement Period"
    sort by start of Global."NormalizeInterval"(relevantDatetime, relevantPeriod)
)}

Glucocorticoid Active Medication Days

Sum("Glucocorticoid Active Medication Duration in Days")

Glucocorticoid Active Medication Duration in Days

( collapse ( ["Medication, Active": "Glucocorticoids (oral only)"] Glucocorticoid
    where Glucocorticoid.relevantPeriod starts before 
    end of "Measurement Period"
).relevantPeriod ) GlucocorticoidIntervals
  return duration in days of ( GlucocorticoidIntervals
      intersect Interval[Patient.birthDatetime, 
      end of "Measurement Period"]
  )

Has 90 or More Active Glucocorticoid Medication Days
- - "Glucocorticoid Active Medication Days" >= 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 of Distinct Age Dependent Combination Risk Factors" + ( if "Has 90 or More Active Glucocorticoid Medication 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"] GastricBypass
      where Global."NormalizeInterval" ( GastricBypass.relevantDatetime, GastricBypass.relevantPeriod ) ends before start of "Measurement Period"
  )
    union ( ["Medication, Active": "Aromatase Inhibitors"] AromataseInhibitorActive
        where Global."NormalizeInterval" ( AromataseInhibitorActive.relevantDatetime, AromataseInhibitorActive.relevantPeriod ) starts before start of "Measurement Period"
    )
    union ( ["Medication, Order": "Aromatase Inhibitors"] AromataseInhibitorOrder
        where AromataseInhibitorOrder.authorDatetime before start of "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 start of Global."NormalizeInterval" ( ProbabilityAssessment.relevantDatetime, ProbabilityAssessment.relevantPeriod ) before start of "Measurement Period"

Osteoporotic Fracture from Patient History

["Diagnosis": "Osteoporotic Fractures"] PathologicalFracture
  where PathologicalFracture.prevalencePeriod starts on or before day of 
  end of "Measurement Period"

Parent History of Hip Fracture Assessment

["Assessment, Performed": "History of hip fracture in parent"] ParentFractureHistory
  where start of Global."NormalizeInterval" ( ParentFractureHistory.relevantDatetime, ParentFractureHistory.relevantPeriod ) 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"]
  union ["Encounter, Performed": "Online Assessments"]
  union ["Encounter, Performed": "Telephone Visits"] ) 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

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

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)

RiskFactorInPatientHistory(Diagnosis List<"Diagnosis">)

First(Diagnosis Dx
    where Dx.prevalencePeriod starts on or before day of 
    end of "Measurement Period"
    sort by start of prevalencePeriod
)

Terminology

code "Birth date" ("LOINC Code (21112-8)")
code "Major osteoporotic fracture 10-year probability [Likelihood] Fracture Risk Assessment" ("LOINC Code (90265-0)")
valueset "Ankylosing Spondylitis" (2.16.840.1.113883.3.464.1003.113.12.1045)
valueset "Aromatase Inhibitors" (2.16.840.1.113883.3.464.1003.196.12.1265)
valueset "Average Number of Drinks per Drinking Day" (2.16.840.1.113883.3.464.1003.106.12.1018)
valueset "BMI Ratio" (2.16.840.1.113883.3.600.1.1490)
valueset "Chronic Liver Disease" (2.16.840.1.113883.3.464.1003.199.12.1035)
valueset "Chronic Malnutrition" (2.16.840.1.113883.3.464.1003.199.12.1036)
valueset "Current Tobacco Smoker" (2.16.840.1.113883.3.600.2390)
valueset "Cushings Syndrome" (2.16.840.1.113883.3.464.1003.117.12.1009)
valueset "DXA (Dual energy Xray Absorptiometry) Scan" (2.16.840.1.113883.3.464.1003.113.12.1051)
valueset "Ehlers Danlos Syndrome" (2.16.840.1.113883.3.464.1003.113.12.1047)
valueset "End Stage Renal Disease" (2.16.840.1.113883.3.526.3.353)
valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
valueset "Female" (2.16.840.1.113883.3.560.100.2)
valueset "Gastric Bypass Surgery" (2.16.840.1.113883.3.464.1003.198.12.1050)
valueset "Glucocorticoids (oral only)" (2.16.840.1.113883.3.464.1003.196.12.1266)
valueset "History of hip fracture in parent" (2.16.840.1.113883.3.464.1003.113.12.1040)
valueset "Hyperparathyroidism" (2.16.840.1.113883.3.464.1003.117.12.1016)
valueset "Hyperthyroidism" (2.16.840.1.113883.3.464.1003.117.12.1015)
valueset "Lupus" (2.16.840.1.113883.3.464.1003.117.12.1010)
valueset "Malabsorption Syndromes" (2.16.840.1.113883.3.464.1003.199.12.1050)
valueset "Marfan's Syndrome" (2.16.840.1.113883.3.464.1003.113.12.1048)
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 "Osteogenesis Imperfecta" (2.16.840.1.113883.3.464.1003.113.12.1044)
valueset "Osteopenia" (2.16.840.1.113883.3.464.1003.113.12.1049)
valueset "Osteoporosis" (2.16.840.1.113883.3.464.1003.113.12.1038)
valueset "Osteoporotic Fractures" (2.16.840.1.113883.3.464.1003.113.12.1050)
valueset "Outpatient Consultation" (2.16.840.1.113883.3.464.1003.101.12.1008)
valueset "Payer" (2.16.840.1.114222.4.11.3591)
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 - Other" (2.16.840.1.113883.3.464.1003.101.12.1030)
valueset "Preventive Care Services-Initial Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1023)
valueset "Psoriatic Arthritis" (2.16.840.1.113883.3.464.1003.113.12.1046)
valueset "Race" (2.16.840.1.114222.4.11.836)
valueset "Rheumatoid Arthritis" (2.16.840.1.113883.3.464.1003.113.12.1005)
valueset "Telephone Visits" (2.16.840.1.113883.3.464.1003.101.12.1080)
valueset "Tobacco Use Screening" (2.16.840.1.113883.3.526.3.1278)
valueset "Type 1 Diabetes" (2.16.840.1.113883.3.464.1003.103.12.1020)
valueset "White" (2.16.840.1.113883.3.464.1003.123.12.1007)

Data Criteria (QDM Data Elements)

"Assessment, Performed: Average Number of Drinks per Drinking Day" using "Average Number of Drinks per Drinking Day (2.16.840.1.113883.3.464.1003.106.12.1018)"
"Assessment, Performed: History of hip fracture in parent" using "History of hip fracture in parent (2.16.840.1.113883.3.464.1003.113.12.1040)"
"Assessment, Performed: Major osteoporotic fracture 10-year probability [Likelihood] Fracture Risk Assessment" using "Major osteoporotic fracture 10-year probability [Likelihood] Fracture Risk Assessment (LOINC Code 90265-0)"
"Assessment, Performed: Tobacco Use Screening" using "Tobacco Use Screening (2.16.840.1.113883.3.526.3.1278)"
"Diagnosis: Ankylosing Spondylitis" using "Ankylosing Spondylitis (2.16.840.1.113883.3.464.1003.113.12.1045)"
"Diagnosis: Chronic Liver Disease" using "Chronic Liver Disease (2.16.840.1.113883.3.464.1003.199.12.1035)"
"Diagnosis: Chronic Malnutrition" using "Chronic Malnutrition (2.16.840.1.113883.3.464.1003.199.12.1036)"
"Diagnosis: Cushings Syndrome" using "Cushings Syndrome (2.16.840.1.113883.3.464.1003.117.12.1009)"
"Diagnosis: Ehlers Danlos Syndrome" using "Ehlers Danlos Syndrome (2.16.840.1.113883.3.464.1003.113.12.1047)"
"Diagnosis: End Stage Renal Disease" using "End Stage Renal Disease (2.16.840.1.113883.3.526.3.353)"
"Diagnosis: Hyperparathyroidism" using "Hyperparathyroidism (2.16.840.1.113883.3.464.1003.117.12.1016)"
"Diagnosis: Hyperthyroidism" using "Hyperthyroidism (2.16.840.1.113883.3.464.1003.117.12.1015)"
"Diagnosis: Lupus" using "Lupus (2.16.840.1.113883.3.464.1003.117.12.1010)"
"Diagnosis: Malabsorption Syndromes" using "Malabsorption Syndromes (2.16.840.1.113883.3.464.1003.199.12.1050)"
"Diagnosis: Marfan's Syndrome" using "Marfan's Syndrome (2.16.840.1.113883.3.464.1003.113.12.1048)"
"Diagnosis: Osteogenesis Imperfecta" using "Osteogenesis Imperfecta (2.16.840.1.113883.3.464.1003.113.12.1044)"
"Diagnosis: Osteopenia" using "Osteopenia (2.16.840.1.113883.3.464.1003.113.12.1049)"
"Diagnosis: Osteoporosis" using "Osteoporosis (2.16.840.1.113883.3.464.1003.113.12.1038)"
"Diagnosis: Osteoporotic Fractures" using "Osteoporotic Fractures (2.16.840.1.113883.3.464.1003.113.12.1050)"
"Diagnosis: Psoriatic Arthritis" using "Psoriatic Arthritis (2.16.840.1.113883.3.464.1003.113.12.1046)"
"Diagnosis: Rheumatoid Arthritis" using "Rheumatoid Arthritis (2.16.840.1.113883.3.464.1003.113.12.1005)"
"Diagnosis: Type 1 Diabetes" using "Type 1 Diabetes (2.16.840.1.113883.3.464.1003.103.12.1020)"
"Diagnostic Study, Order: DXA (Dual energy Xray Absorptiometry) Scan" using "DXA (Dual energy Xray Absorptiometry) Scan (2.16.840.1.113883.3.464.1003.113.12.1051)"
"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: Outpatient Consultation" using "Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008)"
"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 - Other" using "Preventive Care Services - Other (2.16.840.1.113883.3.464.1003.101.12.1030)"
"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: Telephone Visits" using "Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080)"
"Medication, Active: Aromatase Inhibitors" using "Aromatase Inhibitors (2.16.840.1.113883.3.464.1003.196.12.1265)"
"Medication, Active: Glucocorticoids (oral only)" using "Glucocorticoids (oral only) (2.16.840.1.113883.3.464.1003.196.12.1266)"
"Medication, Order: Aromatase Inhibitors" using "Aromatase Inhibitors (2.16.840.1.113883.3.464.1003.196.12.1265)"
"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 Race: White" using "White (2.16.840.1.113883.3.464.1003.123.12.1007)"
"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)"
"Physical Exam, Performed: BMI Ratio" using "BMI Ratio (2.16.840.1.113883.3.600.1.1490)"
"Procedure, Performed: Gastric Bypass Surgery" using "Gastric Bypass Surgery (2.16.840.1.113883.3.464.1003.198.12.1050)"

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