Diabetes: Medical Attention for Nephropathy

eCQM Title	Diabetes: Medical Attention for Nephropathy
eCQM Identifier (Measure Authoring Tool)	134	eCQM Version number	8.4.000
NQF Number	Not Applicable	GUID	7b2a9277-43da-4d99-9bee-6ac271a07747
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	The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period
Copyright	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) 2012-2019 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 2004-2018 American Medical Association. LOINC(R) copyright 2004-2018 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2018 International Health Terminology Standards Development Organisation. ICD-10 copyright 2018 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	As the seventh leading cause of death in the U.S., diabetes kills approximately 79,500 people a year and affects more than 30 million Americans (9.4 percent of the U.S. population) (CDC, 2017a, 2017b). Diabetes is a long-lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (CDC, 2017c). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney failure, amputation of toes, feet or legs, and premature death. (CDC, 2016). In 2017, diabetes cost the U.S. an estimated $327 billion: $237 billion in direct medical costs and $90 billion in reduced productivity. This is a 34 percent increase from the estimated $245 billion spent on diabetes in 2012 (American Diabetes Association, 2018a). High blood sugar levels in patients with diabetes put them at a higher risk of damaging their kidneys and causing chronic kidney disease, which can lead to kidney failure (CDC, 2016, 2017d). During 2011-2012 there were 36.5% new cases of chronic kidney disease (stages 1-4) among 297,000 diabetic patients 20 years and older (Murphy et al., 2016). In 2014, diabetes accounted for 44% of 118,000 new cases of end stage renal disease (United States Renal Data System, 2016).
Clinical Recommendation Statement	American Diabetes Association (2018b ): Screening - At least once a year, assess urinary albumin (e.g., spot urinary albumin-to-creatinine ratio [UACR]) and estimated glomerular filtration rate (eGFR) in patients with type 1 diabetes duration of greater than or equal to 5 years in all patients with type 2 diabetes, and in all patients with comorbid hypertension. (Level of evidence: B) Treatment - An angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) is not recommended for the primary prevention of diabetic kidney disease in patients with diabetes who have normal blood pressure, normal UACR (<30 mg/g creatinine), and normal estimated glomerular filtration rate. (Level of evidence: B) - Either an ACE inhibitor or ARB is suggested for the treatment of the nonpregnant patient with modestly elevated UACR (30-299 mg/g creatinine) (Level of evidence: B) and is strongly recommended for those with urinary albumin to creatinine ratio >=300 mg/g creatinine and/or estimated glomerular filtration rate < 60 mL/min/1.73.m2. (Level of evidence: A) - Periodically monitor serum creatinine and potassium levels for the development of increased creatinine or changes in potassium when ACE inhibitors, angiotensin receptor blockers, or diuretics are used. (Level of evidence: B) - Continued monitoring of UACR in patients with albuminuria treated with an ACE inhibitor or ARBs is reasonable to assess the response to treatment and progression of diabetic kidney disease. (Level of evidence: E) - When estimated glomerular filtration rate is <60 mL/min/1.73 m2, evaluate and manage potential complications of chronic kidney disease. (Level of evidence: E) -Patients should be referred for evaluation for renal replacement treatment if they have an estimated glomerular filtration rate <30 mL/min/1.73 m2. (Level of evidence: A) -Promptly refer to a physician experienced in the care of kidney disease for uncertainty about the etiology of kidney disease, difficult management issues, and rapidly progressing kidney disease. (Level of evidence: B) American Association of Clinical Endocrinologists & American College of Endocrinology (2015): - Beginning 5 years after diagnosis in patients with type 1 diabetes (if diagnosed before age 30) or at diagnosis in patients with type 2 diabetes and those with type 1 diabetes diagnosed after age 30, annual assessment of serum creatinine to determine the estimated glomerular filtration rate (eGFR) and urine albumin excretion rate (AER) should be performed to identify, stage, and monitor progression of diabetic nephropathy (Grade C; best evidence level 3). - Patients with nephropathy should be counseled regarding the need for optimal glycemic control, blood pressure control, dyslipidemia control, and smoking cessation (Grade B; best evidence level 2). - In addition, they should have routine monitoring of albuminuria, kidney function electrolytes, and lipids (Grade B; best evidence level 2). - Associated conditions such as anemia and bone and mineral disorders should be assessed as kidney function declines (Grade D; best evidence level 4). - Referral to a nephrologist is recommended well before the need for renal replacement therapy (Grade D; best evidence level 4).
Improvement Notation	Higher score indicates better quality
Reference	American Association of Clinical Endocrinologists & American College of Endocrinology. (2015). Clinical practice guidelines for developing a diabetes mellitus comprehensive care plan—2015. Endocrine Practice, 21(Suppl. 1). Retrieved from https://www.aace.com/files/dm-guidelines-ccp.pdf
Reference	American Diabetes Association. (2018a). Economic costs of diabetes in the U.S. in 2017. Diabetes Care, 41, 917-928. Retrieved from http://care.diabetesjournals.org/content/early/2018/03/20/dci18-0007
Reference	American Diabetes Association. (2018b). 10. Microvascular complications and foot care: Standards of Medical Care in Diabetes—2018. Diabetes Care, 41(Suppl. 1), S105-S118.
Reference	Centers for Disease Control and Prevention. (2016). At a glance 2016: Diabetes—Working to reverse the U.S. epidemic. Atlanta, GA: Author.
Reference	Centers for Disease Control and Prevention. (2017a). Health, United States, 2016: With chartbook on long-term trends in health. Retrieved from https://www.cdc.gov/nchs/data/hus/hus16.pdf
Reference	Centers for Disease Control and Prevention. (2017b). National diabetes statistics report, 2017. Atlanta, GA: U.S. Department of Health and Human Services, CDC. Retrieved from https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
Reference	Centers for Disease Control and Prevention. (2017c). About diabetes. Retrieved from https://www.cdc.gov/diabetes/basics/diabetes.html
Reference	Centers for Disease Control and Prevention. (2017d). National chronic kidney disease fact sheet. Retrieved from https://www.cdc.gov/diabetes/pubs/pdf/kidney_factsheet.pdf
Reference	Murphy, D., McCulloch, C. E., Lin, F., et al. (2016). Trends in prevalence of chronic kidney disease in the United States. Annals of Internal Medicine, 165(7), 473-481.
Reference	United States Renal Data System. (2016). 2016 USRDS annual data report: Epidemiology of kidney disease in the United States. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.
Definition	None
Guidance	Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included
Transmission Format	TBD
Initial Population	Patients 18-75 years of age with diabetes with a visit during the measurement period
Denominator	Equals Initial Population
Denominator Exclusions	Exclude patients whose hospice care overlaps the measurement period. Exclude patients 66 and older who are living long term in an institution for more than 90 days during the measurement period. Exclude patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured.
Numerator	Patients with a screening for nephropathy or evidence of nephropathy 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[18, 75 )
)
	and exists ( AdultOutpatientEncounters."Qualifying Encounters" )
	and exists ( ["Diagnosis": "Diabetes"] Diabetes
			where Diabetes.prevalencePeriod overlaps "Measurement Period"
	)

- Denominator
  - "Initial Population"

Denominator Exclusions

exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
		where ( Global."CalendarAgeInYearsAt"(BirthDate.birthDatetime, start of "Measurement Period")>= 65 )
			and FrailtyLTI."Has Spent More Than 90 Days in Long Term Care"
)
	or FrailtyLTI."Advanced Illness and Frailty Exclusion Including Under Age 80"
	or Hospice."Has Hospice"

Numerator

exists ( "Active ACE or ARB Medications" )
	or exists ( "Nephropathy Diagnoses" )
	or exists ( "Nephropathy Screenings" )

- Numerator Exclusions
  - None
- Denominator Exceptions
  - None
- Stratification
  - None

Definitions

Active ACE or ARB Medications

["Medication, Active": "ACE Inhibitor or ARB"] ACEorARBMedication
	where ACEorARBMedication.relevantPeriod overlaps "Measurement Period"

AdultOutpatientEncounters.Qualifying Encounters

( ["Encounter, Performed": "Office Visit"]
	union ["Encounter, Performed": "Annual Wellness 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": "Home Healthcare Services"] ) ValidEncounter
	where ValidEncounter.relevantPeriod during "Measurement Period"

FrailtyLTI.Advanced Illness and Frailty Exclusion Including Under Age 80

//If the measure does NOT include populations age 80 and older, then use this logic:
exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
		where Global."CalendarAgeInYearsAt"(BirthDate.birthDatetime, start of "Measurement Period")>= 65
			and "Has Criteria Indicating Frailty"
			and ( Count("Outpatient Encounters with Advanced Illness")>= 2
					or exists ( "Inpatient Encounter with Advanced Illness" )
					or exists "Dementia Medications In Year Before or During Measurement Period"
			)
)

FrailtyLTI.Days Spent in Long Term Care During Measurement Period

"CumulativeDays"("Long Term Care Periods During Measurement Period")

FrailtyLTI.Dementia Medications In Year Before or During Measurement Period

["Medication, Active": "Dementia Medications"] DementiaMed
	where DementiaMed.relevantPeriod overlaps Interval[( start of "Measurement Period" - 1 year ), 
	end of "Measurement Period"]

FrailtyLTI.Has Criteria Indicating Frailty

exists ( ["Device, Order": "Frailty Device"] FrailtyDeviceOrder
		where FrailtyDeviceOrder.authorDatetime during "Measurement Period"
)
	or exists ( ["Device, Applied": "Frailty Device"] FrailtyDeviceApplied
			where FrailtyDeviceApplied.relevantPeriod overlaps "Measurement Period"
	)
	or exists ( ["Diagnosis": "Frailty Diagnosis"] FrailtyDiagnosis
			where FrailtyDiagnosis.prevalencePeriod overlaps "Measurement Period"
	)
	or exists ( ["Encounter, Performed": "Frailty Encounter"] FrailtyEncounter
			where FrailtyEncounter.relevantPeriod overlaps "Measurement Period"
	)
	or exists ( ["Symptom": "Frailty Symptom"] FrailtySymptom
			where FrailtySymptom.prevalencePeriod overlaps "Measurement Period"
	)

FrailtyLTI.Has Spent More Than 90 Days in Long Term Care

"Days Spent in Long Term Care During Measurement Period" > 90

FrailtyLTI.Inpatient Encounter with Advanced Illness

["Encounter, Performed": "Acute Inpatient"] InpatientEncounter
	where exists ( InpatientEncounter.diagnoses Diagnosis
			where Diagnosis in "Advanced Illness"
	)
		and InpatientEncounter.relevantPeriod starts 2 years or less before 
		end of "Measurement Period"

FrailtyLTI.Long Term Care Periods During Measurement Period

( ["Encounter, Performed": "Care Services in Long-Term Residential Facility"]
	union ["Encounter, Performed": "Nursing Facility Visit"] ) LongTermFacilityEncounter
	where LongTermFacilityEncounter.relevantPeriod overlaps "Measurement Period"
	return LongTermFacilityEncounter.relevantPeriod
		intersect "Measurement Period"

FrailtyLTI.Outpatient Encounters with Advanced Illness

( ["Encounter, Performed": "Outpatient"]
	union ["Encounter, Performed": "Observation"]
	union ["Encounter, Performed": "ED"]
	union ["Encounter, Performed": "Nonacute Inpatient"] ) OutpatientEncounter
	where exists ( OutpatientEncounter.diagnoses Diagnosis
			where Diagnosis in "Advanced Illness"
	)
		and OutpatientEncounter.relevantPeriod starts 2 years or less before 
		end of "Measurement Period"

Denominator
- - "Initial Population"

Denominator Exclusions

exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
		where ( Global."CalendarAgeInYearsAt"(BirthDate.birthDatetime, start of "Measurement Period")>= 65 )
			and FrailtyLTI."Has Spent More Than 90 Days in Long Term Care"
)
	or FrailtyLTI."Advanced Illness and Frailty Exclusion Including Under Age 80"
	or Hospice."Has Hospice"

End Stage Renal Disease Encounter

["Encounter, Performed": "ESRD Monthly Outpatient Services"]

Hospice.Has Hospice

exists ( ["Encounter, Performed": "Encounter Inpatient"] DischargeHospice
		where ( DischargeHospice.dischargeDisposition as Code ~ "Discharge to home for hospice care (procedure)"
				or DischargeHospice.dischargeDisposition as Code ~ "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 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[18, 75 )
)
	and exists ( AdultOutpatientEncounters."Qualifying Encounters" )
	and exists ( ["Diagnosis": "Diabetes"] Diabetes
			where Diabetes.prevalencePeriod overlaps "Measurement Period"
	)

Nephropathy Diagnoses

( ["Diagnosis": "Hypertensive Chronic Kidney Disease"]
	union ["Diagnosis": "Kidney Failure"]
	union ["Diagnosis": "Glomerulonephritis and Nephrotic Syndrome"]
	union ["Diagnosis": "Diabetic Nephropathy"]
	union ["Diagnosis": "Proteinuria"] ) NephropathyDiagnoses
	where NephropathyDiagnoses.prevalencePeriod overlaps "Measurement Period"

Nephropathy Screenings

( "Renal Procedures"
	union "Renal Interventions"
	union "End Stage Renal Disease Encounter"
	union "Protein Urea Lab Test" ) ScreeningNephropathy
	where ScreeningNephropathy.relevantPeriod during "Measurement Period"

Numerator

exists ( "Active ACE or ARB Medications" )
	or exists ( "Nephropathy Diagnoses" )
	or exists ( "Nephropathy Screenings" )

Protein Urea Lab Test

["Laboratory Test, Performed": "Urine Protein Tests"] ProteinUreaResult
	where ProteinUreaResult.result is not null

Renal Interventions

["Intervention, Performed": "Other Services Related to Dialysis"]
	union ["Intervention, Performed": "Dialysis Education"]

Renal Procedures

( ["Procedure, Performed": "Kidney Transplant"]
		union ["Procedure, Performed": "Vascular Access for Dialysis"]
		union ["Procedure, Performed": "Dialysis Services"]
)

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

FrailtyLTI.CumulativeDays(Intervals List<Interval<DateTime>>)

Sum((collapse Intervals)CollapsedInterval
		return all duration in days of CollapsedInterval
)

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

Global.ToDate(Value DateTime)

DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezone 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)")
valueset "ACE Inhibitor or ARB" (2.16.840.1.113883.3.526.3.1139)
valueset "Acute Inpatient" (2.16.840.1.113883.3.464.1003.101.12.1083)
valueset "Advanced Illness" (2.16.840.1.113883.3.464.1003.110.12.1082)
valueset "Annual Wellness Visit" (2.16.840.1.113883.3.526.3.1240)
valueset "Care Services in Long-Term Residential Facility" (2.16.840.1.113883.3.464.1003.101.12.1014)
valueset "Dementia Medications" (2.16.840.1.113883.3.464.1003.196.12.1510)
valueset "Diabetes" (2.16.840.1.113883.3.464.1003.103.12.1001)
valueset "Diabetic Nephropathy" (2.16.840.1.113883.3.464.1003.109.12.1004)
valueset "Dialysis Education" (2.16.840.1.113883.3.464.1003.109.12.1016)
valueset "Dialysis Services" (2.16.840.1.113883.3.464.1003.109.12.1013)
valueset "ED" (2.16.840.1.113883.3.464.1003.101.12.1085)
valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
valueset "ESRD Monthly Outpatient Services" (2.16.840.1.113883.3.464.1003.109.12.1014)
valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
valueset "Frailty Device" (2.16.840.1.113883.3.464.1003.118.12.1300)
valueset "Frailty Diagnosis" (2.16.840.1.113883.3.464.1003.113.12.1074)
valueset "Frailty Encounter" (2.16.840.1.113883.3.464.1003.101.12.1088)
valueset "Frailty Symptom" (2.16.840.1.113883.3.464.1003.113.12.1075)
valueset "Glomerulonephritis and Nephrotic Syndrome" (2.16.840.1.113883.3.464.1003.109.12.1018)
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 "Hypertensive Chronic Kidney Disease" (2.16.840.1.113883.3.464.1003.109.12.1017)
valueset "Kidney Failure" (2.16.840.1.113883.3.464.1003.109.12.1028)
valueset "Kidney Transplant" (2.16.840.1.113883.3.464.1003.109.12.1012)
valueset "Nonacute Inpatient" (2.16.840.1.113883.3.464.1003.101.12.1084)
valueset "Nursing Facility Visit" (2.16.840.1.113883.3.464.1003.101.12.1012)
valueset "Observation" (2.16.840.1.113883.3.464.1003.101.12.1086)
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 "Other Services Related to Dialysis" (2.16.840.1.113883.3.464.1003.109.12.1015)
valueset "Outpatient" (2.16.840.1.113883.3.464.1003.101.12.1087)
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-Initial Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1023)
valueset "Proteinuria" (2.16.840.1.113883.3.526.3.1003)
valueset "Race" (2.16.840.1.114222.4.11.836)
valueset "Urine Protein Tests" (2.16.840.1.113883.3.464.1003.109.12.1024)
valueset "Vascular Access for Dialysis" (2.16.840.1.113883.3.464.1003.109.12.1011)

Data Criteria (QDM Data Elements)

"Device, Applied: Frailty Device" using "Frailty Device (2.16.840.1.113883.3.464.1003.118.12.1300)"
"Device, Order: Frailty Device" using "Frailty Device (2.16.840.1.113883.3.464.1003.118.12.1300)"
"Diagnosis: Diabetes" using "Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001)"
"Diagnosis: Diabetic Nephropathy" using "Diabetic Nephropathy (2.16.840.1.113883.3.464.1003.109.12.1004)"
"Diagnosis: Frailty Diagnosis" using "Frailty Diagnosis (2.16.840.1.113883.3.464.1003.113.12.1074)"
"Diagnosis: Glomerulonephritis and Nephrotic Syndrome" using "Glomerulonephritis and Nephrotic Syndrome (2.16.840.1.113883.3.464.1003.109.12.1018)"
"Diagnosis: Hypertensive Chronic Kidney Disease" using "Hypertensive Chronic Kidney Disease (2.16.840.1.113883.3.464.1003.109.12.1017)"
"Diagnosis: Kidney Failure" using "Kidney Failure (2.16.840.1.113883.3.464.1003.109.12.1028)"
"Diagnosis: Proteinuria" using "Proteinuria (2.16.840.1.113883.3.526.3.1003)"
"Encounter, Performed: Acute Inpatient" using "Acute Inpatient (2.16.840.1.113883.3.464.1003.101.12.1083)"
"Encounter, Performed: Annual Wellness Visit" using "Annual Wellness Visit (2.16.840.1.113883.3.526.3.1240)"
"Encounter, Performed: Care Services in Long-Term Residential Facility" using "Care Services in Long-Term Residential Facility (2.16.840.1.113883.3.464.1003.101.12.1014)"
"Encounter, Performed: ED" using "ED (2.16.840.1.113883.3.464.1003.101.12.1085)"
"Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
"Encounter, Performed: ESRD Monthly Outpatient Services" using "ESRD Monthly Outpatient Services (2.16.840.1.113883.3.464.1003.109.12.1014)"
"Encounter, Performed: Frailty Encounter" using "Frailty Encounter (2.16.840.1.113883.3.464.1003.101.12.1088)"
"Encounter, Performed: Home Healthcare Services" using "Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016)"
"Encounter, Performed: Nonacute Inpatient" using "Nonacute Inpatient (2.16.840.1.113883.3.464.1003.101.12.1084)"
"Encounter, Performed: Nursing Facility Visit" using "Nursing Facility Visit (2.16.840.1.113883.3.464.1003.101.12.1012)"
"Encounter, Performed: Observation" using "Observation (2.16.840.1.113883.3.464.1003.101.12.1086)"
"Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)"
"Encounter, Performed: Outpatient" using "Outpatient (2.16.840.1.113883.3.464.1003.101.12.1087)"
"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, 18 and Up" using "Preventive Care Services-Initial Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1023)"
"Intervention, Order: Hospice care ambulatory" using "Hospice care ambulatory (2.16.840.1.113762.1.4.1108.15)"
"Intervention, Performed: Dialysis Education" using "Dialysis Education (2.16.840.1.113883.3.464.1003.109.12.1016)"
"Intervention, Performed: Hospice care ambulatory" using "Hospice care ambulatory (2.16.840.1.113762.1.4.1108.15)"
"Intervention, Performed: Other Services Related to Dialysis" using "Other Services Related to Dialysis (2.16.840.1.113883.3.464.1003.109.12.1015)"
"Laboratory Test, Performed: Urine Protein Tests" using "Urine Protein Tests (2.16.840.1.113883.3.464.1003.109.12.1024)"
"Medication, Active: ACE Inhibitor or ARB" using "ACE Inhibitor or ARB (2.16.840.1.113883.3.526.3.1139)"
"Medication, Active: Dementia Medications" using "Dementia Medications (2.16.840.1.113883.3.464.1003.196.12.1510)"
"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: ONC Administrative Sex" using "ONC Administrative Sex (2.16.840.1.113762.1.4.1)"
"Procedure, Performed: Dialysis Services" using "Dialysis Services (2.16.840.1.113883.3.464.1003.109.12.1013)"
"Procedure, Performed: Kidney Transplant" using "Kidney Transplant (2.16.840.1.113883.3.464.1003.109.12.1012)"
"Procedure, Performed: Vascular Access for Dialysis" using "Vascular Access for Dialysis (2.16.840.1.113883.3.464.1003.109.12.1011)"
"Symptom: Frailty Symptom" using "Frailty Symptom (2.16.840.1.113883.3.464.1003.113.12.1075)"
"Patient Characteristic Birthdate: Birth date" using "Birth date (LOINC Code 21112-8)"

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