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Measure "measure-vte-1-FHIR" Version "3"

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Id: Measure/measure-vte-1-FHIR
Type:
system: http://hl7.org/fhir/measure-type
code: process
Identifier: system: http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/cms
value: 108
system: http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/nqf
value: 0371
Title: Venous Thromboembolism Prophylaxis
Status: active
Description: This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission
Use Context:

code: program

value:
text: eligibile-hospital

Topic:
system: http://loinc.org
code: 57024-2
display: Health Quality Measure Document
Contributor: author: The Joint Commission
Related:

type: citation

citation:
Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of venous thromboembolism. The Eighth ACCP Conference on antithrombotic and thrombolytic therapy. Chest. 2008; 133:381S-453S

type: citation

citation:
Guyatt, G.H., Akl, E.A., Crowther, M., Gutterman, D., Schunemann, H. Antithrombotic Therapy and Prevention of Thrombosis, 9th edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2012; 141(2)(Supp):7S-47S

type: citation

citation:
Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th Edition: American College of Chest Physicians Evidence-based Clinical Practice Guidelines. CHEST 2012 Feb; 141(2) (Supp):e419S-94S.

type: citation

citation:
National Quality Forum. National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism: Policy, Preferred Practices, and Initial Performance Measures. A Consensus Report. Washington, DC. NQF; 2006

type: citation

citation:
Shojania KG, Duncan BW, McDonald DM, et al. (Eds.). (2001). Making healthcare safer; A critical analysis of patient safety practices (Evidence Report/Technology Assessment No. 43). Prepared by the University of California at San Francisco-Stanford Evidenced-based Practice Center under Contract no. 290-97-0013 (AHRQ Publication NO.01-E058). Rockville, MD:Agency for Healthcare Research and Quality.

Library:

reference: Library/library-vte-1-FHIR

Disclaimer: These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty
Scoring:
system: http://hl7.org/fhir/measure-scoring
code: proportion
Rationale: Hospitalized patients at high-risk for VTE may develop an asymptomatic deep vein thrombosis (DVT), and die from pulmonary embolism (PE) even before the diagnosis is suspected. The majority of fatal events occur as sudden or abrupt death, underscoring the importance of prevention as the most critical action step for reducing death from PE (Geerts, et al, 2008).The estimated annual incidence of deep-vein thrombosis (DVT) and pulmonary embolism (PE), known collectively as venous thromboembolism (VTE), is approximately 900,000 (Geerts, et al, 2008). Approximately two-thirds of cases of DVT or PE are associated with recent hospitalization. This is consistent with the 2001 report by The Agency for Healthcare Research and Quality (AHRQ). AHRQ indicates that "the appropriate application of effective preventive measures in hospitals has major potential for improving patient safety by reducing the incidence of venous thromboembolism" (Shojania, 2001).Despite its proven effectiveness, rates of appropriate thromboprophylaxis remain low in both medical and surgical patients. A recent analysis from the ENDORSE survey, which evaluated prophylaxis rates in 17,084 major surgery patients, found that more than one third of patients at risk for VTE (38%) did not receive prophylaxis and that rates varied by surgery type (Cohen, et al., 2008).In a review of evidence-based patient safety practices, the Agency for Healthcare Research and Quality defined thromboprophylaxis against VTE as the "number one patient safety practice" for hospitalized patients (Shojania, 2001). Updated "safe practices" published by the National Quality Forum (NQF) recommend routine evaluation of hospitalized patients for risk of VTE and use of appropriate prophylaxis (National Quality Forum. National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism, 2006).As noted by the ACCP, a vast number of randomized clinical trials provide irrefutable evidence that thromboprophylaxis reduces VTE events, and there are studies that have also shown that fatal PE is prevented by thromboprophylaxis (Geerts, et al. 2008).Some select surgeries have previously been monitored in the Surgical Care Improvement Project; since performance on these surgeries has achieved very high levels, they are not included in this measure.
Clinical Recommendation: Failure to recognize and protect patients at risk for venous thromboembolism (VTE) increases the chances for acutely ill hospitalized patients at high risk for developing a deep vein thrombosis or dying from a pulmonary emboli. Screening all patients is the only evidence based practice in reducing incidence of disease. All hospitalized patients should be evaluated for primary VTE prophylaxis, and given appropriate prophylaxis when indicated.
Guidance: When low dose unfractionated heparin is administered for VTE Prophylaxis, the intended administration route for low dose unfractionated heparin is subcutaneous.Reasons for no pharmacological and no mechanical VTE prophylaxis must be explicitly documented by the MD/APN/PA or pharmacist and linked with VTE prophylaxis. Ambulation alone is not a sufficient reason for not administering VTE prophylaxis. In order for ambulation/patient ambulating to be considered as an acceptable reason, there needs to be explicit documentation, e.g., "patient out of bed and ambulating in halls - no VTE prophylaxis needed."
Group:

Identifier:
value: CMS125-group-1

Population:

Identifier:
value: initial-population-identifier

description: Patients age 18 and older discharged from hospital inpatient acute care without a diagnosis of venous thromboembolism (VTE) or obstetrics with a length of stay less than or equal to 120 days that ends during the measurement period

criteria: Initial Population

Identifier:
value: numerator-identifier

description: Patients who received VTE prophylaxis:- the day of or the day after hospital admission- the day of or the day after surgery end date for surgeries that end the day of or the day after hospital admissionPatients who have documentation of a reason why no VTE prophylaxis was given:- between arrival and hospital admission- the day of or the day after hospital admission- the day of or the day after surgery end date (for surgeries that end the day of or the day after hospital admission)

criteria: Numerator

Identifier:
value: denominator-identifier

description: All patients in the initial population

criteria: Denominator

Identifier:
value: denominator-exclusions-identifier

description: * Patients who have a length of stay less than 2 days* Patients with comfort measures documented anytime between arrival and the day after hospital admission* Patients with comfort measures documented by the day after surgery end date for surgeries that start the day of or the day after hospital admission* Patients who are direct admits to intensive care unit (ICU), or transferred to ICU the day of or the day after hospital admission with ICU length of stay greater than or equal to one day* Patients with a principal diagnosis of mental disorders or stroke* Patients with a principal procedure of Surgical Care Improvement Project (SCIP) VTE selected surgeries

criteria: Denominator Exclusion

Supplemental Data:

Identifier:
value: sde-ethnicity

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Ethnicity

Identifier:
value: sde-payer

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Payer

Identifier:
value: sde-race

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Race

Identifier:
value: sde-sex

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Sex


<?xml version="1.0" encoding="UTF-8"?>
<Measure xmlns="http://hl7.org/fhir">
  <id value="measure-vte-1-FHIR"/>
  <meta>
    <versionId value="3"/>
    <lastUpdated value="2020-06-28T07:17:29.609Z"/>
    <profile value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
      <table class="grid dict">
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Id: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Measure/measure-vte-1-FHIR</td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Type: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <span>
              <br/>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
                  <span>http://hl7.org/fhir/measure-type</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>code: </b>
                  <span>process</span>
                </span>
              </span>
            </span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="2" scope="row">
            <b>Identifier: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <b>system: </b>
            <span>http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/cms</span>
            <br/>
            <b>value: </b>
            <span>108</span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td style="padding-left: 25px padding-right: 25px">
            <b>system: </b>
            <span>http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/nqf</span>
            <br/>
            <b>value: </b>
            <span>0371</span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Title: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Venous Thromboembolism Prophylaxis</td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Status: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">active</td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Description: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission</td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Use Context: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="padding-left: 25px margin-bottom: 5px">
              <b>code: </b>
              <span>program</span>
            </p>
            <p style="padding-left: 25px margin-bottom: 5px">
              <b>value: </b>
              <br/>
              <span>
                <span style="padding-left: 25px">
                  <b>text: </b>
                  <span>eligibile-hospital</span>
                </span>
              </span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Topic: </b>
          </th>
          <td style="padding-right: 25px">
            <span>
              <br/>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
                  <span>http://loinc.org</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>code: </b>
                  <span>57024-2</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>display: </b>
                  <span>Health Quality Measure Document</span>
                </span>
              </span>
            </span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Contributor: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <b>
              <span>author</span>: </b>
            <span>The Joint Commission</span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="5" scope="row">
            <b>Related: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>type: </b>
              <span>citation</span>
            </p>
            <p style="margin-bottom: 5px">
              <b>citation: </b>
              <br/>
              <span>Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of venous thromboembolism. The Eighth ACCP Conference on antithrombotic and thrombolytic therapy. Chest. 2008 133:381S-453S</span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>type: </b>
              <span>citation</span>
            </p>
            <p style="margin-bottom: 5px">
              <b>citation: </b>
              <br/>
              <span>Guyatt, G.H., Akl, E.A., Crowther, M., Gutterman, D., Schunemann, H. Antithrombotic Therapy and Prevention of Thrombosis, 9th edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2012 141(2)(Supp):7S-47S</span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>type: </b>
              <span>citation</span>
            </p>
            <p style="margin-bottom: 5px">
              <b>citation: </b>
              <br/>
              <span>Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th Edition: American College of Chest Physicians Evidence-based Clinical Practice Guidelines. CHEST 2012 Feb 141(2) (Supp):e419S-94S.</span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>type: </b>
              <span>citation</span>
            </p>
            <p style="margin-bottom: 5px">
              <b>citation: </b>
              <br/>
              <span>National Quality Forum. National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism: Policy, Preferred Practices, and Initial Performance Measures. A Consensus Report. Washington, DC. NQF 2006</span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>type: </b>
              <span>citation</span>
            </p>
            <p style="margin-bottom: 5px">
              <b>citation: </b>
              <br/>
              <span>Shojania KG, Duncan BW, McDonald DM, et al. (Eds.). (2001). Making healthcare safer A critical analysis of patient safety practices (Evidence Report/Technology Assessment No. 43). Prepared by the University of California at San Francisco-Stanford Evidenced-based Practice Center under Contract no. 290-97-0013 (AHRQ Publication NO.01-E058). Rockville, MD:Agency for Healthcare Research and Quality.</span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Library: </b>
          </th>
          <td>
            <p style="padding-left: 25px padding-right: 25px">
              <b>reference: </b>
              <span>Library/library-vte-1-FHIR</span>
            </p>
          </td>
        </tr>
        <tr>
          <th scope="row">
            <b>Disclaimer: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty</td>
        </tr>
        <tr>
          <th scope="row">
            <b>Scoring: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <span>
              <br/>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
                  <span>http://hl7.org/fhir/measure-scoring</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>code: </b>
                  <span>proportion</span>
                </span>
              </span>
            </span>
          </td>
        </tr>
        <tr>
          <th scope="row">
            <b>Rationale: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Hospitalized patients at high-risk for VTE may develop an asymptomatic deep vein thrombosis (DVT), and die from pulmonary embolism (PE) even before the diagnosis is suspected. The majority of fatal events occur as sudden or abrupt death, underscoring the importance of prevention as the most critical action step for reducing death from PE (Geerts, et al, 2008).The estimated annual incidence of deep-vein thrombosis (DVT) and pulmonary embolism (PE), known collectively as venous thromboembolism (VTE), is approximately 900,000 (Geerts, et al, 2008). Approximately two-thirds of cases of DVT or PE are associated with recent hospitalization. This is consistent with the 2001 report by The Agency for Healthcare Research and Quality (AHRQ). AHRQ indicates that "the appropriate application of effective preventive measures in hospitals has major potential for improving patient safety by reducing the incidence of venous thromboembolism" (Shojania, 2001).Despite its proven effectiveness, rates of appropriate thromboprophylaxis remain low in both medical and surgical patients. A recent analysis from the ENDORSE survey, which evaluated prophylaxis rates in 17,084 major surgery patients, found that more than one third of patients at risk for VTE (38%) did not receive prophylaxis and that rates varied by surgery type (Cohen, et al., 2008).In a review of evidence-based patient safety practices, the Agency for Healthcare Research and Quality defined thromboprophylaxis against VTE as the "number one patient safety practice" for hospitalized patients (Shojania, 2001). Updated "safe practices" published by the National Quality Forum (NQF) recommend routine evaluation of hospitalized patients for risk of VTE and use of appropriate prophylaxis (National Quality Forum. National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism, 2006).As noted by the ACCP, a vast number of randomized clinical trials provide irrefutable evidence that thromboprophylaxis reduces VTE events, and there are studies that have also shown that fatal PE is prevented by thromboprophylaxis (Geerts, et al. 2008).Some select surgeries have previously been monitored in the Surgical Care Improvement Project since performance on these surgeries has achieved very high levels, they are not included in this measure.</td>
        </tr>
        <tr>
          <th scope="row">
            <b>Clinical Recommendation: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Failure to recognize and protect patients at risk for venous thromboembolism (VTE) increases the chances for acutely ill hospitalized patients at high risk for developing a deep vein thrombosis or dying from a pulmonary emboli. Screening all patients is the only evidence based practice in reducing incidence of disease. All hospitalized patients should be evaluated for primary VTE prophylaxis, and given appropriate prophylaxis when indicated.</td>
        </tr>
        <tr>
          <th scope="row">
            <b>Guidance: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">When low dose unfractionated heparin is administered for VTE Prophylaxis, the intended administration route for low dose unfractionated heparin is subcutaneous.Reasons for no pharmacological and no mechanical VTE prophylaxis must be explicitly documented by the MD/APN/PA or pharmacist and linked with VTE prophylaxis. Ambulation alone is not a sufficient reason for not administering VTE prophylaxis. In order for ambulation/patient ambulating to be considered as an acceptable reason, there needs to be explicit documentation, e.g., "patient out of bed and ambulating in halls - no VTE prophylaxis needed."</td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Group:</b>
          </th>
          <td>
            <p style="padding-left: 25px padding-right: 25px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>CMS125-group-1</span>
                <br/>
              </span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td colspan="2">
            <table style="margin-bottom: 5px width: 100%">
              <tr style="vertical-align: top">
                <th rowspan="4" scope="row" style="padding-left: 25px">
                  <b>Population:</b>
                </th>
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>initial-population-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>description: </b>
                    <span>Patients age 18 and older discharged from hospital inpatient acute care without a diagnosis of venous thromboembolism (VTE) or obstetrics with a length of stay less than or equal to 120 days that ends during the measurement period</span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Initial Population</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>numerator-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>description: </b>
                    <span>Patients who received VTE prophylaxis:- the day of or the day after hospital admission- the day of or the day after surgery end date for surgeries that end the day of or the day after hospital admissionPatients who have documentation of a reason why no VTE prophylaxis was given:- between arrival and hospital admission- the day of or the day after hospital admission- the day of or the day after surgery end date (for surgeries that end the day of or the day after hospital admission)</span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Numerator</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>denominator-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>description: </b>
                    <span>All patients in the initial population</span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Denominator</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>denominator-exclusions-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>description: </b>
                    <span>* Patients who have a length of stay less than 2 days* Patients with comfort measures documented anytime between arrival and the day after hospital admission* Patients with comfort measures documented by the day after surgery end date for surgeries that start the day of or the day after hospital admission* Patients who are direct admits to intensive care unit (ICU), or transferred to ICU the day of or the day after hospital admission with ICU length of stay greater than or equal to one day* Patients with a principal diagnosis of mental disorders or stroke* Patients with a principal procedure of Surgical Care Improvement Project (SCIP) VTE selected surgeries</span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Denominator Exclusion</span>
                  </p>
                </td>
              </tr>
            </table>
          </td>
        </tr>
        <tr>
          <th rowspan="4" scope="row">
            <b>Supplemental Data:</b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>sde-ethnicity</span>
                <br/>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>usage: </b>
              <span>
                <span>
                  <br/>
                  <span>
                    <span style="padding-left: 25px">
                      <b>system: </b>
                      <span>http://hl7.org/fhir/measure-data-usage</span>
                      <br/>
                    </span>
                    <span style="padding-left: 25px">
                      <b>code: </b>
                      <span>supplemental-data</span>
                    </span>
                  </span>
                </span>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>criteria: </b>
              <span>SDE Ethnicity</span>
            </p>
          </td>
        </tr>
        <tr>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>sde-payer</span>
                <br/>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>usage: </b>
              <span>
                <span>
                  <br/>
                  <span>
                    <span style="padding-left: 25px">
                      <b>system: </b>
                      <span>http://hl7.org/fhir/measure-data-usage</span>
                      <br/>
                    </span>
                    <span style="padding-left: 25px">
                      <b>code: </b>
                      <span>supplemental-data</span>
                    </span>
                  </span>
                </span>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>criteria: </b>
              <span>SDE Payer</span>
            </p>
          </td>
        </tr>
        <tr>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>sde-race</span>
                <br/>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>usage: </b>
              <span>
                <span>
                  <br/>
                  <span>
                    <span style="padding-left: 25px">
                      <b>system: </b>
                      <span>http://hl7.org/fhir/measure-data-usage</span>
                      <br/>
                    </span>
                    <span style="padding-left: 25px">
                      <b>code: </b>
                      <span>supplemental-data</span>
                    </span>
                  </span>
                </span>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>criteria: </b>
              <span>SDE Race</span>
            </p>
          </td>
        </tr>
        <tr>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>sde-sex</span>
                <br/>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>usage: </b>
              <span>
                <span>
                  <br/>
                  <span>
                    <span style="padding-left: 25px">
                      <b>system: </b>
                      <span>http://hl7.org/fhir/measure-data-usage</span>
                      <br/>
                    </span>
                    <span style="padding-left: 25px">
                      <b>code: </b>
                      <span>supplemental-data</span>
                    </span>
                  </span>
                </span>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>criteria: </b>
              <span>SDE Sex</span>
            </p>
          </td>
        </tr>
      </table>
    </div>
  </text>
  <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
    <valueCode value="Encounter"/>
  </extension>
  <url value="http://hl7.org/fhir/us/cqfmeasures/Measure/measure-vte-1-FHIR"/>
  <identifier>
    <use value="official"/>
    <system value="http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/cms"/>
    <value value="108"/>
  </identifier>
  <identifier>
    <use value="official"/>
    <system value="http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/nqf"/>
    <value value="0371"/>
  </identifier>
  <version value="7.4.000"/>
  <name value="VTE_1_FHIR"/>
  <title value="Venous Thromboembolism Prophylaxis"/>
  <status value="active"/>
  <experimental value="true"/>
  <date value="2018-08-31"/>
  <publisher value="The Joint Commission"/>
  <description value="This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission"/>
  <approvalDate value="2019-03-08"/>
  <lastReviewDate value="2019-03-08"/>
  <effectivePeriod>
    <start value="2018-01-01"/>
    <end value="2018-12-31"/>
  </effectivePeriod>
  <useContext>
    <code>
      <code value="program"/>
    </code>
    <valueCodeableConcept>
      <text value="eligibile-hospital"/>
    </valueCodeableConcept>
  </useContext>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <topic>
    <coding>
      <system value="http://loinc.org"/>
      <code value="57024-2"/>
      <display value="Health Quality Measure Document"/>
    </coding>
  </topic>
  <contributor>
    <type value="author"/>
    <name value="The Joint Commission"/>
  </contributor>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="https://www.jointcommission.org/"/>
    </telecom>
  </contact>
  <copyright value="Measure specifications are in the Public Domain.&#10;&#10;LOINC(R) is a registered trademark of the Regenstrief Institute.&#10;&#10;This material contains SNOMED Clinical Terms(R) (SNOMED CT(C)) copyright 2004-2017 International Health Terminology Standards Development Organization. All rights reserved."/>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of venous thromboembolism. The Eighth ACCP Conference on antithrombotic and thrombolytic therapy. Chest. 2008 133:381S-453S"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Guyatt, G.H., Akl, E.A., Crowther, M., Gutterman, D., Schunemann, H. Antithrombotic Therapy and Prevention of Thrombosis, 9th edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2012 141(2)(Supp):7S-47S"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th Edition: American College of Chest Physicians Evidence-based Clinical Practice Guidelines. CHEST 2012 Feb 141(2) (Supp):e419S-94S."/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="National Quality Forum. National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism: Policy, Preferred Practices, and Initial Performance Measures. A Consensus Report. Washington, DC. NQF 2006"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Shojania KG, Duncan BW, McDonald DM, et al. (Eds.). (2001). Making healthcare safer A critical analysis of patient safety practices (Evidence Report/Technology Assessment No. 43). Prepared by the University of California at San Francisco-Stanford Evidenced-based Practice Center under Contract no. 290-97-0013 (AHRQ Publication NO.01-E058). Rockville, MD:Agency for Healthcare Research and Quality."/>
  </relatedArtifact>
  <library>
    <reference value="Library/library-vte-1-FHIR"/>
  </library>
  <disclaimer value="These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty"/>
  <scoring>
    <coding>
      <system value="http://hl7.org/fhir/measure-scoring"/>
      <code value="proportion"/>
    </coding>
  </scoring>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/measure-type"/>
      <code value="process"/>
    </coding>
  </type>
  <rationale value="Hospitalized patients at high-risk for VTE may develop an asymptomatic deep vein thrombosis (DVT), and die from pulmonary embolism (PE) even before the diagnosis is suspected. The majority of fatal events occur as sudden or abrupt death, underscoring the importance of prevention as the most critical action step for reducing death from PE (Geerts, et al, 2008).&#10;&#10;The estimated annual incidence of deep-vein thrombosis (DVT) and pulmonary embolism (PE), known collectively as venous thromboembolism (VTE), is approximately 900,000 (Geerts, et al, 2008). Approximately two-thirds of cases of DVT or PE are associated with recent hospitalization. This is consistent with the 2001 report by The Agency for Healthcare Research and Quality (AHRQ). AHRQ indicates that &quot;the appropriate application of effective preventive measures in hospitals has major potential for improving patient safety by reducing the incidence of venous thromboembolism&quot; (Shojania, 2001).&#10;&#10;Despite its proven effectiveness, rates of appropriate thromboprophylaxis remain low in both medical and surgical patients. A recent analysis from the ENDORSE survey, which evaluated prophylaxis rates in 17,084 major surgery patients, found that more than one third of patients at risk for VTE (38%) did not receive prophylaxis and that rates varied by surgery type (Cohen, et al., 2008).&#10;&#10;In a review of evidence-based patient safety practices, the Agency for Healthcare Research and Quality defined thromboprophylaxis against VTE as the &quot;number one patient safety practice&quot; for hospitalized patients (Shojania, 2001). Updated &quot;safe practices&quot; published by the National Quality Forum (NQF) recommend routine evaluation of hospitalized patients for risk of VTE and use of appropriate prophylaxis (National Quality Forum. National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism, 2006).&#10;&#10;As noted by the ACCP, a vast number of randomized clinical trials provide irrefutable evidence that thromboprophylaxis reduces VTE events, and there are studies that have also shown that fatal PE is prevented by thromboprophylaxis (Geerts, et al. 2008).&#10;&#10;Some select surgeries have previously been monitored in the Surgical Care Improvement Project since performance on these surgeries has achieved very high levels, they are not included in this measure."/>
  <clinicalRecommendationStatement value="Failure to recognize and protect patients at risk for venous thromboembolism (VTE) increases the chances for acutely ill hospitalized patients at high risk for developing a deep vein thrombosis or dying from a pulmonary emboli. Screening all patients is the only evidence based practice in reducing incidence of disease. All hospitalized patients should be evaluated for primary VTE prophylaxis, and given appropriate prophylaxis when indicated."/>
  <improvementNotation value="increase"/>
  <guidance value="When low dose unfractionated heparin is administered for VTE Prophylaxis, the intended administration route for low dose unfractionated heparin is subcutaneous.&#10;&#10;Reasons for no pharmacological and no mechanical VTE prophylaxis must be explicitly documented by the MD/APN/PA or pharmacist and linked with VTE prophylaxis. Ambulation alone is not a sufficient reason for not administering VTE prophylaxis. In order for ambulation/patient ambulating to be considered as an acceptable reason, there needs to be explicit documentation, e.g., &quot;patient out of bed and ambulating in halls - no VTE prophylaxis needed.&quot;"/>
  <group>
    <identifier>
      <value value="CMS125-group-1"/>
    </identifier>
    <population>
      <identifier>
        <value value="initial-population-identifier"/>
      </identifier>
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="initial-population"/>
          <display value="Initial Population"/>
        </coding>
      </code>
      <description value="Patients age 18 and older discharged from hospital inpatient acute care without a diagnosis of venous thromboembolism (VTE) or obstetrics with a length of stay less than or equal to 120 days that ends during the measurement period"/>
      <criteria value="Initial Population"/>
    </population>
    <population>
      <identifier>
        <value value="numerator-identifier"/>
      </identifier>
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="numerator"/>
          <display value="Numerator"/>
        </coding>
      </code>
      <description value="Patients who received VTE prophylaxis:&#10;- the day of or the day after hospital admission&#10;- the day of or the day after surgery end date for surgeries that end the day of or the day after hospital admission&#10;&#10;Patients who have documentation of a reason why no VTE prophylaxis was given:&#10;- between arrival and hospital admission&#10;- the day of or the day after hospital admission&#10;- the day of or the day after surgery end date (for surgeries that end the day of or the day after hospital admission)"/>
      <criteria value="Numerator"/>
    </population>
    <population>
      <identifier>
        <value value="denominator-identifier"/>
      </identifier>
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="denominator"/>
          <display value="Denominator"/>
        </coding>
      </code>
      <description value="All patients in the initial population"/>
      <criteria value="Denominator"/>
    </population>
    <population>
      <identifier>
        <value value="denominator-exclusions-identifier"/>
      </identifier>
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="denominator-exclusion"/>
          <display value="Denominator Exclusion"/>
        </coding>
      </code>
      <description value="* Patients who have a length of stay less than 2 days&#10;* Patients with comfort measures documented anytime between arrival and the day after hospital admission&#10;* Patients with comfort measures documented by the day after surgery end date for surgeries that start the day of or the day after hospital admission&#10;* Patients who are direct admits to intensive care unit (ICU), or transferred to ICU the day of or the day after hospital admission with ICU length of stay greater than or equal to one day&#10;* Patients with a principal diagnosis of mental disorders or stroke&#10;* Patients with a principal procedure of Surgical Care Improvement Project (SCIP) VTE selected surgeries"/>
      <criteria value="Denominator Exclusion"/>
    </population>
  </group>
  <supplementalData>
    <identifier>
      <value value="sde-ethnicity"/>
    </identifier>
    <usage>
      <coding>
        <system value="http://hl7.org/fhir/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <criteria value="SDE Ethnicity"/>
  </supplementalData>
  <supplementalData>
    <identifier>
      <value value="sde-payer"/>
    </identifier>
    <usage>
      <coding>
        <system value="http://hl7.org/fhir/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <criteria value="SDE Payer"/>
  </supplementalData>
  <supplementalData>
    <identifier>
      <value value="sde-race"/>
    </identifier>
    <usage>
      <coding>
        <system value="http://hl7.org/fhir/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <criteria value="SDE Race"/>
  </supplementalData>
  <supplementalData>
    <identifier>
      <value value="sde-sex"/>
    </identifier>
    <usage>
      <coding>
        <system value="http://hl7.org/fhir/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <criteria value="SDE Sex"/>
  </supplementalData>
</Measure>

Measure "measure-terminology-FHIR" Version "3"

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This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

Id: Measure/measure-terminology-FHIR
Type: system: http://hl7.org/fhir/measure-type
code: process
Identifier: system: http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm
value: Terminology_FHIR
Title: Terminology FHIR
Status: active
Description: This example illustrates the use of risk adjustment variables within a measure represented as a FHIR eCQM
Topic: system: http://loinc.org
code: 57024-2
display: Health Quality Measure Document
Library:

reference: Library/library-terminology-FHIR

Scoring: system: http://hl7.org/fhir/measure-scoring
code: cohort
Group:

Identifier:
value: group-1

Population:

Identifier:
value: initial-population-identifier

criteria: Initial Population


<?xml version="1.0" encoding="UTF-8"?>
<Measure xmlns="http://hl7.org/fhir">
  <id value="measure-terminology-FHIR"/>
  <meta>
    <versionId value="3"/>
    <lastUpdated value="2020-06-28T07:17:29.250Z"/>
    <profile value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cohort-measure-cqfm"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
      <table class="grid dict">
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Id: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Measure/measure-terminology-FHIR</td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Type: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <span>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
                  <span>http://hl7.org/fhir/measure-type</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>code: </b>
                  <span>process</span>
                </span>
              </span>
            </span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Identifier: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <b>system: </b>
            <span>http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm</span>
            <br/>
            <b>value: </b>
            <span>Terminology_FHIR</span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Title: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Terminology FHIR</td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Status: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">active</td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Description: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">This example illustrates the use of risk adjustment variables within a measure represented as a FHIR eCQM</td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Topic: </b>
          </th>
          <td style="padding-right: 25px">
            <span>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
                  <span>http://loinc.org</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>code: </b>
                  <span>57024-2</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>display: </b>
                  <span>Health Quality Measure Document</span>
                </span>
              </span>
            </span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Library: </b>
          </th>
          <td>
            <p style="padding-left: 25px padding-right: 25px">
              <b>reference: </b>
              <span>Library/library-terminology-FHIR</span>
            </p>
          </td>
        </tr>
        <tr>
          <th scope="row">
            <b>Scoring: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <span>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
                  <span>http://hl7.org/fhir/measure-scoring</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>code: </b>
                  <span>cohort</span>
                </span>
              </span>
            </span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Group:</b>
          </th>
          <td>
            <p style="padding-left: 25px padding-right: 25px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>group-1</span>
                <br/>
              </span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td colspan="2">
            <table style="margin-bottom: 5px width: 100%">
              <tr style="vertical-align: top">
                <th rowspan="1" scope="row" style="padding-left: 25px">
                  <b>Population:</b>
                </th>
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>initial-population-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Initial Population</span>
                  </p>
                </td>
              </tr>
            </table>
          </td>
        </tr>
      </table>
    </div>
  </text>
  <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
    <valueCode value="Encounter"/>
  </extension>
  <url value="http://hl7.org/fhir/us/cqfmeasures/Measure/measure-terminology-FHIR"/>
  <identifier>
    <use value="official"/>
    <system value="http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm"/>
    <value value="Terminology_FHIR"/>
  </identifier>
  <version value="1.0.0"/>
  <name value="Terminology_FHIR"/>
  <title value="Terminology FHIR"/>
  <status value="active"/>
  <experimental value="true"/>
  <date value="2019-02-21"/>
  <publisher value="Health Level 7 International - Clinical Quality Information Work Group"/>
  <description value="This example illustrates the use of risk adjustment variables within a measure represented as a FHIR eCQM"/>
  <approvalDate value="2019-03-08"/>
  <lastReviewDate value="2019-03-08"/>
  <effectivePeriod>
    <start value="2018-01-01"/>
    <end value="2018-12-31"/>
  </effectivePeriod>
  <topic>
    <coding>
      <system value="http://loinc.org"/>
      <code value="57024-2"/>
      <display value="Health Quality Measure Document"/>
    </coding>
  </topic>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/cqi/index.cfm"/>
    </telecom>
  </contact>
  <library>
    <reference value="Library/library-terminology-FHIR"/>
  </library>
  <scoring>
    <coding>
      <system value="http://hl7.org/fhir/measure-scoring"/>
      <code value="cohort"/>
    </coding>
  </scoring>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/measure-type"/>
      <code value="process"/>
    </coding>
  </type>
  <improvementNotation value="decrease"/>
  <group>
    <identifier>
      <value value="group-1"/>
    </identifier>
    <population>
      <identifier>
        <value value="initial-population-identifier"/>
      </identifier>
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="initial-population"/>
          <display value="Initial Population"/>
        </coding>
      </code>
      <criteria value="Initial Population"/>
    </population>
  </group>
</Measure>

Measure "measure-risk-adjustment-FHIR2" Version "3"

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

Id: Measure/measure-risk-adjustment-FHIR2
Type:
system: http://hl7.org/fhir/measure-type
code: process
Identifier: system: http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm
value: RiskAdjustment_FHIR2
Title: Risk Adjustment FHIR DSTU2
Status: active
Description: This example illustrates the use of risk adjustment variables within a measure represented as a FHIR eCQM
Topic:
system: http://loinc.org
code: 57024-2
display: Health Quality Measure Document
Library:

reference: Library/library-risk-adjustment-FHIR2

Scoring:
system: http://hl7.org/fhir/measure-scoring
code: proportion
Group:

Identifier:
value: group-1

Population:

Identifier:
value: initial-population-identifier

criteria: Initial Population

Identifier:
value: numerator-identifier

criteria: Numerator

Identifier:
value: denominator-identifier

criteria: Denominator

Supplemental Data:

Identifier:
value: sde-ethnicity

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Ethnicity

Identifier:
value: sde-payer

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Payer

Identifier:
value: sde-race

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Race

Identifier:
value: sde-sex

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Sex

Identifier:
value: hepatic-failure

usage:
system: http://hl7.org/fhir/measure-data-usage
code: risk-adjustment-factor

criteria: Hepatic Failure

Identifier:
value: cirrhosis-dx

usage:
system: http://hl7.org/fhir/measure-data-usage
code: risk-adjustment-factor

criteria: Cirrhosis Dx

Identifier:
value: bilirubin-test

usage:
system: http://hl7.org/fhir/measure-data-usage
code: risk-adjustment-factor

criteria: Bilirubin Test

Identifier:
value: serum-albumin-test

usage:
system: http://hl7.org/fhir/measure-data-usage
code: risk-adjustment-factor

criteria: Serum Albumin Test


<?xml version="1.0" encoding="UTF-8"?>
<Measure xmlns="http://hl7.org/fhir">
  <id value="measure-risk-adjustment-FHIR2"/>
  <meta>
    <versionId value="3"/>
    <lastUpdated value="2020-06-28T07:17:28.906Z"/>
    <profile value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
      <table class="grid dict">
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Id: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Measure/measure-risk-adjustment-FHIR2</td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Type: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <span>
              <br/>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
                  <span>http://hl7.org/fhir/measure-type</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>code: </b>
                  <span>process</span>
                </span>
              </span>
            </span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Identifier: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <b>system: </b>
            <span>http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm</span>
            <br/>
            <b>value: </b>
            <span>RiskAdjustment_FHIR2</span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Title: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Risk Adjustment FHIR DSTU2</td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Status: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">active</td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Description: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">This example illustrates the use of risk adjustment variables within a measure represented as a FHIR eCQM</td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Topic: </b>
          </th>
          <td style="padding-right: 25px">
            <span>
              <br/>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
                  <span>http://loinc.org</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>code: </b>
                  <span>57024-2</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>display: </b>
                  <span>Health Quality Measure Document</span>
                </span>
              </span>
            </span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Library: </b>
          </th>
          <td>
            <p style="padding-left: 25px padding-right: 25px">
              <b>reference: </b>
              <span>Library/library-risk-adjustment-FHIR2</span>
            </p>
          </td>
        </tr>
        <tr>
          <th scope="row">
            <b>Scoring: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <span>
              <br/>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
                  <span>http://hl7.org/fhir/measure-scoring</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>code: </b>
                  <span>proportion</span>
                </span>
              </span>
            </span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Group:</b>
          </th>
          <td>
            <p style="padding-left: 25px padding-right: 25px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>group-1</span>
                <br/>
              </span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td colspan="2">
            <table style="margin-bottom: 5px width: 100%">
              <tr style="vertical-align: top">
                <th rowspan="3" scope="row" style="padding-left: 25px">
                  <b>Population:</b>
                </th>
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>initial-population-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Initial Population</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>numerator-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Numerator</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>denominator-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Denominator</span>
                  </p>
                </td>
              </tr>
            </table>
          </td>
        </tr>
        <tr>
          <th rowspan="8" scope="row">
            <b>Supplemental Data:</b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>sde-ethnicity</span>
                <br/>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>usage: </b>
              <span>
                <span>
                  <br/>
                  <span>
                    <span style="padding-left: 25px">
                      <b>system: </b>
                      <span>http://hl7.org/fhir/measure-data-usage</span>
                      <br/>
                    </span>
                    <span style="padding-left: 25px">
                      <b>code: </b>
                      <span>supplemental-data</span>
                    </span>
                  </span>
                </span>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>criteria: </b>
              <span>SDE Ethnicity</span>
            </p>
          </td>
        </tr>
        <tr>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>sde-payer</span>
                <br/>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>usage: </b>
              <span>
                <span>
                  <br/>
                  <span>
                    <span style="padding-left: 25px">
                      <b>system: </b>
                      <span>http://hl7.org/fhir/measure-data-usage</span>
                      <br/>
                    </span>
                    <span style="padding-left: 25px">
                      <b>code: </b>
                      <span>supplemental-data</span>
                    </span>
                  </span>
                </span>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>criteria: </b>
              <span>SDE Payer</span>
            </p>
          </td>
        </tr>
        <tr>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>sde-race</span>
                <br/>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>usage: </b>
              <span>
                <span>
                  <br/>
                  <span>
                    <span style="padding-left: 25px">
                      <b>system: </b>
                      <span>http://hl7.org/fhir/measure-data-usage</span>
                      <br/>
                    </span>
                    <span style="padding-left: 25px">
                      <b>code: </b>
                      <span>supplemental-data</span>
                    </span>
                  </span>
                </span>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>criteria: </b>
              <span>SDE Race</span>
            </p>
          </td>
        </tr>
        <tr>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>sde-sex</span>
                <br/>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>usage: </b>
              <span>
                <span>
                  <br/>
                  <span>
                    <span style="padding-left: 25px">
                      <b>system: </b>
                      <span>http://hl7.org/fhir/measure-data-usage</span>
                      <br/>
                    </span>
                    <span style="padding-left: 25px">
                      <b>code: </b>
                      <span>supplemental-data</span>
                    </span>
                  </span>
                </span>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>criteria: </b>
              <span>SDE Sex</span>
            </p>
          </td>
        </tr>
        <tr>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>hepatic-failure</span>
                <br/>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>usage: </b>
              <span>
                <span>
                  <br/>
                  <span>
                    <span style="padding-left: 25px">
                      <b>system: </b>
                      <span>http://hl7.org/fhir/measure-data-usage</span>
                      <br/>
                    </span>
                    <span style="padding-left: 25px">
                      <b>code: </b>
                      <span>risk-adjustment-factor</span>
                    </span>
                  </span>
                </span>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>criteria: </b>
              <span>Hepatic Failure</span>
            </p>
          </td>
        </tr>
        <tr>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>cirrhosis-dx</span>
                <br/>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>usage: </b>
              <span>
                <span>
                  <br/>
                  <span>
                    <span style="padding-left: 25px">
                      <b>system: </b>
                      <span>http://hl7.org/fhir/measure-data-usage</span>
                      <br/>
                    </span>
                    <span style="padding-left: 25px">
                      <b>code: </b>
                      <span>risk-adjustment-factor</span>
                    </span>
                  </span>
                </span>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>criteria: </b>
              <span>Cirrhosis Dx</span>
            </p>
          </td>
        </tr>
        <tr>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>bilirubin-test</span>
                <br/>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>usage: </b>
              <span>
                <span>
                  <br/>
                  <span>
                    <span style="padding-left: 25px">
                      <b>system: </b>
                      <span>http://hl7.org/fhir/measure-data-usage</span>
                      <br/>
                    </span>
                    <span style="padding-left: 25px">
                      <b>code: </b>
                      <span>risk-adjustment-factor</span>
                    </span>
                  </span>
                </span>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>criteria: </b>
              <span>Bilirubin Test</span>
            </p>
          </td>
        </tr>
        <tr>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>serum-albumin-test</span>
                <br/>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>usage: </b>
              <span>
                <span>
                  <br/>
                  <span>
                    <span style="padding-left: 25px">
                      <b>system: </b>
                      <span>http://hl7.org/fhir/measure-data-usage</span>
                      <br/>
                    </span>
                    <span style="padding-left: 25px">
                      <b>code: </b>
                      <span>risk-adjustment-factor</span>
                    </span>
                  </span>
                </span>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>criteria: </b>
              <span>Serum Albumin Test</span>
            </p>
          </td>
        </tr>
      </table>
    </div>
  </text>
  <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
    <valueCode value="Encounter"/>
  </extension>
  <url value="http://hl7.org/fhir/us/cqfmeasures/Measure/measure-risk-adjustment-FHIR2"/>
  <identifier>
    <use value="official"/>
    <system value="http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm"/>
    <value value="RiskAdjustment_FHIR2"/>
  </identifier>
  <version value="1.0.0"/>
  <name value="RiskAdjustment_FHIR2"/>
  <title value="Risk Adjustment FHIR DSTU2"/>
  <status value="active"/>
  <experimental value="true"/>
  <date value="2019-02-21"/>
  <publisher value="Health Level 7 International - Clinical Quality Information Work Group"/>
  <description value="This example illustrates the use of risk adjustment variables within a measure represented as a FHIR eCQM"/>
  <approvalDate value="2019-03-08"/>
  <lastReviewDate value="2019-03-08"/>
  <effectivePeriod>
    <start value="2018-01-01"/>
    <end value="2018-12-31"/>
  </effectivePeriod>
  <topic>
    <coding>
      <system value="http://loinc.org"/>
      <code value="57024-2"/>
      <display value="Health Quality Measure Document"/>
    </coding>
  </topic>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/cqi/index.cfm"/>
    </telecom>
  </contact>
  <library>
    <reference value="Library/library-risk-adjustment-FHIR2"/>
  </library>
  <scoring>
    <coding>
      <system value="http://hl7.org/fhir/measure-scoring"/>
      <code value="proportion"/>
    </coding>
  </scoring>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/measure-type"/>
      <code value="process"/>
    </coding>
  </type>
  <improvementNotation value="decrease"/>
  <group>
    <identifier>
      <value value="group-1"/>
    </identifier>
    <population>
      <identifier>
        <value value="initial-population-identifier"/>
      </identifier>
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="initial-population"/>
          <display value="Initial Population"/>
        </coding>
      </code>
      <criteria value="Initial Population"/>
    </population>
    <population>
      <identifier>
        <value value="numerator-identifier"/>
      </identifier>
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="numerator"/>
          <display value="Numerator"/>
        </coding>
      </code>
      <criteria value="Numerator"/>
    </population>
    <population>
      <identifier>
        <value value="denominator-identifier"/>
      </identifier>
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="denominator"/>
          <display value="Denominator"/>
        </coding>
      </code>
      <criteria value="Denominator"/>
    </population>
  </group>
  <supplementalData>
    <identifier>
      <value value="sde-ethnicity"/>
    </identifier>
    <usage>
      <coding>
        <system value="http://hl7.org/fhir/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <criteria value="SDE Ethnicity"/>
  </supplementalData>
  <supplementalData>
    <identifier>
      <value value="sde-payer"/>
    </identifier>
    <usage>
      <coding>
        <system value="http://hl7.org/fhir/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <criteria value="SDE Payer"/>
  </supplementalData>
  <supplementalData>
    <identifier>
      <value value="sde-race"/>
    </identifier>
    <usage>
      <coding>
        <system value="http://hl7.org/fhir/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <criteria value="SDE Race"/>
  </supplementalData>
  <supplementalData>
    <identifier>
      <value value="sde-sex"/>
    </identifier>
    <usage>
      <coding>
        <system value="http://hl7.org/fhir/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <criteria value="SDE Sex"/>
  </supplementalData>
  <supplementalData>
    <identifier>
      <value value="hepatic-failure"/>
    </identifier>
    <usage>
      <coding>
        <system value="http://hl7.org/fhir/measure-data-usage"/>
        <code value="risk-adjustment-factor"/>
      </coding>
    </usage>
    <criteria value="Hepatic Failure"/>
  </supplementalData>
  <supplementalData>
    <identifier>
      <value value="cirrhosis-dx"/>
    </identifier>
    <usage>
      <coding>
        <system value="http://hl7.org/fhir/measure-data-usage"/>
        <code value="risk-adjustment-factor"/>
      </coding>
    </usage>
    <criteria value="Cirrhosis Dx"/>
  </supplementalData>
  <supplementalData>
    <identifier>
      <value value="bilirubin-test"/>
    </identifier>
    <usage>
      <coding>
        <system value="http://hl7.org/fhir/measure-data-usage"/>
        <code value="risk-adjustment-factor"/>
      </coding>
    </usage>
    <criteria value="Bilirubin Test"/>
  </supplementalData>
  <supplementalData>
    <identifier>
      <value value="serum-albumin-test"/>
    </identifier>
    <usage>
      <coding>
        <system value="http://hl7.org/fhir/measure-data-usage"/>
        <code value="risk-adjustment-factor"/>
      </coding>
    </usage>
    <criteria value="Serum Albumin Test"/>
  </supplementalData>
</Measure>

Measure "measure-exm55-FHIR" Version "3"

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This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

Id: Measure/measure-exm55-FHIR
Type: system: http://hl7.org/fhir/measure-type
code: process
Identifier: system: http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm
value: 55
Title: Median ED Visit Duration
Status: active
Description: This example illustrates a continuous variable measure represented as a FHIR eCQM
Use Context:

code: program

value:
text: eligible-hospital

Topic: system: http://loinc.org
code: 57024-2
display: Health Quality Measure Document
Library:

reference: Library/library-exm55-FHIR

Scoring: system: http://hl7.org/fhir/measure-scoring
code: continuous-variable
Group:

Identifier:
value: group-1

Population:

Identifier:
value: initial-population-identifier

criteria: Initial Population

Identifier:
value: measure-population-identifier

criteria: Measure Population

Identifier:
value: measure-population-exclusion-identifier

criteria: Measure Population Exclusion

Identifier:
value: measure-observation-identifier

criteria: Measure Observation

Stratifier:

Identifier:
value: stratifier-1-identifier

criteria: Stratification 1

Identifier:
value: stratifier-2-identifier

criteria: Stratification 2

Identifier:
value: stratifier-3-identifier

criteria: Stratification 3


<?xml version="1.0" encoding="UTF-8"?>
<Measure xmlns="http://hl7.org/fhir">
  <id value="measure-exm55-FHIR"/>
  <meta>
    <versionId value="3"/>
    <lastUpdated value="2020-06-28T07:17:28.562Z"/>
    <profile value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cv-measure-cqfm"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
      <table class="grid dict">
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Id: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Measure/measure-exm55-FHIR</td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Type: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <span>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
                  <span>http://hl7.org/fhir/measure-type</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>code: </b>
                  <span>process</span>
                </span>
              </span>
            </span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Identifier: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <b>system: </b>
            <span>http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm</span>
            <br/>
            <b>value: </b>
            <span>55</span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Title: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Median ED Visit Duration</td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Status: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">active</td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Description: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">This example illustrates a continuous variable measure represented as a FHIR eCQM</td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Use Context: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="padding-left: 25px margin-bottom: 5px">
              <b>code: </b>
              <span>program</span>
            </p>
            <p style="padding-left: 25px margin-bottom: 5px">
              <b>value: </b>
              <br/>
              <span>
                <span style="padding-left: 25px">
                  <b>text: </b>
                  <span>eligible-hospital</span>
                </span>
              </span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Topic: </b>
          </th>
          <td style="padding-right: 25px">
            <span>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
                  <span>http://loinc.org</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>code: </b>
                  <span>57024-2</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>display: </b>
                  <span>Health Quality Measure Document</span>
                </span>
              </span>
            </span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Library: </b>
          </th>
          <td>
            <p style="padding-left: 25px padding-right: 25px">
              <b>reference: </b>
              <span>Library/library-exm55-FHIR</span>
            </p>
          </td>
        </tr>
        <tr>
          <th scope="row">
            <b>Scoring: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <span>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
                  <span>http://hl7.org/fhir/measure-scoring</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>code: </b>
                  <span>continuous-variable</span>
                </span>
              </span>
            </span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Group:</b>
          </th>
          <td>
            <p style="padding-left: 25px padding-right: 25px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>group-1</span>
                <br/>
              </span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td colspan="2">
            <table style="margin-bottom: 5px width: 100%">
              <tr style="vertical-align: top">
                <th rowspan="4" scope="row" style="padding-left: 25px">
                  <b>Population:</b>
                </th>
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>initial-population-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Initial Population</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>measure-population-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Measure Population</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>measure-population-exclusion-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Measure Population Exclusion</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>measure-observation-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Measure Observation</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <th rowspan="3" scope="row" style="padding-left: 25px">
                  <b>Stratifier:</b>
                </th>
                <td>
                  <p style="padding-left: 25px margin-bottom: 5px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>stratifier-1-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Stratification 1</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <td>
                  <p style="padding-left: 25px margin-bottom: 5px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>stratifier-2-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Stratification 2</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <td>
                  <p style="padding-left: 25px margin-bottom: 5px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>stratifier-3-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Stratification 3</span>
                  </p>
                </td>
              </tr>
            </table>
          </td>
        </tr>
      </table>
    </div>
  </text>
  <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
    <valueCode value="Encounter"/>
  </extension>
  <url value="http://hl7.org/fhir/us/cqfmeasures/Measure/measure-exm55-FHIR"/>
  <identifier>
    <use value="official"/>
    <system value="http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm"/>
    <value value="55"/>
  </identifier>
  <version value="5.0.0"/>
  <name value="EXM55"/>
  <title value="Median ED Visit Duration"/>
  <status value="active"/>
  <experimental value="true"/>
  <date value="2019-02-21"/>
  <publisher value="Health Level 7 International - Clinical Quality Information Work Group"/>
  <description value="This example illustrates a continuous variable measure represented as a FHIR eCQM"/>
  <approvalDate value="2019-03-08"/>
  <lastReviewDate value="2019-03-08"/>
  <effectivePeriod>
    <start value="2018-01-01"/>
    <end value="2018-12-31"/>
  </effectivePeriod>
  <useContext>
    <code>
      <code value="program"/>
    </code>
    <valueCodeableConcept>
      <text value="eligible-hospital"/>
    </valueCodeableConcept>
  </useContext>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <topic>
    <coding>
      <system value="http://loinc.org"/>
      <code value="57024-2"/>
      <display value="Health Quality Measure Document"/>
    </coding>
  </topic>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/cqi/index.cfm"/>
    </telecom>
  </contact>
  <library>
    <reference value="Library/library-exm55-FHIR"/>
  </library>
  <scoring>
    <coding>
      <system value="http://hl7.org/fhir/measure-scoring"/>
      <code value="continuous-variable"/>
    </coding>
  </scoring>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/measure-type"/>
      <code value="process"/>
    </coding>
  </type>
  <improvementNotation value="decrease"/>
  <group>
    <identifier>
      <value value="group-1"/>
    </identifier>
    <population>
      <identifier>
        <value value="initial-population-identifier"/>
      </identifier>
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="initial-population"/>
          <display value="Initial Population"/>
        </coding>
      </code>
      <criteria value="Initial Population"/>
    </population>
    <population>
      <identifier>
        <value value="measure-population-identifier"/>
      </identifier>
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="measure-population"/>
          <display value="Measure Population"/>
        </coding>
      </code>
      <criteria value="Measure Population"/>
    </population>
    <population>
      <identifier>
        <value value="measure-population-exclusion-identifier"/>
      </identifier>
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="measure-population-exclusion"/>
          <display value="Measure Population Exclusion"/>
        </coding>
      </code>
      <criteria value="Measure Population Exclusion"/>
    </population>
    <population>
      <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference">
        <valueString value="measure-population-identifier"/>
      </extension>
      <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod">
        <valueCode value="median"/>
      </extension>
      <identifier>
        <value value="measure-observation-identifier"/>
      </identifier>
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="measure-observation"/>
          <display value="Measure Observation"/>
        </coding>
      </code>
      <criteria value="Measure Observation"/>
    </population>
    <stratifier>
      <identifier>
        <value value="stratifier-1-identifier"/>
      </identifier>
      <criteria value="Stratification 1"/>
    </stratifier>
    <stratifier>
      <identifier>
        <value value="stratifier-2-identifier"/>
      </identifier>
      <criteria value="Stratification 2"/>
    </stratifier>
    <stratifier>
      <identifier>
        <value value="stratifier-3-identifier"/>
      </identifier>
      <criteria value="Stratification 3"/>
    </stratifier>
  </group>
</Measure>

Measure "measure-exm146-FHIR" Version "3"

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This Resource , XML or JSON representation, or the full version history.. provenance for this resource
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Id: Measure/measure-exm146-FHIR
Type: system: http://hl7.org/fhir/measure-type
code: process
Identifier: system: http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm
value: 146
Title: Appropriate Testing for Children with Pharyngitis
Status: active
Description: Percentage of children 2-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode.
Purpose: Group A streptococcal bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms (IDSA 2002). The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment (Linder et al. 2005). A study on antibiotic treatment of children with sore throat found that although only 15 to 36 percent of children with sore throat have Strep A pharyngitis, physicians prescribed antibiotics to 53 percent of children with a chief complaint of sore throat between 1995 and 2003 (Linder et al. 2005).
Use Context:

code: program

value:
text: eligible-provider

Topic: system: http://loinc.org
code: 57024-2
display: Health Quality Measure Document
Contributor: author: National Committee for Quality Assurance
Related:

type: citation

citation:
Linder, J.A., D.W. Bates, G.M. Lee, J.A. Finkelstein. 2005. “Antibiotic treatment of children with sore throat.” JAMA 294(18):2315-2322.

type: citation

citation:
Bisno, A.L., M.A. Gerber, J.M. Gwaltney Jr., E.L. Kaplan, R.H. Schwartz, Infectious Diseases Society of America. 2002. “Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Infectious Diseases Society of America.” Clin Infect Dis 35(2):113-25.

type: citation

citation:
Institute for Clinical Systems Improvement (ICSI). 2008. "Diagnosis and treatment of respiratory illness in children and adults." Bloomington: Institute for Clinical Systems Improvement (ICSI).

type: citation

citation:
Michigan Quality Improvement Consortium. 2007. Acute pharyngitis in children. Southfield: Michigan Quality Improvement Consortium.

Library:

reference: Library/library-exm146-FHIR

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. <br> Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Scoring: system: http://hl7.org/fhir/measure-scoring
code: proportion
Rationale: Group A streptococcal bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms (IDSA 2002). The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment (Linder et al. 2005). A study on antibiotic treatment of children with sore throat found that although only 15 to 36 percent of children with sore throat have Strep A pharyngitis, physicians prescribed antibiotics to 53 percent of children with a chief complaint of sore throat between 1995 and 2003 (Linder et al. 2005).
Clinical Recommendation: Institute for Clinical Systems Improvement (ICSI) (2007) <br> Reduce unnecessary use of antibiotics. Antibiotic treatment should be reserved for a bacterial illness. Diagnosis of group A beta streptococcal Pharyngitis should be made by laboratory testing rather than clinically. <br>Infectious Disease Society of America (Bisno et al. 2002) <br>The signs and symptoms of group A streptococcal and other (most frequently viral) pharyngitides overlap broadly. Therefore, unless the physician is able with confidence to exclude the diagnosis of streptococcal pharyngitis on epidemiological and clinical grounds alone, a laboratory test should be done to determine whether group A streptococci are present in the pharynx. <br>With the exception of very rare infections by certain other pharyngeal bacterial pathogens (eg, Corynebacterium diphtheriae and Neisseria gonorrhoeae), antimicrobial therapy is of no proven benefit as treatment for acute pharyngitis due to bacteria other than group A streptococci. Therefore, it is extremely important that physicians exclude the diagnosis of group A streptococcal pharyngitis to prevent inappropriate administration of antimicrobials to large numbers of patients with pharyngitis. <br>Michigan Quality Improvement Consortium (2007)<br>Probability of group A beta hemolytic streptococci (GABHS): Low; Testing: None; Treatment: Symptomatic treatment only. Avoid antibiotics. Probability of GABHS: Intermediate or High; Testing: Throat Culture (TC) OR Rapid Screen; Treatment: If TC is positive, use antibiotics. If TC is negative, use symptomatic treatment only. Avoid antibiotics. If treatment is started and culture result is negative, stop antibiotics. If Rapid Screen is positive, use antibiotics. If Rapid Screen is negative, culture (Culture is optional for age 16 and over) and only use antibiotics if throat culture is positive. (Michigan, 2007)
Guidance: This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. If the patient has more than one episode, include all episodes in the measure.
Group:

Identifier:
value: group-1

Population:

Identifier:
value: initial-population-identifier

criteria: Initial Population

Identifier:
value: numerator-identifier

criteria: Numerator

Identifier:
value: denominator-identifier

criteria: Denominator

Identifier:
value: denominator-exclusions-identifier

criteria: Denominator Exclusion


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            <b>Title: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Appropriate Testing for Children with Pharyngitis</td>
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            <b>Status: </b>
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            <b>Description: </b>
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          <td style="padding-left: 25px padding-right: 25px">Percentage of children 2-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode.</td>
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          <td style="padding-left: 25px padding-right: 25px">Group A streptococcal bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms (IDSA 2002). The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment (Linder et al. 2005). A study on antibiotic treatment of children with sore throat found that although only 15 to 36 percent of children with sore throat have Strep A pharyngitis, physicians prescribed antibiotics to 53 percent of children with a chief complaint of sore throat between 1995 and 2003 (Linder et al. 2005).</td>
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                  <b>system: </b>
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            <span>National Committee for Quality Assurance</span>
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            <p style="margin-bottom: 5px">
              <b>type: </b>
              <span>citation</span>
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            <p style="margin-bottom: 5px">
              <b>citation: </b>
              <br/>
              <span>Linder, J.A., D.W. Bates, G.M. Lee, J.A. Finkelstein. 2005. &#8220;Antibiotic treatment of children with sore throat.&#8221; JAMA 294(18):2315-2322.</span>
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              <b>type: </b>
              <span>citation</span>
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              <b>citation: </b>
              <br/>
              <span>Bisno, A.L., M.A. Gerber, J.M. Gwaltney Jr., E.L. Kaplan, R.H. Schwartz, Infectious Diseases Society of America. 2002. &#8220;Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Infectious Diseases Society of America.&#8221; Clin Infect Dis 35(2):113-25.</span>
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              <b>citation: </b>
              <br/>
              <span>Institute for Clinical Systems Improvement (ICSI). 2008. "Diagnosis and treatment of respiratory illness in children and adults." Bloomington: Institute for Clinical Systems Improvement (ICSI).</span>
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              <b>citation: </b>
              <br/>
              <span>Michigan Quality Improvement Consortium. 2007. Acute pharyngitis in children. Southfield: Michigan Quality Improvement Consortium.</span>
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              <b>reference: </b>
              <span>Library/library-exm146-FHIR</span>
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          <td style="padding-left: 25px padding-right: 25px">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. &lt;br&gt; Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</td>
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                  <span>http://hl7.org/fhir/measure-scoring</span>
                  <br/>
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                  <b>code: </b>
                  <span>proportion</span>
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          <td style="padding-left: 25px padding-right: 25px">Group A streptococcal bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms (IDSA 2002). The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment (Linder et al. 2005). A study on antibiotic treatment of children with sore throat found that although only 15 to 36 percent of children with sore throat have Strep A pharyngitis, physicians prescribed antibiotics to 53 percent of children with a chief complaint of sore throat between 1995 and 2003 (Linder et al. 2005).</td>
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            <b>Clinical Recommendation: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Institute for Clinical Systems Improvement (ICSI) (2007) &lt;br&gt; Reduce unnecessary use of antibiotics. Antibiotic treatment should be reserved for a bacterial illness. Diagnosis of group A beta streptococcal Pharyngitis should be made by laboratory testing rather than clinically. &lt;br&gt;Infectious Disease Society of America (Bisno et al. 2002) &lt;br&gt;The signs and symptoms of group A streptococcal and other (most frequently viral) pharyngitides overlap broadly. Therefore, unless the physician is able with confidence to exclude the diagnosis of streptococcal pharyngitis on epidemiological and clinical grounds alone, a laboratory test should be done to determine whether group A streptococci are present in the pharynx. &lt;br&gt;With the exception of very rare infections by certain other pharyngeal bacterial pathogens (eg, Corynebacterium diphtheriae and Neisseria gonorrhoeae), antimicrobial therapy is of no proven benefit as treatment for acute pharyngitis due to bacteria other than group A streptococci. Therefore, it is extremely important that physicians exclude the diagnosis of group A streptococcal pharyngitis to prevent inappropriate administration of antimicrobials to large numbers of patients with pharyngitis. &lt;br&gt;Michigan Quality Improvement Consortium (2007)&lt;br&gt;Probability of group A beta hemolytic streptococci (GABHS): Low Testing: None Treatment: Symptomatic treatment only. Avoid antibiotics. Probability of GABHS: Intermediate or High Testing: Throat Culture (TC) OR Rapid Screen Treatment: If TC is positive, use antibiotics. If TC is negative, use symptomatic treatment only. Avoid antibiotics. If treatment is started and culture result is negative, stop antibiotics. If Rapid Screen is positive, use antibiotics. If Rapid Screen is negative, culture (Culture is optional for age 16 and over) and only use antibiotics if throat culture is positive. (Michigan, 2007)</td>
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        <tr>
          <th scope="row">
            <b>Guidance: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. If the patient has more than one episode, include all episodes in the measure.</td>
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  <copyright value="Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). &#13;&#10;The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. &#13;&#10;(c) 2008 -2014 National Committee for Quality Assurance. All Rights Reserved. &#13;&#10;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 CPT or other codes contained in the specifications.&#13;&#10;CPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2013 World Health Organization. All Rights Reserved."/>
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  <relatedArtifact>
    <type value="citation"/>
    <citation value="Institute for Clinical Systems Improvement (ICSI). 2008. &quot;Diagnosis and treatment of respiratory illness in children and adults.&quot; Bloomington: Institute for Clinical Systems Improvement (ICSI)."/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Michigan Quality Improvement Consortium. 2007. Acute pharyngitis in children. Southfield: Michigan Quality Improvement Consortium."/>
  </relatedArtifact>
  <library>
    <reference value="Library/library-exm146-FHIR"/>
  </library>
  <disclaimer value="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 &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND. &lt;br&gt; Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]."/>
  <scoring>
    <coding>
      <system value="http://hl7.org/fhir/measure-scoring"/>
      <code value="proportion"/>
    </coding>
  </scoring>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/measure-type"/>
      <code value="process"/>
    </coding>
  </type>
  <rationale value="Group A streptococcal bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms (IDSA 2002). The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment (Linder et al. 2005). A study on antibiotic treatment of children with sore throat found that although only 15 to 36 percent of children with sore throat have Strep A pharyngitis, physicians prescribed antibiotics to 53 percent of children with a chief complaint of sore throat between 1995 and 2003 (Linder et al. 2005)."/>
  <clinicalRecommendationStatement value="Institute for Clinical Systems Improvement (ICSI) (2007) &lt;br&gt; Reduce unnecessary use of antibiotics. Antibiotic treatment should be reserved for a bacterial illness. Diagnosis of group A beta streptococcal Pharyngitis should be made by laboratory testing rather than clinically. &lt;br&gt;Infectious Disease Society of America (Bisno et al. 2002) &lt;br&gt;The signs and symptoms of group A streptococcal and other (most frequently viral) pharyngitides overlap broadly. Therefore, unless the physician is able with confidence to exclude the diagnosis of streptococcal pharyngitis on epidemiological and clinical grounds alone, a laboratory test should be done to determine whether group A streptococci are present in the pharynx. &lt;br&gt;With the exception of very rare infections by certain other pharyngeal bacterial pathogens (eg, Corynebacterium diphtheriae and Neisseria gonorrhoeae), antimicrobial therapy is of no proven benefit as treatment for acute pharyngitis due to bacteria other than group A streptococci. Therefore, it is extremely important that physicians exclude the diagnosis of group A streptococcal pharyngitis to prevent inappropriate administration of antimicrobials to large numbers of patients with pharyngitis. &lt;br&gt;Michigan Quality Improvement Consortium (2007)&lt;br&gt;Probability of group A beta hemolytic streptococci (GABHS): Low Testing: None Treatment: Symptomatic treatment only. Avoid antibiotics. Probability of GABHS: Intermediate or High Testing: Throat Culture (TC) OR Rapid Screen Treatment: If TC is positive, use antibiotics. If TC is negative, use symptomatic treatment only. Avoid antibiotics. If treatment is started and culture result is negative, stop antibiotics. If Rapid Screen is positive, use antibiotics. If Rapid Screen is negative, culture (Culture is optional for age 16 and over) and only use antibiotics if throat culture is positive. (Michigan, 2007)"/>
  <improvementNotation value="increase"/>
  <guidance value="This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. If the patient has more than one episode, include all episodes in the measure."/>
  <group>
    <identifier>
      <value value="group-1"/>
    </identifier>
    <population>
      <identifier>
        <value value="initial-population-identifier"/>
      </identifier>
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="initial-population"/>
          <display value="Initial Population"/>
        </coding>
      </code>
      <criteria value="Initial Population"/>
    </population>
    <population>
      <identifier>
        <value value="numerator-identifier"/>
      </identifier>
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="numerator"/>
          <display value="Numerator"/>
        </coding>
      </code>
      <criteria value="Numerator"/>
    </population>
    <population>
      <identifier>
        <value value="denominator-identifier"/>
      </identifier>
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="denominator"/>
          <display value="Denominator"/>
        </coding>
      </code>
      <criteria value="Denominator"/>
    </population>
    <population>
      <identifier>
        <value value="denominator-exclusions-identifier"/>
      </identifier>
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="denominator-exclusion"/>
          <display value="Denominator Exclusion"/>
        </coding>
      </code>
      <criteria value="Denominator Exclusion"/>
    </population>
  </group>
</Measure>

Measure "measure-exm130-FHIR" Version "3"

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

Id: Measure/measure-exm130-FHIR
Type:
system: http://hl7.org/fhir/measure-type
code: process
Identifier: system: http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/cms
value: 130
system: http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/nqf
value: 0034
Title: Colorectal Cancer Screening
Status: active
Description: Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
Purpose: Patients 50-75 years of age with a visit during the measurement period
Use Context:

code: program

value:
text: eligible-provider

Topic:
system: http://loinc.org
code: 57024-2
display: Health Quality Measure Document
Contributor: author: National Committee for Quality Assurance
Related:

type: citation

citation:
U.S. Preventive Services Task Force. "Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement." JAMA, vol. 315, no. 23, 2016, pp. 2564-2575. doi: 10.1001/jama.2016.5989

type: citation

citation:
Howlader, N., A.M. Noone, M. Krapcho, D. Miller, K. Bishop, C.L. Kosary, M. Yu, J. Ruhl, Z. Tatalovich, A. Mariotto, D.R. Lewis, H.S. Chen, E.J. Feuer, and K.A. Cronin. "SEER Cancer Statistics Review, 1975-2014." Washington, DC: National Cancer Institute, 2017. Available at https://seer.cancer.gov/csr/1975_2014/

type: citation

citation:
American Cancer Society. "Can Colorectal Polyps and Cancer Be Found Early?" Last modified March 2017. Washington, DC: American Cancer Society. Available at https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/detection.html.

Library:

reference: Library/library-exm130-FHIR

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].
Scoring:
system: http://hl7.org/fhir/measure-scoring
code: proportion
Rationale: Colorectal cancer represents 8 percent of all new cancer cases and is the second leading cause of cancer deaths in the United States. In 2017, there were an estimated 135,430 new cases of colorectal cancer and an estimated 50,260 deaths attributed to it. According to the National Cancer Institute, about 4.3 percent of men and women will be diagnosed with colorectal cancer at some point during their lifetimes. For most adults, older age is the most important risk factor for colorectal cancer, although being male and black are also associated with higher incidence and mortality. Colorectal cancer is most frequently diagnosed among people 65 to 74 years old (Howlader et al. 2017). Screening can be effective for finding precancerous lesions (polyps) that could later become malignant, and for detecting early cancers that can be more easily and effectively treated. Precancerous polyps usually take about 10 to 15 years to develop into colorectal cancer, and most can be found and removed before turning into cancer. The five-year relative survival rate for people whose colorectal cancer is found in the early stage before it has spread is about 90 percent (American Cancer Society 2017).
Clinical Recommendation: The U. S. Preventive Services Task Force (2016) recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. This is a Grade A recommendation (U.S. Preventive Services Task Force 2016). Screening tests: -Colonoscopy (every 10 years) -Flexible sigmoidoscopy (every 5 years) -Fecal occult blood test (annually) -FIT-DNA (every 3 years) -Computed tomographic colonography (every 5 years)
Guidance: 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. Do not count DRE, FOBT tests performed in an office setting or performed on a sample collected via DRE.
Group:

Identifier:
value: group-1

Population:

Identifier:
value: initial-population-identifier

criteria: Initial Population

Identifier:
value: numerator-identifier

criteria: Numerator

Identifier:
value: denominator-identifier

criteria: Denominator

Identifier:
value: denominator-exclusions-identifier

criteria: Denominator Exclusion

Supplemental Data:

Identifier:
value: sde-ethnicity

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Ethnicity

Identifier:
value: sde-payer

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Payer

Identifier:
value: sde-race

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Race

Identifier:
value: sde-sex

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Sex


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<Measure xmlns="http://hl7.org/fhir">
  <id value="measure-exm130-FHIR"/>
  <meta>
    <versionId value="3"/>
    <lastUpdated value="2020-06-28T07:17:27.843Z"/>
    <profile value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
      <table class="grid dict">
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Id: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Measure/measure-exm130-FHIR</td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Type: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <span>
              <br/>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
                  <span>http://hl7.org/fhir/measure-type</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>code: </b>
                  <span>process</span>
                </span>
              </span>
            </span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="2" scope="row">
            <b>Identifier: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <b>system: </b>
            <span>http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/cms</span>
            <br/>
            <b>value: </b>
            <span>130</span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td style="padding-left: 25px padding-right: 25px">
            <b>system: </b>
            <span>http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/nqf</span>
            <br/>
            <b>value: </b>
            <span>0034</span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Title: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Colorectal Cancer Screening</td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Status: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">active</td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Description: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer</td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Purpose: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Patients 50-75 years of age with a visit during the measurement period</td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Use Context: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="padding-left: 25px margin-bottom: 5px">
              <b>code: </b>
              <span>program</span>
            </p>
            <p style="padding-left: 25px margin-bottom: 5px">
              <b>value: </b>
              <br/>
              <span>
                <span style="padding-left: 25px">
                  <b>text: </b>
                  <span>eligible-provider</span>
                </span>
              </span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Topic: </b>
          </th>
          <td style="padding-right: 25px">
            <span>
              <br/>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
                  <span>http://loinc.org</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>code: </b>
                  <span>57024-2</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>display: </b>
                  <span>Health Quality Measure Document</span>
                </span>
              </span>
            </span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Contributor: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <b>
              <span>author</span>: </b>
            <span>National Committee for Quality Assurance</span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="3" scope="row">
            <b>Related: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>type: </b>
              <span>citation</span>
            </p>
            <p style="margin-bottom: 5px">
              <b>citation: </b>
              <br/>
              <span>U.S. Preventive Services Task Force. "Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement." JAMA, vol. 315, no. 23, 2016, pp. 2564-2575. doi: 10.1001/jama.2016.5989</span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>type: </b>
              <span>citation</span>
            </p>
            <p style="margin-bottom: 5px">
              <b>citation: </b>
              <br/>
              <span>Howlader, N., A.M. Noone, M. Krapcho, D. Miller, K. Bishop, C.L. Kosary, M. Yu, J. Ruhl, Z. Tatalovich, A. Mariotto, D.R. Lewis, H.S. Chen, E.J. Feuer, and K.A. Cronin. "SEER Cancer Statistics Review, 1975-2014." Washington, DC: National Cancer Institute, 2017. Available at https://seer.cancer.gov/csr/1975_2014/</span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>type: </b>
              <span>citation</span>
            </p>
            <p style="margin-bottom: 5px">
              <b>citation: </b>
              <br/>
              <span>American Cancer Society. "Can Colorectal Polyps and Cancer Be Found Early?" Last modified March 2017. Washington, DC: American Cancer Society. Available at https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/detection.html.</span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Library: </b>
          </th>
          <td>
            <p style="padding-left: 25px padding-right: 25px">
              <b>reference: </b>
              <span>Library/library-exm130-FHIR</span>
            </p>
          </td>
        </tr>
        <tr>
          <th scope="row">
            <b>Disclaimer: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">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].</td>
        </tr>
        <tr>
          <th scope="row">
            <b>Scoring: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <span>
              <br/>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
                  <span>http://hl7.org/fhir/measure-scoring</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>code: </b>
                  <span>proportion</span>
                </span>
              </span>
            </span>
          </td>
        </tr>
        <tr>
          <th scope="row">
            <b>Rationale: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Colorectal cancer represents 8 percent of all new cancer cases and is the second leading cause of cancer deaths in the United States. In 2017, there were an estimated 135,430 new cases of colorectal cancer and an estimated 50,260 deaths attributed to it. According to the National Cancer Institute, about 4.3 percent of men and women will be diagnosed with colorectal cancer at some point during their lifetimes. For most adults, older age is the most important risk factor for colorectal cancer, although being male and black are also associated with higher incidence and mortality. Colorectal cancer is most frequently diagnosed among people 65 to 74 years old (Howlader et al. 2017). Screening can be effective for finding precancerous lesions (polyps) that could later become malignant, and for detecting early cancers that can be more easily and effectively treated. Precancerous polyps usually take about 10 to 15 years to develop into colorectal cancer, and most can be found and removed before turning into cancer. The five-year relative survival rate for people whose colorectal cancer is found in the early stage before it has spread is about 90 percent (American Cancer Society 2017).</td>
        </tr>
        <tr>
          <th scope="row">
            <b>Clinical Recommendation: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">The U. S. Preventive Services Task Force (2016) recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. This is a Grade A recommendation (U.S. Preventive Services Task Force 2016). Screening tests: -Colonoscopy (every 10 years) -Flexible sigmoidoscopy (every 5 years) -Fecal occult blood test (annually) -FIT-DNA (every 3 years) -Computed tomographic colonography (every 5 years)</td>
        </tr>
        <tr>
          <th scope="row">
            <b>Guidance: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">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. Do not count DRE, FOBT tests performed in an office setting or performed on a sample collected via DRE.</td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Group:</b>
          </th>
          <td>
            <p style="padding-left: 25px padding-right: 25px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>group-1</span>
                <br/>
              </span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td colspan="2">
            <table style="margin-bottom: 5px width: 100%">
              <tr style="vertical-align: top">
                <th rowspan="4" scope="row" style="padding-left: 25px">
                  <b>Population:</b>
                </th>
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>initial-population-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Initial Population</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>numerator-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Numerator</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>denominator-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Denominator</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>denominator-exclusions-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Denominator Exclusion</span>
                  </p>
                </td>
              </tr>
            </table>
          </td>
        </tr>
        <tr>
          <th rowspan="4" scope="row">
            <b>Supplemental Data:</b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
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              <b>criteria: </b>
              <span>SDE Ethnicity</span>
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                      <b>system: </b>
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            <p style="margin-bottom: 5px">
              <b>criteria: </b>
              <span>SDE Payer</span>
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            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>sde-race</span>
                <br/>
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            </p>
            <p style="margin-bottom: 5px">
              <b>usage: </b>
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                  <br/>
                  <span>
                    <span style="padding-left: 25px">
                      <b>system: </b>
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                      <br/>
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                    <span style="padding-left: 25px">
                      <b>code: </b>
                      <span>supplemental-data</span>
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            </p>
            <p style="margin-bottom: 5px">
              <b>criteria: </b>
              <span>SDE Race</span>
            </p>
          </td>
        </tr>
        <tr>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>sde-sex</span>
                <br/>
              </span>
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            <p style="margin-bottom: 5px">
              <b>usage: </b>
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                <span>
                  <br/>
                  <span>
                    <span style="padding-left: 25px">
                      <b>system: </b>
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                    <span style="padding-left: 25px">
                      <b>code: </b>
                      <span>supplemental-data</span>
                    </span>
                  </span>
                </span>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>criteria: </b>
              <span>SDE Sex</span>
            </p>
          </td>
        </tr>
      </table>
    </div>
  </text>
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  <url value="http://hl7.org/fhir/us/cqfmeasures/Measure/measure-exm130-FHIR"/>
  <identifier>
    <use value="official"/>
    <system value="http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/cms"/>
    <value value="130"/>
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  <identifier>
    <use value="official"/>
    <system value="http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/nqf"/>
    <value value="0034"/>
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  <version value="7.2.000"/>
  <name value="EXM130"/>
  <title value="Colorectal Cancer Screening"/>
  <status value="active"/>
  <experimental value="true"/>
  <date value="2018-08-28"/>
  <publisher value="National Committee for Quality Assurance"/>
  <description value="Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer"/>
  <purpose value="Patients 50-75 years of age with a visit during the measurement period"/>
  <approvalDate value="2016-01-01"/>
  <lastReviewDate value="2016-09-01"/>
  <effectivePeriod>
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    <end value="2018-12-31"/>
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      <system value="url"/>
      <value value="http://www.ncqa.org/"/>
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  <copyright value="This Physician Performance Measure (Measure) and related data specifications 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 (eg, 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) 2012-2017 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 2004-2017 American Medical Association. LOINC(R) copyright 2004-2017 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R] ) copyright 2004-2017 International Health Terminology Standards Development Organisation. ICD-10 copyright 2017 World Health Organization. All Rights Reserved."/>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="U.S. Preventive Services Task Force. &quot;Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement.&quot; JAMA, vol. 315, no. 23, 2016, pp. 2564-2575. doi: 10.1001/jama.2016.5989"/>
  </relatedArtifact>
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    <citation value="Howlader, N., A.M. Noone, M. Krapcho, D. Miller, K. Bishop, C.L. Kosary, M. Yu, J. Ruhl, Z. Tatalovich, A. Mariotto, D.R. Lewis, H.S. Chen, E.J. Feuer, and K.A. Cronin. &quot;SEER Cancer Statistics Review, 1975-2014.&quot; Washington, DC: National Cancer Institute, 2017. Available at https://seer.cancer.gov/csr/1975_2014/"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="American Cancer Society. &quot;Can Colorectal Polyps and Cancer Be Found Early?&quot; Last modified March 2017. Washington, DC: American Cancer Society. Available at https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/detection.html."/>
  </relatedArtifact>
  <library>
    <reference value="Library/library-exm130-FHIR"/>
  </library>
  <disclaimer value="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 &quot;AS IS&quot; 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]."/>
  <scoring>
    <coding>
      <system value="http://hl7.org/fhir/measure-scoring"/>
      <code value="proportion"/>
    </coding>
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    <coding>
      <system value="http://hl7.org/fhir/measure-type"/>
      <code value="process"/>
    </coding>
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  <rationale value="Colorectal cancer represents 8 percent of all new cancer cases and is the second leading cause of cancer deaths in the United States. In 2017, there were an estimated 135,430 new cases of colorectal cancer and an estimated 50,260 deaths attributed to it. According to the National Cancer Institute, about 4.3 percent of men and women will be diagnosed with colorectal cancer at some point during their lifetimes. For most adults, older age is the most important risk factor for colorectal cancer, although being male and black are also associated with higher incidence and mortality. Colorectal cancer is most frequently diagnosed among people 65 to 74 years old (Howlader et al. 2017). Screening can be effective for finding precancerous lesions (polyps) that could later become malignant, and for detecting early cancers that can be more easily and effectively treated. Precancerous polyps usually take about 10 to 15 years to develop into colorectal cancer, and most can be found and removed before turning into cancer. The five-year relative survival rate for people whose colorectal cancer is found in the early stage before it has spread is about 90 percent (American Cancer Society 2017)."/>
  <clinicalRecommendationStatement value="The U. S. Preventive Services Task Force (2016) recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. This is a Grade A recommendation (U.S. Preventive Services Task Force 2016). Screening tests: -Colonoscopy (every 10 years) -Flexible sigmoidoscopy (every 5 years) -Fecal occult blood test (annually) -FIT-DNA (every 3 years) -Computed tomographic colonography (every 5 years)"/>
  <improvementNotation value="increase"/>
  <guidance value="Patient self-report for procedures as well as diagnostic studies should be recorded in &quot;Procedure, Performed&quot; template or &quot;Diagnostic Study, Performed&quot; template in QRDA-1. Do not count DRE, FOBT tests performed in an office setting or performed on a sample collected via DRE."/>
  <group>
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    <criteria value="SDE Payer"/>
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        <system value="http://hl7.org/fhir/measure-data-usage"/>
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      <coding>
        <system value="http://hl7.org/fhir/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <criteria value="SDE Sex"/>
  </supplementalData>
</Measure>

Measure "measure-exm125-FHIR" Version "3"

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

Id: Measure/measure-exm125-FHIR
Type:
system: http://hl7.org/fhir/measure-type
code: process
Identifier: system: http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/cms
value: 146
system: http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/nqf
value: 0002
Title: Breast Cancer Screening
Status: active
Description: Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer
Purpose: Women 51-74 years of age with a visit during the measurement period
Use Context:

code: program

value:
text: eligibile-provider

Topic:
system: http://loinc.org
code: 57024-2
display: Health Quality Measure Document
Contributor: author: National Committee for Quality Assurance
Related:

type: citation

citation:
American Cancer Society. 2010. Cancer Facts & Figures 2010. Atlanta: American Cancer Society.

type: citation

citation:
National Cancer Institute. 2010. "Breast Cancer Screening." http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional

type: citation

citation:
National Business Group on Health. 2011. Pathways to Managing Cancer in the Workplace. Washington: National Business Group on Health.

type: citation

citation:
U.S. Preventive Services Task Force (USPSTF). 2009. 1) "Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement." 2) "December 2009 addendum." Ann Intern Med 151(10):716-726.

type: citation

citation:
BreastCancer.org. 2012. U.S. Breast Cancer Statistics. www.breastcancer.org/symptoms/understand_bc/statistics.jsp

Library:

reference: Library/library-exm125-FHIR

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.
Scoring:
system: http://hl7.org/fhir/measure-scoring
code: proportion
Rationale: Breast cancer is one of the most common types of cancers, accounting for a quarter of all new cancer diagnoses for women in the U.S. (BreastCancer.Org, 2011). It ranks as the second leading cause of cancer-related mortality in women, accounting for nearly 40,000 estimated deaths in 2013 (American Cancer Society, 2011). <br> According to the National Cancer Institute's Surveillance Epidemiology and End Results program, the chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 30, it is one in 2,212. By age 40, the chances increase to one in 235, by age 50, it becomes one in 54, and, by age 60, it is one in 25. From 2004 to 2008, the median age at the time of breast cancer diagnosis was 61 years among adult women (Tangka et al, 2010). <br> In the U.S., costs associated with a diagnosis of breast cancer range from $451 to $2,520, factoring in continued testing, multiple office visits, and varying procedures. The total costs related to breast cancer add up to nearly $7 billion per year in the U.S., including $2 billion spent on late-stage treatment (Lavigne et al, 2008; Boykoff et al, 2009).
Clinical Recommendation: The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50-74 years (B recommendation). The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms (C recommendation). The Task Force concludes the evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years and older (I statement). <br> U.S. Preventive Services Task Force (2009) <br> Grade: B recommendation. The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. <br> Grade: C recommendation. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. <br> Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. <br> Grade: D recommendation. The USPSTF recommends against teaching breast self-examination (BSE). <br> Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older. <br> Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.
Guidance: 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. <br> This measure evaluates primary screening. Do not count biopsies, breast ultrasounds, MRIs or tomosynthesis (3D mammography), because they are not appropriate methods for primary breast cancer screening.
Group:

Identifier:
value: group-1

Population:

Identifier:
value: initial-population-identifier

criteria: Initial Population

Identifier:
value: numerator-identifier

criteria: Numerator

Identifier:
value: denominator-identifier

criteria: Denominator

Identifier:
value: denominator-exclusions-identifier

criteria: Denominator Exclusion

Supplemental Data:

Identifier:
value: sde-ethnicity

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Ethnicity

Identifier:
value: sde-payer

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Payer

Identifier:
value: sde-race

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Race

Identifier:
value: sde-sex

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Sex


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          <td style="padding-left: 25px padding-right: 25px">Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer</td>
        </tr>
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          </th>
          <td style="padding-left: 25px padding-right: 25px">Women 51-74 years of age with a visit during the measurement period</td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
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                  <span>eligibile-provider</span>
                </span>
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          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Topic: </b>
          </th>
          <td style="padding-right: 25px">
            <span>
              <br/>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
                  <span>http://loinc.org</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>code: </b>
                  <span>57024-2</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>display: </b>
                  <span>Health Quality Measure Document</span>
                </span>
              </span>
            </span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Contributor: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <b>
              <span>author</span>: </b>
            <span>National Committee for Quality Assurance</span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="5" scope="row">
            <b>Related: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>type: </b>
              <span>citation</span>
            </p>
            <p style="margin-bottom: 5px">
              <b>citation: </b>
              <br/>
              <span>American Cancer Society. 2010. Cancer Facts &amp; Figures 2010. Atlanta: American Cancer Society.</span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>type: </b>
              <span>citation</span>
            </p>
            <p style="margin-bottom: 5px">
              <b>citation: </b>
              <br/>
              <span>National Cancer Institute. 2010. "Breast Cancer Screening." http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional</span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>type: </b>
              <span>citation</span>
            </p>
            <p style="margin-bottom: 5px">
              <b>citation: </b>
              <br/>
              <span>National Business Group on Health. 2011. Pathways to Managing Cancer in the Workplace. Washington: National Business Group on Health.</span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>type: </b>
              <span>citation</span>
            </p>
            <p style="margin-bottom: 5px">
              <b>citation: </b>
              <br/>
              <span>U.S. Preventive Services Task Force (USPSTF). 2009. 1) "Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement." 2) "December 2009 addendum." Ann Intern Med 151(10):716-726.</span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>type: </b>
              <span>citation</span>
            </p>
            <p style="margin-bottom: 5px">
              <b>citation: </b>
              <br/>
              <span>BreastCancer.org. 2012. U.S. Breast Cancer Statistics. www.breastcancer.org/symptoms/understand_bc/statistics.jsp</span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Library: </b>
          </th>
          <td>
            <p style="padding-left: 25px padding-right: 25px">
              <b>reference: </b>
              <span>Library/library-exm125-FHIR</span>
            </p>
          </td>
        </tr>
        <tr>
          <th scope="row">
            <b>Disclaimer: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">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.</td>
        </tr>
        <tr>
          <th scope="row">
            <b>Scoring: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <span>
              <br/>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
                  <span>http://hl7.org/fhir/measure-scoring</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>code: </b>
                  <span>proportion</span>
                </span>
              </span>
            </span>
          </td>
        </tr>
        <tr>
          <th scope="row">
            <b>Rationale: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Breast cancer is one of the most common types of cancers, accounting for a quarter of all new cancer diagnoses for women in the U.S. (BreastCancer.Org, 2011). It ranks as the second leading cause of cancer-related mortality in women, accounting for nearly 40,000 estimated deaths in 2013 (American Cancer Society, 2011). &lt;br&gt; According to the National Cancer Institute's Surveillance Epidemiology and End Results program, the chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 30, it is one in 2,212. By age 40, the chances increase to one in 235, by age 50, it becomes one in 54, and, by age 60, it is one in 25. From 2004 to 2008, the median age at the time of breast cancer diagnosis was 61 years among adult women (Tangka et al, 2010). &lt;br&gt; In the U.S., costs associated with a diagnosis of breast cancer range from $451 to $2,520, factoring in continued testing, multiple office visits, and varying procedures. The total costs related to breast cancer add up to nearly $7 billion per year in the U.S., including $2 billion spent on late-stage treatment (Lavigne et al, 2008 Boykoff et al, 2009).</td>
        </tr>
        <tr>
          <th scope="row">
            <b>Clinical Recommendation: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50-74 years (B recommendation). The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms (C recommendation). The Task Force concludes the evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years and older (I statement). &lt;br&gt; U.S. Preventive Services Task Force (2009) &lt;br&gt; Grade: B recommendation. The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. &lt;br&gt; Grade: C recommendation. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. &lt;br&gt; Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. &lt;br&gt; Grade: D recommendation. The USPSTF recommends against teaching breast self-examination (BSE). &lt;br&gt; Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older. &lt;br&gt; Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.</td>
        </tr>
        <tr>
          <th scope="row">
            <b>Guidance: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">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. &lt;br&gt; This measure evaluates primary screening. Do not count biopsies, breast ultrasounds, MRIs or tomosynthesis (3D mammography), because they are not appropriate methods for primary breast cancer screening.</td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Group:</b>
          </th>
          <td>
            <p style="padding-left: 25px padding-right: 25px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>group-1</span>
                <br/>
              </span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td colspan="2">
            <table style="margin-bottom: 5px width: 100%">
              <tr style="vertical-align: top">
                <th rowspan="4" scope="row" style="padding-left: 25px">
                  <b>Population:</b>
                </th>
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>initial-population-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Initial Population</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>numerator-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Numerator</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>denominator-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Denominator</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>denominator-exclusions-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Denominator Exclusion</span>
                  </p>
                </td>
              </tr>
            </table>
          </td>
        </tr>
        <tr>
          <th rowspan="4" scope="row">
            <b>Supplemental Data:</b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>sde-ethnicity</span>
                <br/>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>usage: </b>
              <span>
                <span>
                  <br/>
                  <span>
                    <span style="padding-left: 25px">
                      <b>system: </b>
                      <span>http://hl7.org/fhir/measure-data-usage</span>
                      <br/>
                    </span>
                    <span style="padding-left: 25px">
                      <b>code: </b>
                      <span>supplemental-data</span>
                    </span>
                  </span>
                </span>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>criteria: </b>
              <span>SDE Ethnicity</span>
            </p>
          </td>
        </tr>
        <tr>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>sde-payer</span>
                <br/>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>usage: </b>
              <span>
                <span>
                  <br/>
                  <span>
                    <span style="padding-left: 25px">
                      <b>system: </b>
                      <span>http://hl7.org/fhir/measure-data-usage</span>
                      <br/>
                    </span>
                    <span style="padding-left: 25px">
                      <b>code: </b>
                      <span>supplemental-data</span>
                    </span>
                  </span>
                </span>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>criteria: </b>
              <span>SDE Payer</span>
            </p>
          </td>
        </tr>
        <tr>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>sde-race</span>
                <br/>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>usage: </b>
              <span>
                <span>
                  <br/>
                  <span>
                    <span style="padding-left: 25px">
                      <b>system: </b>
                      <span>http://hl7.org/fhir/measure-data-usage</span>
                      <br/>
                    </span>
                    <span style="padding-left: 25px">
                      <b>code: </b>
                      <span>supplemental-data</span>
                    </span>
                  </span>
                </span>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>criteria: </b>
              <span>SDE Race</span>
            </p>
          </td>
        </tr>
        <tr>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>sde-sex</span>
                <br/>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>usage: </b>
              <span>
                <span>
                  <br/>
                  <span>
                    <span style="padding-left: 25px">
                      <b>system: </b>
                      <span>http://hl7.org/fhir/measure-data-usage</span>
                      <br/>
                    </span>
                    <span style="padding-left: 25px">
                      <b>code: </b>
                      <span>supplemental-data</span>
                    </span>
                  </span>
                </span>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>criteria: </b>
              <span>SDE Sex</span>
            </p>
          </td>
        </tr>
      </table>
    </div>
  </text>
  <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
    <valueCode value="boolean"/>
  </extension>
  <url value="http://hl7.org/fhir/us/cqfmeasures/Measure/measure-exm125-FHIR"/>
  <identifier>
    <use value="official"/>
    <system value="http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/cms"/>
    <value value="146"/>
  </identifier>
  <identifier>
    <use value="official"/>
    <system value="http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/nqf"/>
    <value value="0002"/>
  </identifier>
  <version value="6.2.000"/>
  <name value="EXM125"/>
  <title value="Breast Cancer Screening"/>
  <status value="active"/>
  <experimental value="true"/>
  <date value="2018-08-31"/>
  <publisher value="National Committee for Quality Assurance"/>
  <description value="Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer"/>
  <purpose value="Women 51-74 years of age with a visit during the measurement period"/>
  <approvalDate value="2016-01-01"/>
  <lastReviewDate value="2016-09-01"/>
  <effectivePeriod>
    <start value="2018-01-01"/>
    <end value="2018-12-31"/>
  </effectivePeriod>
  <useContext>
    <code>
      <code value="program"/>
    </code>
    <valueCodeableConcept>
      <text value="eligibile-provider"/>
    </valueCodeableConcept>
  </useContext>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <topic>
    <coding>
      <system value="http://loinc.org"/>
      <code value="57024-2"/>
      <display value="Health Quality Measure Document"/>
    </coding>
  </topic>
  <contributor>
    <type value="author"/>
    <name value="National Committee for Quality Assurance"/>
  </contributor>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.ncqa.org/"/>
    </telecom>
  </contact>
  <copyright value="This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). The Measure is copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, 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 must be approved by NCQA and are subject to a license at the discretion of 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. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved. &lt;br&gt; 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 CPT or other codes contained in the specifications. &lt;br&gt; CPT(R) contained in the Measure specifications is copyright 2004-2016 American Medical Association. LOINC(R) copyright 2004-2016 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2016 International Health Terminology Standards Development Organisation. ICD-10 copyright 2016 World Health Organization. All Rights Reserved. &lt;br&gt; The American Hospital Association holds a copyright to the National Uniform Billing Committee (NUBC) codes contained in the measure specifications. The NUBC codes in the specifications are included with the permission of the AHA. The NUBC codes contained in the specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting Measure results or using Measure results for their internal quality improvement purposes. All other uses of the NUBC codes require a license from the AHA. Anyone desiring to use the NUBC codes in a commercial product to generate Measure results, or for any other commercial use, must obtain a commercial use license directly from the AHA. To inquire about licensing, contact ub04@healthforum.com."/>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="American Cancer Society. 2010. Cancer Facts &amp; Figures 2010. Atlanta: American Cancer Society."/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="National Cancer Institute. 2010. &quot;Breast Cancer Screening.&quot; http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="National Business Group on Health. 2011. Pathways to Managing Cancer in the Workplace. Washington: National Business Group on Health."/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="U.S. Preventive Services Task Force (USPSTF). 2009. 1) &quot;Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement.&quot; 2) &quot;December 2009 addendum.&quot; Ann Intern Med 151(10):716-726."/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="BreastCancer.org. 2012. U.S. Breast Cancer Statistics. www.breastcancer.org/symptoms/understand_bc/statistics.jsp"/>
  </relatedArtifact>
  <library>
    <reference value="Library/library-exm125-FHIR"/>
  </library>
  <disclaimer value="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 &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND."/>
  <scoring>
    <coding>
      <system value="http://hl7.org/fhir/measure-scoring"/>
      <code value="proportion"/>
    </coding>
  </scoring>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/measure-type"/>
      <code value="process"/>
    </coding>
  </type>
  <rationale value="Breast cancer is one of the most common types of cancers, accounting for a quarter of all new cancer diagnoses for women in the U.S. (BreastCancer.Org, 2011). It ranks as the second leading cause of cancer-related mortality in women, accounting for nearly 40,000 estimated deaths in 2013 (American Cancer Society, 2011). &lt;br&gt; According to the National Cancer Institute&apos;s Surveillance Epidemiology and End Results program, the chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 30, it is one in 2,212. By age 40, the chances increase to one in 235, by age 50, it becomes one in 54, and, by age 60, it is one in 25. From 2004 to 2008, the median age at the time of breast cancer diagnosis was 61 years among adult women (Tangka et al, 2010). &lt;br&gt; In the U.S., costs associated with a diagnosis of breast cancer range from $451 to $2,520, factoring in continued testing, multiple office visits, and varying procedures. The total costs related to breast cancer add up to nearly $7 billion per year in the U.S., including $2 billion spent on late-stage treatment (Lavigne et al, 2008 Boykoff et al, 2009)."/>
  <clinicalRecommendationStatement value="The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50-74 years (B recommendation). The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient&apos;s values regarding specific benefits and harms (C recommendation). The Task Force concludes the evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years and older (I statement). &lt;br&gt; U.S. Preventive Services Task Force (2009) &lt;br&gt; Grade: B recommendation. The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. &lt;br&gt; Grade: C recommendation. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient&apos;s values regarding specific benefits and harms. &lt;br&gt; Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. &lt;br&gt; Grade: D recommendation. The USPSTF recommends against teaching breast self-examination (BSE). &lt;br&gt; Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older. &lt;br&gt; Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer."/>
  <improvementNotation value="increase"/>
  <guidance value="Patient self-report for procedures as well as diagnostic studies should be recorded in &apos;Procedure, Performed&apos; template or &apos;Diagnostic Study, Performed&apos; template in QRDA-1. Patient self-report is not allowed for laboratory tests. &lt;br&gt; This measure evaluates primary screening. Do not count biopsies, breast ultrasounds, MRIs or tomosynthesis (3D mammography), because they are not appropriate methods for primary breast cancer screening."/>
  <group>
    <identifier>
      <value value="group-1"/>
    </identifier>
    <population>
      <identifier>
        <value value="initial-population-identifier"/>
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      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="initial-population"/>
          <display value="Initial Population"/>
        </coding>
      </code>
      <criteria value="Initial Population"/>
    </population>
    <population>
      <identifier>
        <value value="numerator-identifier"/>
      </identifier>
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="numerator"/>
          <display value="Numerator"/>
        </coding>
      </code>
      <criteria value="Numerator"/>
    </population>
    <population>
      <identifier>
        <value value="denominator-identifier"/>
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      </code>
      <criteria value="Denominator"/>
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      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="denominator-exclusion"/>
          <display value="Denominator Exclusion"/>
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      <criteria value="Denominator Exclusion"/>
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  <supplementalData>
    <identifier>
      <value value="sde-ethnicity"/>
    </identifier>
    <usage>
      <coding>
        <system value="http://hl7.org/fhir/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <criteria value="SDE Ethnicity"/>
  </supplementalData>
  <supplementalData>
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      <value value="sde-payer"/>
    </identifier>
    <usage>
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        <system value="http://hl7.org/fhir/measure-data-usage"/>
        <code value="supplemental-data"/>
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    <criteria value="SDE Payer"/>
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      <value value="sde-race"/>
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    <usage>
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        <system value="http://hl7.org/fhir/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <criteria value="SDE Race"/>
  </supplementalData>
  <supplementalData>
    <identifier>
      <value value="sde-sex"/>
    </identifier>
    <usage>
      <coding>
        <system value="http://hl7.org/fhir/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <criteria value="SDE Sex"/>
  </supplementalData>
</Measure>

Measure "measure-exm124-FHIR" Version "3"

Tags: (no tags)  +

This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

Id: Measure/measure-exm124-FHIR
Type:
system: http://hl7.org/fhir/measure-type
code: process
Identifier: system: http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/cms
value: 130
system: http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/nqf
value: 0034
Title: Cervical Cancer Screening
Status: active
Description: Percentage of women 21-64 years of age who were screened for cervical cancer using either of the following criteria: <br> * Women age 21-64 who had cervical cytology performed every 3 years <br.* Women age 30-64 who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years
Purpose: Women 23-64 years of age with a visit during the measurement period
Use Context:

code: program

value:
text: eligible-provider

Topic:
system: http://loinc.org
code: 57024-2
display: Health Quality Measure Document
Contributor: author: National Committee for Quality Assurance
Related:

type: citation

citation:
Howlader, N., Noone, A.M., Krapcho, M., Miller, D., Bishop, K., Altekruse, S.F., Kosary, C.L., Yu, M., Ruhl, J., Tatalovich, Z., Mariotto, A., Lewis, D.R., Chen, H.S., Feuer, E.J., and Cronin, K.A. 2016. "SEER Cancer Statistics Review, 1975-2013." National Cancer Institute. (December 5, 2016) http://seer.cancer.gov/csr/1975_2013/

type: citation

citation:
National Business Group on Health. 2011. "Pathways to Managing Cancer in the Workplace." (May 8, 2012). http://www.tcyh.org/employers/downloads/Pathways_Managing_Cancer_2011.pdf

type: citation

citation:
Feig S. 2011. Comparison of Costs and Benefits of Breast Cancer Screening with Mammography, Ultrasonagraphy, and MRI. Obstetrics and Gynecology Clinics of North America. 38(1):179-96.

type: citation

citation:
U.S. Preventive Services Task Force (USPSTF). 2016. "Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement." Ann Intern Med. 164(4):279-296. doi:10.7326/M15-2886.

Library:

reference: Library/library-exm124-FHIR

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. <br> Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Scoring:
system: http://hl7.org/fhir/measure-scoring
code: proportion
Rationale: Breast cancer is one of the most common types of cancers, accounting for 15 percent of all new cancer diagnoses in the U.S. (Howlader et al, 2016). In 2013, over 3 million women were estimated to be living with breast cancer in the U.S. and it is estimated that 12 percent of women will be diagnosed with breast cancer at some point during their lifetime (Howlader et al, 2016). <br> While there are other factors that affect a woman's risk of developing breast cancer, advancing age is a primary risk factor. Breast cancer is most frequently diagnosed among women ages 55-64; the median age at diagnosis is 62 years (Howlader et al, 2016). The chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 40, the chances are 1 in 235; by age 50 it becomes 1 in 54; by age 60, it is 1 in 25 (National Business Group on Health, 2011). <br> In the U.S., costs associated with a diagnosis of breast cancer range from $451 to $2,520, factoring in continued testing, multiple office visits and procedures. The total costs related to breast cancer add up to nearly $7 billion per year in the U.S., including $2 billion spent on late-stage treatment (National Business Group on Health, 2011). If breast cancer is detected through mammography screening and diagnosed in its earliest stages, treatment may be less expensive (Feig, 2011).
Clinical Recommendation: The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50-74 years (B recommendation). <br> The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years (C recommendation). (USPSTF, 2016) <br> The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older (I statement). (USPSTF, 2016) <br> The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis (DBT) as a primary screening method for breast cancer (I Statement). (USPSTF, 2016) <br> The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, magnetic resonance imaging, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram (I statement). (USPSTF, 2016)
Guidance: To ensure the measure is only looking for a cervical cytology test only after a woman turns 21 years of age, the youngest age in the initial population is 23. <br> 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. <br> Include only cytology and HPV "co-testing"; in co-testing, both cytology and HPV tests are performed (i.e., the samples are collected and both tests are ordered, regardless of the cytology result) on the same date of service. Do not include reflex testing. In addition, if the medical record indicates the HPV test was performed only after determining the cytology result, this is considered reflex testing and does not meet criteria for the measure.
Group:

Identifier:
value: group-1

Population:

Identifier:
value: initial-population-identifier

criteria: Initial Population

Identifier:
value: numerator-identifier

criteria: Numerator

Identifier:
value: denominator-identifier

criteria: Denominator

Identifier:
value: denominator-exclusions-identifier

criteria: Denominator Exclusion

Supplemental Data:

Identifier:
value: sde-ethnicity

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Ethnicity

Identifier:
value: sde-payer

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Payer

Identifier:
value: sde-race

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Race

Identifier:
value: sde-sex

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Sex


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          <td style="padding-left: 25px padding-right: 25px">Measure/measure-exm124-FHIR</td>
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        <tr style="vertical-align: top">
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            <span>
              <br/>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
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                  <br/>
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        </tr>
        <tr style="vertical-align: top">
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            <b>system: </b>
            <span>http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/cms</span>
            <br/>
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            <span>130</span>
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            <span>http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/nqf</span>
            <br/>
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          </td>
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        <tr style="vertical-align: top">
          <th scope="row">
            <b>Title: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Cervical Cancer Screening</td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Status: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">active</td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Description: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Percentage of women 21-64 years of age who were screened for cervical cancer using either of the following criteria: &lt;br&gt; * Women age 21-64 who had cervical cytology performed every 3 years &lt;br.* Women age 30-64 who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years</td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Purpose: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Women 23-64 years of age with a visit during the measurement period</td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Use Context: </b>
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            <p style="padding-left: 25px margin-bottom: 5px">
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                  <b>text: </b>
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            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Topic: </b>
          </th>
          <td style="padding-right: 25px">
            <span>
              <br/>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
                  <span>http://loinc.org</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>code: </b>
                  <span>57024-2</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>display: </b>
                  <span>Health Quality Measure Document</span>
                </span>
              </span>
            </span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Contributor: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <b>
              <span>author</span>: </b>
            <span>National Committee for Quality Assurance</span>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="4" scope="row">
            <b>Related: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>type: </b>
              <span>citation</span>
            </p>
            <p style="margin-bottom: 5px">
              <b>citation: </b>
              <br/>
              <span>Howlader, N., Noone, A.M., Krapcho, M., Miller, D., Bishop, K., Altekruse, S.F., Kosary, C.L., Yu, M., Ruhl, J., Tatalovich, Z., Mariotto, A., Lewis, D.R., Chen, H.S., Feuer, E.J., and Cronin, K.A. 2016. "SEER Cancer Statistics Review, 1975-2013." National Cancer Institute. (December 5, 2016) http://seer.cancer.gov/csr/1975_2013/</span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>type: </b>
              <span>citation</span>
            </p>
            <p style="margin-bottom: 5px">
              <b>citation: </b>
              <br/>
              <span>National Business Group on Health. 2011. "Pathways to Managing Cancer in the Workplace." (May 8, 2012). http://www.tcyh.org/employers/downloads/Pathways_Managing_Cancer_2011.pdf</span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>type: </b>
              <span>citation</span>
            </p>
            <p style="margin-bottom: 5px">
              <b>citation: </b>
              <br/>
              <span>Feig S. 2011. Comparison of Costs and Benefits of Breast Cancer Screening with Mammography, Ultrasonagraphy, and MRI. Obstetrics and Gynecology Clinics of North America. 38(1):179-96.</span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>type: </b>
              <span>citation</span>
            </p>
            <p style="margin-bottom: 5px">
              <b>citation: </b>
              <br/>
              <span>U.S. Preventive Services Task Force (USPSTF). 2016. "Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement." Ann Intern Med. 164(4):279-296. doi:10.7326/M15-2886.</span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <th rowspan="1" scope="row">
            <b>Library: </b>
          </th>
          <td>
            <p style="padding-left: 25px padding-right: 25px">
              <b>reference: </b>
              <span>Library/library-exm124-FHIR</span>
            </p>
          </td>
        </tr>
        <tr>
          <th scope="row">
            <b>Disclaimer: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">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. &lt;br&gt; Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</td>
        </tr>
        <tr>
          <th scope="row">
            <b>Scoring: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <span>
              <br/>
              <span>
                <span style="padding-left: 25px">
                  <b>system: </b>
                  <span>http://hl7.org/fhir/measure-scoring</span>
                  <br/>
                </span>
                <span style="padding-left: 25px">
                  <b>code: </b>
                  <span>proportion</span>
                </span>
              </span>
            </span>
          </td>
        </tr>
        <tr>
          <th scope="row">
            <b>Rationale: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">Breast cancer is one of the most common types of cancers, accounting for 15 percent of all new cancer diagnoses in the U.S. (Howlader et al, 2016). In 2013, over 3 million women were estimated to be living with breast cancer in the U.S. and it is estimated that 12 percent of women will be diagnosed with breast cancer at some point during their lifetime (Howlader et al, 2016). &lt;br&gt; While there are other factors that affect a woman's risk of developing breast cancer, advancing age is a primary risk factor. Breast cancer is most frequently diagnosed among women ages 55-64 the median age at diagnosis is 62 years (Howlader et al, 2016). The chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 40, the chances are 1 in 235 by age 50 it becomes 1 in 54 by age 60, it is 1 in 25 (National Business Group on Health, 2011). &lt;br&gt; In the U.S., costs associated with a diagnosis of breast cancer range from $451 to $2,520, factoring in continued testing, multiple office visits and procedures. The total costs related to breast cancer add up to nearly $7 billion per year in the U.S., including $2 billion spent on late-stage treatment (National Business Group on Health, 2011). If breast cancer is detected through mammography screening and diagnosed in its earliest stages, treatment may be less expensive (Feig, 2011).</td>
        </tr>
        <tr>
          <th scope="row">
            <b>Clinical Recommendation: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50-74 years (B recommendation). &lt;br&gt; The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years (C recommendation). (USPSTF, 2016) &lt;br&gt; The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older (I statement). (USPSTF, 2016) &lt;br&gt; The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis (DBT) as a primary screening method for breast cancer (I Statement). (USPSTF, 2016) &lt;br&gt; The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, magnetic resonance imaging, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram (I statement). (USPSTF, 2016)</td>
        </tr>
        <tr>
          <th scope="row">
            <b>Guidance: </b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">To ensure the measure is only looking for a cervical cytology test only after a woman turns 21 years of age, the youngest age in the initial population is 23. &lt;br&gt; 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. &lt;br&gt; Include only cytology and HPV "co-testing" in co-testing, both cytology and HPV tests are performed (i.e., the samples are collected and both tests are ordered, regardless of the cytology result) on the same date of service. Do not include reflex testing. In addition, if the medical record indicates the HPV test was performed only after determining the cytology result, this is considered reflex testing and does not meet criteria for the measure.</td>
        </tr>
        <tr style="vertical-align: top">
          <th scope="row">
            <b>Group:</b>
          </th>
          <td>
            <p style="padding-left: 25px padding-right: 25px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>group-1</span>
                <br/>
              </span>
            </p>
          </td>
        </tr>
        <tr style="vertical-align: top">
          <td colspan="2">
            <table style="margin-bottom: 5px width: 100%">
              <tr style="vertical-align: top">
                <th rowspan="4" scope="row" style="padding-left: 25px">
                  <b>Population:</b>
                </th>
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>initial-population-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Initial Population</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>numerator-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Numerator</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>denominator-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Denominator</span>
                  </p>
                </td>
              </tr>
              <tr style="vertical-align: top">
                <td>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>Identifier:</b>
                    <br/>
                    <span style="padding-left: 25px">
                      <b>value: </b>
                      <span>denominator-exclusions-identifier</span>
                      <br/>
                    </span>
                  </p>
                  <p style="margin-bottom: 5px padding-left: 25px">
                    <b>criteria: </b>
                    <span>Denominator Exclusion</span>
                  </p>
                </td>
              </tr>
            </table>
          </td>
        </tr>
        <tr>
          <th rowspan="4" scope="row">
            <b>Supplemental Data:</b>
          </th>
          <td style="padding-left: 25px padding-right: 25px">
            <p style="margin-bottom: 5px">
              <b>Identifier:</b>
              <br/>
              <span style="padding-left: 25px">
                <b>value: </b>
                <span>sde-ethnicity</span>
                <br/>
              </span>
            </p>
            <p style="margin-bottom: 5px">
              <b>usage: </b>
              <span>
                <span>
                  <br/>
                  <span>
                    <span style="padding-left: 25px">
                      <b>system: </b>
                      <span>http://hl7.org/fhir/measure-data-usage</span>
                      <br/>
                    </span>
                    <span style="padding-left: 25px">
                      <b>code: </b>
                      <span>supplemental-data</span>
                    </span>
                  </span