Exclusive Breastfeeding Measure (id = "measure-exclusive-breastfeeding")

<?xml version="1.0" encoding="UTF-8"?>

<Measure xmlns="http://hl7.org/fhir">
  <id value="measure-exclusive-breastfeeding"/> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml"><table class="grid dict"><tr> <td> <b> Id: </b> </td> </tr> <tr> <td style="padding-left: 25px; padding-right: 25px;">Measure/measure-exclusive-breastfeeding</td> </tr> </table> <p/>  <table class="grid dict"><tr> <td> <b> Identifier: </b> </td> </tr> <tr> <td style="padding-left: 25px; padding-right: 25px;"><b> value: </b> <span> exclusive-breastfeeding-measure</span> </td> </tr> </table> <p/>  <table class="grid dict"><tr> <td> <b> Title: </b> </td> </tr> <tr> <td style="padding-left: 25px; padding-right: 25px;">Exclusive Breastfeeding Measure</td> </tr> </table> <p/>  <table class="grid dict"><tr> <td> <b> Status: </b> </td> </tr> <tr> <td style="padding-left: 25px; padding-right: 25px;">active</td> </tr> </table> <p/>  <table class="grid dict"><tr> <td> <b> Description: </b> </td> </tr> <tr> <td style="padding-left: 25px; padding-right: 25px;">Exclusive breastfeeding measure of outcomes for exclusive breastmilk feeding of
             newborns.</td> </tr> </table> <p/>  <table class="grid dict"><tr> <td> <b> Purpose: </b> </td> </tr> <tr> <td style="padding-left: 25px; padding-right: 25px;">Exclusive breast milk feeding for the first 6 months of neonatal life can result
             in numerous long-term health benefits for both mother and newborn and is recommended
             by a number of national and international organizations. Evidence suggests that
             the prenatal and intrapartum period is critical for the success of exclusive (or
             any) breast feeding. Therefore, it is recommended that newborns are fed breast
             milk only from birth to discharge.</td> </tr> </table> <p/>  <table class="grid dict"><tr> <td> <b> Topic: </b> </td> </tr> <tr> <td style="padding-right: 25px;"><span style="padding-left: 25px;"><b> text: </b> <span> Exclusive Breastfeeding</span> <br/>  </span> </td> </tr> </table> <p/>  <table class="grid dict"><tr> <td> <b> Library: </b> </td> </tr> <tr> <td style="padding-left: 25px; padding-right: 25px;"><b> reference: </b> <span> Library/library-exclusive-breastfeeding-cqm-logic</span> </td> </tr> </table> <p/>  <table class="grid dict"><tr> <td> <b> Type: </b> </td> </tr> <tr> <td style="padding-left: 25px; padding-right: 25px;">outcome</td> </tr> </table> <p/>  <table class="grid dict"><tr> <td> <b> Group:</b> </td> </tr> <tr> <td style="padding-left: 25px; padding-right: 25px;"><b> Identifier:</b> <br/>  <span style="padding-left: 25px;"><b> value: </b> <span> Population Group 1</span> <br/>  </span> </td> </tr> <tr> <td style="padding-left: 25px; padding-right: 25px;"><b> Population:</b> <br/>  <p style="margin-bottom: 5px; padding-left: 25px;"><b> type:</b> <span> initial-population</span> </p> <p style="margin-bottom: 5px; padding-left: 25px;"><b> Identifier:</b> <br/>  <span style="padding-left: 25px;"><b> value: </b> <span> initial-population-1-identifier</span> <br/>  </span> </p> <p style="margin-bottom: 5px; padding-left: 25px;"><b> criteria: </b> <span> InitialPopulation1</span> </p> </td> </tr> <tr> <td style="padding-left: 25px; padding-right: 25px;"><b> Population:</b> <br/>  <p style="margin-bottom: 5px; padding-left: 25px;"><b> type:</b> <span> denominator</span> </p> <p style="margin-bottom: 5px; padding-left: 25px;"><b> Identifier:</b> <br/>  <span style="padding-left: 25px;"><b> value: </b> <span> denominator-1-identifier</span> <br/>  </span> </p> <p style="margin-bottom: 5px; padding-left: 25px;"><b> criteria: </b> <span> Denominator1</span> </p> </td> </tr> <tr> <td style="padding-left: 25px; padding-right: 25px;"><b> Population:</b> <br/>  <p style="margin-bottom: 5px; padding-left: 25px;"><b> type:</b> <span> denominator-exclusion</span> </p> <p style="margin-bottom: 5px; padding-left: 25px;"><b> Identifier:</b> <br/>  <span style="padding-left: 25px;"><b> value: </b> <span> denominator-exclusions-1-identifier</span> <br/>  </span> </p> <p style="margin-bottom: 5px; padding-left: 25px;"><b> criteria: </b> <span> DenominatorExclusions1</span> </p> </td> </tr> <tr> <td style="padding-left: 25px; padding-right: 25px;"><b> Population:</b> <br/>  <p style="margin-bottom: 5px; padding-left: 25px;"><b> type:</b> <span> numerator</span> </p> <p style="margin-bottom: 5px; padding-left: 25px;"><b> Identifier:</b> <br/>  <span style="padding-left: 25px;"><b> value: </b> <span> numerator-1-identifier</span> <br/>  </span> </p> <p style="margin-bottom: 5px; padding-left: 25px;"><b> criteria: </b> <span> Numerator1</span> </p> </td> </tr> </table> <table class="grid dict"><tr> <td> <b> Group:</b> </td> </tr> <tr> <td style="padding-left: 25px; padding-right: 25px;"><b> Identifier:</b> <br/>  <span style="padding-left: 25px;"><b> value: </b> <span> Population Group 2</span> <br/>  </span> </td> </tr> <tr> <td style="padding-left: 25px; padding-right: 25px;"><b> Population:</b> <br/>  <p style="margin-bottom: 5px; padding-left: 25px;"><b> type:</b> <span> initial-population</span> </p> <p style="margin-bottom: 5px; padding-left: 25px;"><b> Identifier:</b> <br/>  <span style="padding-left: 25px;"><b> value: </b> <span> initial-population-2-identifier</span> <br/>  </span> </p> <p style="margin-bottom: 5px; padding-left: 25px;"><b> criteria: </b> <span> InitialPopulation2</span> </p> </td> </tr> <tr> <td style="padding-left: 25px; padding-right: 25px;"><b> Population:</b> <br/>  <p style="margin-bottom: 5px; padding-left: 25px;"><b> type:</b> <span> denominator</span> </p> <p style="margin-bottom: 5px; padding-left: 25px;"><b> Identifier:</b> <br/>  <span style="padding-left: 25px;"><b> value: </b> <span> denominator-2-identifier</span> <br/>  </span> </p> <p style="margin-bottom: 5px; padding-left: 25px;"><b> criteria: </b> <span> Denominator2</span> </p> </td> </tr> <tr> <td style="padding-left: 25px; padding-right: 25px;"><b> Population:</b> <br/>  <p style="margin-bottom: 5px; padding-left: 25px;"><b> type:</b> <span> denominator-exclusion</span> </p> <p style="margin-bottom: 5px; padding-left: 25px;"><b> Identifier:</b> <br/>  <span style="padding-left: 25px;"><b> value: </b> <span> denominator-exclusions-2-identifier</span> <br/>  </span> </p> <p style="margin-bottom: 5px; padding-left: 25px;"><b> criteria: </b> <span> DenominatorExclusions2</span> </p> </td> </tr> <tr> <td style="padding-left: 25px; padding-right: 25px;"><b> Population:</b> <br/>  <p style="margin-bottom: 5px; padding-left: 25px;"><b> type:</b> <span> numerator</span> </p> <p style="margin-bottom: 5px; padding-left: 25px;"><b> Identifier:</b> <br/>  <span style="padding-left: 25px;"><b> value: </b> <span> numerator-2-identifier</span> <br/>  </span> </p> <p style="margin-bottom: 5px; padding-left: 25px;"><b> criteria: </b> <span> Numerator2</span> </p> </td> </tr> </table> </div> 
  </text> 
  <identifier> 
    <use value="official"/> 
    <value value="exclusive-breastfeeding-measure"/> 
  </identifier> 
  <version value="5.0.0"/> 
  <title value="Exclusive Breastfeeding Measure"/> 
  <status value="active"/> 
  <date value="2015-03-08"/> 
  <description value="Exclusive breastfeeding measure of outcomes for exclusive breastmilk feeding of
   newborns."/> 
  <purpose value="Measure of newborns who were fed breast milk only since birth"/> 
  <topic> 
    <text value="Exclusive Breastfeeding"/> 
  </topic> 
  <relatedArtifact> 
  <type value="documentation"/> 
  <citation value="American Academy of Pediatrics. (2005). Section on Breastfeeding. Policy Statement:Breastfeed
    ing and the Use of Human Milk. Pediatrics.115:496-506."/> 
  </relatedArtifact> 
  <relatedArtifact> 
  <type value="documentation"/> 
  <citation value="American College of Obstetricians and Gynecologists. (Feb. 2007). Committee on
     Obstetric Practice and Committee on Health Care for Underserved Women. Breastfeeding:
     Maternal and Infant Aspects. ACOG Committee Opinion 361."/> 
  </relatedArtifact> 
  <relatedArtifact> 
  <type value="documentation"/> 
  <citation value="California Department of Public Health. (2006). Genetic Disease Branch. California
     In-Hospital Breastfeeding as Indicated on the Newborn Screening Test Form, Statewide,
     County and Hospital of Occurrence: Available at: http://www.cdph.ca.gov/data/statistics/Pages
    /BreastfeedingStatistics.aspx."/> 
  </relatedArtifact> 
  <relatedArtifact> 
  <type value="documentation"/> 
  <citation value="Centers for Disease Control and Prevention. (Aug 3, 2007). Breastfeeding trends
     and updated national health objectives for exclusive breastfeeding--United States
     birth years 2000-2004. MMWR - Morbidity &amp; Mortality Weekly Report. 56(30):760-3."/> 
  </relatedArtifact> 
  <relatedArtifact> 
  <type value="documentation"/> 
  <citation value="Centers for Disease Control and Prevention. (2014). Division of Nutrition, Physical
     Activity and Obesity. Breastfeeding Report Card. Available at: http://www.cdc.gov/breastfeedi
    ng/pdf/2014breastfeedingreportcard.pdf"/> 
  </relatedArtifact> 
  <relatedArtifact> 
  <type value="documentation"/> 
  <citation value="Ip, S., Chung, M., Raman, G., et al. (2007). Breastfeeding and maternal and infant
     health outcomes in developed countries. Rockville, MD: US Department of Health
     and Human Services. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfou
    t.pdf"/> 
  </relatedArtifact> 
  <relatedArtifact> 
  <type value="documentation"/> 
  <citation value="Kramer, M.S. &amp; Kakuma, R. (2002).Optimal duration of exclusive breastfeeding.
     [107 refs] Cochrane Database of Systematic Reviews. (1):CD003517."/> 
  </relatedArtifact> 
  <relatedArtifact> 
  <type value="documentation"/> 
  <citation value="Petrova, A., Hegyi, T., &amp; Mehta, R. (2007). Maternal race/ethnicity and one-month
     exclusive breastfeeding in association with the in-hospital feeding modality. Breastfeeding
     Medicine. 2(2):92-8."/> 
  </relatedArtifact> 
  <relatedArtifact> 
  <type value="documentation"/> 
  <citation value="Shealy, K.R., Li, R., Benton-Davis, S., &amp; Grummer-Strawn, L.M. (2005).The CDC
     guide to breastfeeding interventions. Atlanta, GA: US Department of Health and
     Human Services, CDC. Available at: http://www.cdc.gov/breastfeeding/pdf/breastfeeding_interve
    ntions.pdf."/> 
  </relatedArtifact> 
  <relatedArtifact> 
  <type value="documentation"/> 
  <citation value="Taveras, E.M., Li, R., Grummer-Strawn, L., Richardson, M., Marshall, R., Rego,
     V.H., Miroshnik, I., &amp; Lieu, T.A. (2004). Opinions and practices of clinicians
     associated with continuation of exclusive breastfeeding. Pediatrics. 113(4):e283-90."/> 
  </relatedArtifact> 
  <relatedArtifact> 
  <type value="documentation"/> 
  <citation value="US Department of Health and Human Services. (2007). Healthy People 2010 Midcourse
     Review. Washington, DC: US Department of Health and Human Services. Available at:
     http://www.healthypeople.gov/2010/data/midcourse/?visit=1."/> 
  </relatedArtifact> 
  <relatedArtifact> 
  <type value="documentation"/> 
  <citation value="World Health Organization. (1991). Indicators for assessing breastfeeding practices.
     Geneva, Switzerland: World Health Organization. Available at: http://whqlibdoc.who.int/hq/199
    1/WHO_CDD_SER_91.14.pdf?ua=1."/> 
  </relatedArtifact> 

  <!--   This measure replaces the previous version of the exclusive breastmilk feeding
   measure   -->
  <relatedArtifact> 
    <type value="predecessor"/> 
    <resource value="http://example.org/fhir/Measure/measure-predecessor-example"/> 
  </relatedArtifact> 
  <!--   This measure derives from the previous version, and changes the logic to add
   ACOG revitalize guidelines for gestational age calculation   -->
  <relatedArtifact> 
    <type value="derived-from"/> 
    <resource value="http://example.org/fhir/Measure/measure-predecessor-example"/> 
  </relatedArtifact> 
  <library value="http://example.org/fhir/Library/library-exclusive-breastfeeding-cqm-logic"/> 
  <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> 
    <code value="proportion"/> 
  </coding> 
  </scoring> 
  <type> 
  <coding> 
    <code value="process"/> 
  </coding> 
  </type> 
  <rationale value="Exclusive breast milk feeding for the first 6 months of neonatal life has long
   been the expressed goal of World Health Organization (WHO), Department of Health
   and Human Services (DHHS), American Academy of Pediatrics (AAP) and American College
   of Obstetricians and Gynecologists (ACOG). ACOG has recently reiterated its position
   (ACOG, 2007). A recent Cochrane review substantiates the benefits (Kramer et al.,
   2002). Much evidence has now focused on the prenatal and intrapartum period as
   critical for the success of exclusive (or any) BF (Centers for Disease Control
   and Prevention [CDC], 2007; Petrova et al., 2007; Shealy et al., 2005; Taveras
   et al., 2004). Exclusive breast milk feeding rate during birth hospital stay has
   been calculated by the California Department of Public Health for the last several
   years using newborn genetic disease testing data. Healthy People 2010 and the CDC
   have also been active in promoting this goal."/> 
  <clinicalRecommendationStatement value="Exclusive breast milk feeding for the first 6 months of neonatal life can result
   in numerous long-term health benefits for both mother and newborn and is recommended
   by a number of national and international organizations. Evidence suggests that
   the prenatal and intrapartum period is critical for the success of exclusive (or
   any) breast feeding. Therefore, it is recommended that newborns are fed breast
   milk only from birth to discharge."/> 
  <improvementNotation> 
    <coding> 
      <system value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/> 
      <code value="increase"/> 
    </coding> 
  </improvementNotation> 
  <term> 
    <definition value="Gestational age is calculated using the ACOG ReVITALize guidelines with Estimated
     Due Date (EDD) http://www.acog.org/about_acog/acog_departments/patient_safety_and_quality_imp
    rovement/~/media/departments/patient%20safety%20and%20quality%20improvement/201213issuesandrat
    ionale-gestationalageterm.pdf. The exam used needs to be the most recent exam associated
     with this pregnancy"/> 
  </term> 
  <guidance value="A discharge to a designated cancer center or children's hospital should be captured
   as a discharge to an acute care facility. It is acceptable to calculate Gestational
   Age using the American College of Obstetricians and Gynecologists ReVITALize guidelines,
   which define Gestational Age as calculated using the best obstetrical Estimated
   Due Date (EDD) based on the formula: Gestational Age= (280-(EDD-Reference Date))/7
   where Reference Date is the date on which you are trying to determine gestational
   age. For PC-05, Reference Date is the Birth Date. Note however that the calculation
   may yield a non-whole number and gestational age should be rounded off to the nearest
   completed week. For example, an infant born on the 5th day of the 36th week (35
   weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks."/> 
  <group id="PopulationGroup1">
    <population> 
      <code> <coding> <code value="initial-population"/> </coding> </code> 
      <criteria> <language value="text/cql"/> <expression value="InitialPopulation1"/> </criteria> 
    </population> 
    <population> 
      <code> <coding> <code value="denominator"/> </coding> </code> 
      <criteria> <language value="text/cql"/> <expression value="Denominator1"/> </criteria> 
    </population> 
    <population> 
      <code> <coding> <code value="denominator-exclusions"/> </coding> </code> 
      <criteria> <language value="text/cql"/> <expression value="DenominatorExclusions1"/> </criteria> 
    </population> 
    <population> 
      <code> <coding> <code value="numerator"/> </coding> </code> 
      <criteria> <language value="text/cql"/> <expression value="Numerator1"/> </criteria> 
    </population> 
  </group> 
  <group id="PopulationGroup2">
    <population> 
      <code> <coding> <code value="initial-population"/> </coding> </code> 
      <criteria> <language value="text/cql"/> <expression value="InitialPopulation2"/> </criteria> 
    </population> 
    <population> 
      <code> <coding> <code value="denominator"/> </coding> </code> 
      <criteria> <language value="text/cql"/> <expression value="Denominator2"/> </criteria> 
    </population> 
    <population> 
      <code> <coding> <code value="denominator-exclusion"/> </coding> </code> 
      <criteria> <language value="text/cql"/> <expression value="DenominatorExclusions2"/> </criteria> 
    </population> 
    <population> 
      <code> <coding> <code value="numerator"/> </coding> </code> 
      <criteria> <language value="text/cql"/> <expression value="Numerator2"/> </criteria> 
    </population> 
  </group> 
</Measure>