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:Breastfeeding
     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.as
    px."/> 
  </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/breastfeeding/pdf/2014breas
    tfeedingreportcard.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/brfout.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_interventions.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.g
    ov/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/1991/WHO_CDD_SER_9
    1.14.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_improvement/~/
    media/departments/patient%20safety%20and%20quality%20improvement/201213issuesandrationale-gestational
    ageterm.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>