Quality Measure STU2 for FHIR R4 Implementation Guide
This page is part of the Quality Measure STU2 for FHIR R4 Implementation Guide (v1.1.0: STU 2 Ballot 1) based on FHIR R4. The current version which supercedes this version is 3.0.0. For a full list of available versions, see the Directory of published versions 
<Measure xmlns="http://hl7.org/fhir"> <id value="measure-vte-1-FHIR"/> <meta> <versionId value="2"/> <lastUpdated value="2019-11-09T04:34:49.724+00:00"/> <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 style="width: 60%; border-bottom: none;" class="header_table"> <!-- <tr th:if="${resource.hasId()}" style="vertical-align: top;"><th style="background-color:#656565; width:20%" scope="row"><span class="td_label">Id: </span></th><td style="width:80%" colspan="3" th:narrative="${resource.id}"></td></tr> --><tr style="vertical-align: top;"><td scope="row" style="background-color:#656565; width:20%"><span class="td_label">Measure Title</span></td><td colspan="1" style="width:60%"><h1 style="font-size:10px">Venous Thromboembolism Prophylaxis</h1></td><td scope="row" style="background-color:#656565; width:10%"><span class="td_label">Measure ID</span></td><td colspan="1" style="width:10%"><h1 style="font-size:10px">VTE_1_FHIR</h1></td></tr> <!-- <th:block th:each="ident, iter : ${resource.identifier}"><tr th:if="${ident.type.coding[0].code == 'CMS'}" style="vertical-align: top;"><td style="background-color:#656565; width:20%" scope="row"><span class="td_label">eCQM Identifier (Measure Authoring Tool)</span></td><td style="width:30%" th:narrative="${ident.value}"></td><td style="background-color:#656565; width:20%" scope="row"><span class="td_label">eCQM Version number</span></td><td style="width:30%" th:narrative="${resource.version}"></td></tr></th:block><th:block th:each="ident, iter : ${resource.identifier}"><tr th:if="${ident.type.coding[0].code == 'NQF'}" style="vertical-align: top;"><td style="background-color:#656565; width:20%" scope="row"><span class="td_label">NQF Number</span></td><td style="width:30%" th:narrative="${ident.value}"></td><td style="background-color:#656565; width:20%" scope="row"><span class="td_label">GUID</span></td><td style="width:30%" th:narrative="${resource.url}"></td></tr></th:block> --><tr style="vertical-align: top;"><td scope="row" style="background-color:#656565; width:20%"><span class="td_label">Description</span></td><td colspan="3" style="width:80%"><div style="width:660px;overflow-x:hidden;overflow-y:auto"><pre><p>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</p> </pre> </div> </td> </tr> <tr> <td scope="row" style="background-color:#656565; width:20%"><span class="td_label">Measurement Period</span></td> <td colspan="3" style="width:80%">January 1 - December 31</td> </tr> <!-- <tr> <td style="background-color:#656565; width:20%" scope="row"><span class="td_label">Measure Steward</span></td> <td style="width:80%" colspan="3" th:narrative="${resource.publisher}"></td> </tr> <tr> <td style="background-color:#656565; width:20%" scope="row"><span class="td_label">Measure Developer</span></td> <td style="width:80%" colspan="3" th:narrative="${resource.publisher}"></td> </tr> --> <!-- <tr th:if="${resource.hasDisclaimer()}"> <td style="background-color:#656565; width:20%" scope="row"><span class="td_label">Disclaimer</span></td> <td style="width:80%" colspan="3"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre th:text="${resource.disclaimer}"></pre> </div> </td> </tr> --> <tr> <td scope="row" style="background-color:#656565; width:20%"><span class="td_label">Copyright and Disclaimer Notice</span></td> <td colspan="3" style="width:80%"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre>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</pre> <br/> <pre>Measure specifications are in the Public Domain. LOINC(R) is a registered trademark of the Regenstrief Institute. This material contains SNOMED Clinical Terms(R) (SNOMED CT(C)) copyright 2004-2017 International Health Terminology Standards Development Organization. All rights reserved.</pre> </div> </td> </tr> <tr> <td scope="row" style="background-color:#656565; width:20%"><span class="td_label">Clinical Recommendation Statement</span></td> <td colspan="3" style="width:80%"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"><p>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.</p> </div> </td> </tr> <tr style="vertical-align: top;"> <td rowspan="5" scope="row" style="background-color:#656565; width:20%"><span class="td_label">References</span></td> <td colspan="3" style="width:80%"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre>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</pre> </div> </td> </tr> <tr style="vertical-align: top;"> <td colspan="3" style="width:80%"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre>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</pre> </div> </td> </tr> <tr style="vertical-align: top;"> <td colspan="3" style="width:80%"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre>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.</pre> </div> </td> </tr> <tr style="vertical-align: top;"> <td colspan="3" style="width:80%"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre>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</pre> </div> </td> </tr> <tr style="vertical-align: top;"> <td colspan="3" style="width:80%"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre>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.</pre> </div> </td> </tr> <tr> <td colspan="4" scope="row" style="background-color:#656565; width:100%"><span class="td_label">Characteristics</span></td> </tr> <tr> <td scope="row" style="width:20%"><span>Scoring</span></td> <td colspan="3" style="width:80%">Proportion</td> </tr> <!-- <tr th:if="${resource.hasCompositeScoring()}"> <td style="width:20%" scope="row"><span class="td_label">Composite Scoring</span></td> <td style="width:80%" colspan="3" th:narrative="${resource.compositeScoring.getText().substring(0, 1).toUpperCase() + resource.compositeScoring.getText().substring(1)}"></td> </tr> --> <tr style="vertical-align: top;"> <td rowspan="1" scope="row" style="width:20%"><span>Type</span></td> <td colspan="3" style="width:80%">Process</td> </tr> <!-- <tr th:if="${resource.hasStatus()}" style="vertical-align: top;"> <td style="background-color:#656565; width:20%" scope="row"><span class="td_label">Status</span></td> <td style="width:80%" colspan="3" th:narrative="${resource.status.toString().substring(0, 1).toUpperCase() + resource.status.toString().substring(1).toLowerCase()}"></td> </tr> <tr th:if="${resource.hasPurpose()}" style="vertical-align: top;"> <td style="background-color:#656565; width:20%" scope="row"><span class="td_label">Purpose</span></td> <td style="width:80%" colspan="3" th:narrative="${resource.purpose}"></td> </tr> <tr th:if="${resource.hasUsage()}" style="vertical-align: top;" > <td style="background-color:#656565; width:20%" scope="row"><span class="td_label">Usage</span></td> <td style="width:80%" colspan="3" th:narrative="${resource.usage}"></td> </tr> <th:block th:each="context, iter : ${resource.useContext}" > <tr style="vertical-align: top;"> <td th:if="${iter.index == 0}" th:rowspan="${iter.size}" style="background-color:#656565; width:20%" scope="row"><span class="td_label">Use Context</span></td> <td style="width:80%" colspan="3" th:narrative="${context}"></td> </tr> </th:block> <th:block th:each="topics, iter : ${resource.topic}" > <tr style="vertical-align: top;"> <td th:if="${iter.index == 0}" th:rowspan="${iter.size}" style="background-color:#656565; width:20%" scope="row"><span class="td_label">Topic</span></td> <td style="width:80%" colspan="3" th:narrative="${topics}"></td> </tr> </th:block> <th:block th:each="cont, iter : ${resource.contributor}" > <tr style="vertical-align: top;"> <td th:if="${iter.index == 0}" th:rowspan="${iter.size}" style="background-color:#656565; width:20%" scope="row"><span class="td_label">Contributor</span></td> <td style="width:80%" colspan="3"> <b><span th:narrative="${cont.type.toCode()}"></span>: </b><span th:narrative="${cont.name}"></span> </td> </tr> </th:block> --> <!-- <th:block th:each="lib, iter : ${resource.library}" > <tr style="vertical-align: top;"> <td th:if="${iter.index == 0}" th:rowspan="${iter.size}" style="background-color:#656565; width:20%" scope="row"><span class="td_label">Library</span></td> <td style="width:80%" colspan="3"> <p th:if="${lib.hasIdentifier()}"><b>identifier: </b><span th:narrative="${lib.identifier}"></span></p> <p th:if="${lib.hasReference()}"><b>reference: </b><span th:narrative="${lib.reference}"></span></p> <p th:if="${lib.hasDisplay()}"><b>display: </b><span th:narrative="${lib.display}"></span></p> </td> </tr> </th:block> --> <!-- <tr th:if="${resource.hasRateAggregation()}" > <td style="background-color:#656565; width:20%" scope="row"><span class="td_label">Rate Aggregation</span></td> <td style="width:80%" colspan="3"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre th:text="${resource.rateAggregation}"></pre> </div> </td> </tr> <tr th:if="${resource.hasRationale()}"> <td style="background-color:#656565; width:20%" scope="row"><span class="td_label">Rationale</span></td> <td style="width:80%" colspan="3"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre th:text="${resource.rationale}"></pre> </div> </td> </tr> --> <tr> <td scope="row" style="width:20%"><span>Improvement Notation</span></td> <td colspan="3" style="width:80%">A higher rate indicates better performance.</td> </tr> <tr> <td scope="row" style="width:20%"><span>Guidance</span></td> <td colspan="3" style="width:80%"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"><p>When low dose unfractionated heparin is administered for VTE Prophylaxis, the intended administration route for low dose unfractionated heparin is subcutaneous.</p> <p>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."</p> </div> </td> </tr> <tr> <td colspan="4" scope="row" style="background-color:#656565; width:100%"><span class="td_label">Definitions</span></td> </tr> <tr style="vertical-align: top;"> <td scope="row" style="background-color:#656565; width:20%"><span class="td_label">Numerator</span></td> <td colspan="3" style="width:80%"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre>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 admission Patients 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)</pre> </div> </td> </tr> <tr style="vertical-align: top;"> <td scope="row" style="background-color:#656565; width:20%"><span class="td_label">Denominator</span></td> <td colspan="3" style="width:80%"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre>All patients in the initial population</pre> </div> </td> </tr> <tr style="vertical-align: top;"> <td scope="row" style="background-color:#656565; width:20%"><span class="td_label">Initial Population</span></td> <td colspan="3" style="width:80%"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre>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</pre> </div> </td> </tr> <tr style="vertical-align: top;"> <td scope="row" style="background-color:#656565; width:20%"><span class="td_label">Denominator Exclusion</span></td> <td colspan="3" style="width:80%"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre>* 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</pre> </div> </td> </tr> <!-- <th:block th:each="groups, iter : ${resource.uniquePopulationGroup}" > <tr style="vertical-align: top;"> <td style="background-color:#656565; width:20%" scope="row"><span class="td_label" th:text="${groups.identifier.value}"></span></td> <td style="width:80%" colspan="3"> <div style="width:660px;overflow-x:hidden;overflow-y:auto"> <pre th:text="${pops.description}"></pre> </div> </td> </tr> </th:block> --> </table> <table style="width: 60%; border-top: none; border-bottom: none" class="header_table"> </table> <table style="width: 60%; border-top: none;" class="header_table"> <!-- <th:block th:each="supples, iter : ${resource.supplementalData}"> <tr> <th th:if="${iter.index == 0}" th:rowspan="${iter.size}" scope="row"><b>Supplemental Data:</b></th> <td style="width:80%" colspan="3" > <p style="margin-bottom: 5px;" th:narrative="${supples.identifier}"></p> <p style="margin-bottom: 5px;" th:each="uses : ${supples.usage}"> <b>usage: </b> <span th:narrative="${uses}"></span> </p> <p style="margin-bottom: 5px;" th:if="${supples.hasCriteria()}"> <b>criteria: </b> <span th:narrative="${supples.criteria}"></span> </p> <p style="margin-bottom: 5px;" th:if="${supples.hasPath()}"> <b>path: </b> <span th:narrative="${supples.path}"></span> </p> </td> </tr> </th:block> --> <!-- <th:block th:each="param, iter : ${resource.parameter}"> <tr style="vertical-align: top;"> <th th:if="${iter.index == 0}" th:rowspan="${iter.size}" scope="row"><b>Parameter: </b></th> <td style="width:80%" colspan="3" > <span th:if="${param.hasName()}"> <b>name: </b> <span th:narrative="${param.name}"></span> <br/> </span> <b>use: </b> <span th:narrative="${param.use.toCode()}"></span> <br/> <span th:if="${param.hasMin()}"> <b>minimum cardinality: </b> <span th:narrative="${param.min}"></span> <br/> </span> <span th:if="${param.hasMax()}"> <b>maximum cardinality: </b> <span th:narrative="${param.max}"></span> <br/> </span> <b>type: </b> <span th:narrative="${param.type}"></span> <br/> <span th:if="${param.hasDocumentation()}"> <b>documentation: </b> <span th:narrative="${param.documentation}"></span> <br/> </span> <span th:if="${param.hasProfile()}"> <b>profile: </b> <span th:narrative="${param.profile}"></span> <br/> </span> <p style="margin-bottom: 5px;"></p> </td> </tr> </th:block> --> <!-- <th:block th:each="dataReq, iter : ${resource.dataRequirement}"> <tr style="vertical-align: top;"> <th th:if="${iter.index == 0}" th:rowspan="${iter.size}" scope="row" ><b>Data Requirements: </b></th> <td style="width:80%" colspan="3" th:narrative="${dataReq}"></td> </tr> </th:block> --> </table> <h2><a name="toc">Table of Contents</a></h2> <ul style="padding-left: 50px;"> <li><a href="#d1e405">Population Criteria</a></li> <li><a href="#d1e649">Definitions</a></li> <li><a href="#d1e650">Functions</a></li> <li> <!-- a href="#d1e555" -->Terminology <!-- /a --></li> <li> <!-- a href="#d1e647" -->Data Criteria (QDM Data Elements) <!-- /a --></li> <li><a href="#d1e767">Supplemental Data Elements</a></li> <li><a href="#d1e879">Risk Adjustment Variables</a></li> </ul> <div style="float:left; background:teal; height:3px; width:80%"/> <pre><br/></pre> <h3><a name="d1e405" href="#toc">Population Criteria</a></h3> <div> <ul style="list-style:none;padding-left:10px;"> <li style="list-style:none;padding-left:0px;" class="list-unstyled"> <div class="treeview hover p-l-10"> <ul class="list-unstyled"> <li class="list-unstyled"> <ul class="code"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul> <li style="padding-left: 0px;"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@7080284b</pre> </div></li> </ul> </div></li> </ul></li> </ul> </div> <div class="treeview hover p-l-10"> <ul class="list-unstyled"> <li class="list-unstyled"> <ul class="code"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul> <li style="padding-left: 0px;"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@77d7173e</pre> </div></li> </ul> </div></li> </ul></li> </ul> </div> <div class="treeview hover p-l-10"> <ul class="list-unstyled"> <li class="list-unstyled"> <ul class="code"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul> <li style="padding-left: 0px;"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@1e2f3b25</pre> </div></li> </ul> </div></li> </ul></li> </ul> </div> <div class="treeview hover p-l-10"> <ul class="list-unstyled"> <li class="list-unstyled"> <ul class="code"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul> <li style="padding-left: 0px;"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@64de44ed</pre> </div></li> </ul> </div></li> </ul></li> </ul> </div> </li> </ul> </div> <h3><a name="d1e649" href="#toc">Definitions</a></h3> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@156dfa4d</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@5a4c7139</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@3d5d9f46</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@2b325d2c</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@51f77595</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@680b032b</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@39fd06c3</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@9fe7ed</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@6a2e71b6</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@5a0c3583</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@b16eb1f</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@74c9d51f</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@6d73a9f1</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@56e839f1</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@6a9a7e20</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@50412f41</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@200d3899</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@37bdaad8</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@eefa971</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@578da4ca</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@1e0d8752</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@44bc1521</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@37eb88e6</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@dfad125</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@7f3fe0df</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@5b0ee704</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@30c9f83b</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@6be174fe</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@6b585845</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@4742b4ed</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@3835841e</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@58135162</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@71a0a055</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@23978750</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@3796e248</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@754c3d99</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@11a996d</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@1e282319</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@1e2c0636</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@a98409f</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@5f1c7150</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@73b141</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@7e900acf</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <h3><a name="d1e650" href="#toc">Functions</a></h3> <div> <ul style="list-style:none;padding-left: 10px;"> <li style="list-style:none;" class="list-unstyled"> <div> <ul style="list-style:none;padding-left:0;" class="list-unstyled"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@3644213a</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <!-- <h3><a name="d1e555" href="#toc">Terminology</a></h3> --> <!-- <div> --> <!-- <ul style="padding-left: 50px;"> --> <!-- <li th:each="terms, iter : ${resource.terminology}" style="width:80%" th:text="${terms.getDefinition()}"></li> --> <!-- </ul> --> <!-- </div> --> <!-- <h3><a name="d1e647" href="#toc">Data Criteria (QDM Data Elements)</a></h3> --> <!-- <div> --> <!-- <ul style="padding-left: 50px;"> --> <!-- <li th:each="data, iter : ${resource.dataCriteria}" style="width:80%" th:text="${data}"></li> --> <!-- </ul> --> <!-- </div> --> <h3><a name="d1e767" href="#toc">Supplemental Data Elements</a></h3> <div> <ul style="list-style:none;padding-left: 25px;"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@1e282319</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 25px;"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@1e2c0636</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 25px;"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@a98409f</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <div> <ul style="list-style:none;padding-left: 25px;"> <li class="list-unstyled"> <div class="treeview hover p-l-10"> <ul style="margin-right: 20%; opacity: 1;" class="code"> <li class="list-unstyled"> <div> <ul style="padding-left: 0px;"> <li style="padding-left: 0px;" class="list-unstyled"> <div> <pre class="cql-definition-body">org.hl7.fhir.r4.model.Expression@5f1c7150</pre> </div></li> </ul> </div></li> </ul> </div></li> </ul> </div> <h3><a name="d1e879" href="#toc">Risk Adjustment Variables</a></h3> <div> <ul style="list-style:none;padding-left: 25px;"> <li>None</li> </ul> </div> <div style="float:left; background:teal; height:3px; width:80%"/> <table> <!-- <tr th:if="${resource.hasSet()}" > --> <!-- <td style="background-color:#656565; width:20%" scope="row"><span class="td_label">Measure Set</span></td> --> <!-- <td style="width:80%" th:narrative="${resource.set}"></td> --> <!-- </tr> --> <!-- <th:block th:each="con, iter : ${resource.content}"> <tr th:if="${con.contentType == 'text/cql'}" style="vertical-align: top;"> <td style="background-color:#656565; width:20%" scope="row"><span class="td_label">Content</span></td> <td style="width:80%" ><b>type: </b><span th:text="${con.contentType}"></span></td> </tr> <tr th:if="${con.contentType == 'text/cql'}"> <td style="width:100%" colspan="2" > <th:block th:if="${con.getData() != null }" > <pre><code th:class="${con.contentType == 'text/cql' ? 'language-cql' : 'language-xml'}" th:text="${new java.lang.String(con.getData())}"></code></pre> </th:block> <th:block th:if="${con.getData() == null }" > <span><i><content is empty></i></span> </th:block> </td> </tr> </th:block > --> </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://example.org/fhir/cqi/ecqm/Measure/Identifier/cms"/> <value value="108"/> </identifier> <identifier> <use value="official"/> <system value="http://example.org/fhir/cqi/ecqm/Measure/Identifier/nqf"/> <value value="0371"/> </identifier> <version value="1.1.0"/> <name value="VTE_1_FHIR"/> <title value="Venous Thromboembolism Prophylaxis"/> <status value="active"/> <experimental value="true"/> <date value="2018-08-31T00:00:00+00:00"/> <publisher value="The Joint Commission"/> <contact> <telecom> <system value="url"/> <value value="https://www.jointcommission.org/"/> </telecom> </contact> <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"/> <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"/> <display value="United States of America"/> </coding> </jurisdiction> <copyright value="Measure specifications are in the Public Domain. LOINC(R) is a registered trademark of the Regenstrief Institute. This material contains SNOMED Clinical Terms(R) (SNOMED CT(C)) copyright 2004-2017 International Health Terminology Standards Development Organization. All rights reserved."/> <approvalDate value="2019-03-08"/> <lastReviewDate value="2019-03-08"/> <effectivePeriod> <start value="2018-01-01T00:00:00+00:00"/> <end value="2018-12-31T00:00:00+00:00"/> </effectivePeriod> <topic> <coding> <system value="http://loinc.org"/> <code value="57024-2"/> <display value="Health Quality Measure Document"/> </coding> </topic> <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> <relatedArtifact> <type value="depends-on"/> <resource value="Library/fhirhelpers"/> </relatedArtifact> <relatedArtifact> <type value="depends-on"/> <resource value="Library/matglobalcommonfunctions-fhir"/> </relatedArtifact> <relatedArtifact> <type value="depends-on"/> <resource value="Library/vteicu-fhir"/> </relatedArtifact> <relatedArtifact> <type value="depends-on"/> <resource value="Library/supplementaldataelements-fhir"/> </relatedArtifact> <library value="Library/vte-1-fhir"/> <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://terminology.hl7.org/CodeSystem/measure-scoring"/> <code value="proportion"/> <display value="Proportion"/> </coding> </scoring> <type> <coding> <system value="http://terminology.hl7.org/CodeSystem/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). 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."/> <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> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/> <code value="increase"/> <display value="Increased score indicates improvement"/> </coding> </improvementNotation> <guidance value="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> <population> <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> <language value="text/cql"/> <expression value="Initial Population"/> </criteria> </population> <population> <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: - 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 Patients 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> <language value="text/cql"/> <expression value="Numerator"/> </criteria> </population> <population> <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> <language value="text/cql"/> <expression value="Denominator"/> </criteria> </population> <population> <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 * 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> <language value="text/cql"/> <expression value="Denominator Exclusion"/> </criteria> </population> </group> <supplementalData> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <criteria> <language value="text/cql"/> <expression value="SDE Ethnicity"/> </criteria> </supplementalData> <supplementalData> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <criteria> <language value="text/cql"/> <expression value="SDE Payer"/> </criteria> </supplementalData> <supplementalData> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <criteria> <language value="text/cql"/> <expression value="SDE Race"/> </criteria> </supplementalData> <supplementalData> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <criteria> <language value="text/cql"/> <expression value="SDE Sex"/> </criteria> </supplementalData> </Measure>
© HL7.org (Clinical Quality Information WG). hl7.fhir.us.cqfmeasures#1.1.0 based on FHIR v4.0.1 generated 24/12/2019.
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