Quality Measure STU1 for FHIR STU3 Implementation Guide
This page is part of the Quality Measure STU2 for FHIR R4 Implementation Guide (v1.0.0: STU 1) based on FHIR R3. 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="5"/> <lastUpdated value="2019-11-06T18:37:59.147-05:00"/> <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"><input id="Initial Population" type="checkbox"/><label for="Initial Population" class="list-header"><strong>Initial Population</strong></label> <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"> "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions"</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"><input id="Numerator" type="checkbox"/><label for="Numerator" class="list-header"><strong>Numerator</strong></label> <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"> "VTE Prophylaxis Received on Day of or Day After Admission or Procedure" union ( "Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure" intersect ( "Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE" union "Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery" ) ) union "Low Risk for VTE or Anticoagulant Administered" union "No VTE Prophylaxis Due to Medical Reason" union "No VTE Prophylaxis Due to Patient Refusal"</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"><input id="Denominator" type="checkbox"/><label for="Denominator" class="list-header"><strong>Denominator</strong></label> <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"> "Initial Population"</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"><input id="Denominator Exclusion" type="checkbox"/><label for="Denominator Exclusion" class="list-header"><strong>Denominator Exclusion</strong></label> <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"> "Encounter Less Than 2 Days" union "Encounter With ICU Location Stay 1 Day or More" union "Encounter With Principal Diagnosis of Mental Disorder or Stroke" union "Encounter With Principal Procedure of SCIP VTE Selected Surgery" union "Intervention Comfort Measures on Day of or Day After Start of Hospitalization" union "Intervention Comfort Measures on Day of or Day After Procedure"</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"> <input id="Admission Without VTE or Obstetrical Conditions" type="checkbox"/> <label for="Admission Without VTE or Obstetrical Conditions" class="list-header"><strong>Admission Without VTE or Obstetrical Conditions</strong></label> <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"> (Global."Inpatient Encounter" InpatientEncounter where not (Global.EncounterDiagnosis(InpatientEncounter).code in "Obstetrics" or Global.EncounterDiagnosis(InpatientEncounter).code in "Venous Thromboembolism" or Global.EncounterDiagnosis(InpatientEncounter).code in "Obstetrics VTE" ) ) intersect (Global."Inpatient Encounter" InpatientEncounter without ( ["Condition": code in "Obstetrics"] union ["Condition": code in "Venous Thromboembolism"] union ["Condition": code in "Obstetrics VTE"]) Diagnosis such that Diagnosis.clinicalStatus = 'active' and Diagnosis.verificationStatus = 'confirmed' and Global."Normalize Onset"(Diagnosis.onset) during Global."Hospitalization"(InpatientEncounter) )</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"> <input id="Denominator" type="checkbox"/> <label for="Denominator" class="list-header"><strong>Denominator</strong></label> <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"> "Initial Population"</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"> <input id="Denominator Exclusion" type="checkbox"/> <label for="Denominator Exclusion" class="list-header"><strong>Denominator Exclusion</strong></label> <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"> "Encounter Less Than 2 Days" union "Encounter With ICU Location Stay 1 Day or More" union "Encounter With Principal Diagnosis of Mental Disorder or Stroke" union "Encounter With Principal Procedure of SCIP VTE Selected Surgery" union "Intervention Comfort Measures on Day of or Day After Start of Hospitalization" union "Intervention Comfort Measures on Day of or Day After Procedure"</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"> <input id="ED Visit" type="checkbox"/> <label for="ED Visit" class="list-header"><strong>ED Visit</strong></label> <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"> ["Encounter": type in "Emergency Department Visit"] EDVisit where EDVisit.status = 'finished'</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"> <input id="Encounter Less Than 2 Days" type="checkbox"/> <label for="Encounter Less Than 2 Days" class="list-header"><strong>Encounter Less Than 2 Days</strong></label> <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"> "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter where Global."LengthInDays"(FHIRHelpers.ToInterval(QualifyingEncounter.period))< 2</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"> <input id="Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" type="checkbox"/> <label for="Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" class="list-header"><strong>Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions</strong></label> <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"> ( Global."Inpatient Encounter" InpatientEncounter with ["Patient"] BirthDate such that Global."CalendarAgeInYearsAt"(ToDateTime(BirthDate.birthDate), start of FHIRHelpers.ToInterval(InpatientEncounter.period)) >= 18 ) intersect "Admission Without VTE or Obstetrical Conditions"</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"> <input id="Encounter With ICU Location Stay 1 Day or More" type="checkbox"/> <label for="Encounter With ICU Location Stay 1 Day or More" class="list-header"><strong>Encounter With ICU Location Stay 1 Day or More</strong></label> <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"> "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter where exists ( QualifyingEncounter.location Location where Global.GetLocation(Location.location).type in "Intensive Care Unit" and Global."LengthInDays"(Location.period)>= 1 and Location.period starts during VTEICU."CalendarDayOfOrDayAfter"(start of FHIRHelpers.ToInterval(QualifyingEncounter.period)) )</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"> <input id="Encounter With Principal Diagnosis of Mental Disorder or Stroke" type="checkbox"/> <label for="Encounter With Principal Diagnosis of Mental Disorder or Stroke" class="list-header"><strong>Encounter With Principal Diagnosis of Mental Disorder or Stroke</strong></label> <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"> "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter where Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Mental Health Diagnoses" or Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Hemorrhagic Stroke" or Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Ischemic Stroke"</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"> <input id="Encounter With Principal Procedure of SCIP VTE Selected Surgery" type="checkbox"/> <label for="Encounter With Principal Procedure of SCIP VTE Selected Surgery" class="list-header"><strong>Encounter With Principal Procedure of SCIP VTE Selected Surgery</strong></label> <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"> "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter with ( "SCIP VTE Selected Surgery" Procedure where GetExtension(Procedure.extension, 'http://example.org/StructureDefinition/ordinality').value ~ "Principal" ) SelectedProcedure such that SelectedProcedure.performed during FHIRHelpers.ToInterval( QualifyingEncounter.period)</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"> <input id="Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE" type="checkbox"/> <label for="Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE" class="list-header"><strong>Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE</strong></label> <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"> ( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter with ["Condition": code in "Atrial Fibrillation/Flutter"] AtrialFibrillation such that AtrialFibrillation.clinicalStatus = 'active' and AtrialFibrillation.verificationStatus = 'confirmed' and Global."Normalize Onset"(AtrialFibrillation.onset) on or before end of FHIRHelpers.ToInterval(QualifyingEncounter.period) ) union ( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter where Global.EncounterDiagnosis(QualifyingEncounter).code in "Atrial Fibrillation/Flutter" ) union ( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter with ["Condition": code in "Venous Thromboembolism"] VTEDiagnosis such that VTEDiagnosis.clinicalStatus in { 'inactive', 'remission', 'resolved' } and VTEDiagnosis.verificationStatus = 'confirmed' and Global."Normalize Onset"(VTEDiagnosis.onset) before start of FHIRHelpers.ToInterval(QualifyingEncounter.period) )</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"> <input id="Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery" type="checkbox"/> <label for="Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery" class="list-header"><strong>Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery</strong></label> <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"> "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter with ( ["Procedure": "Hip Replacement Surgery"] union ["Procedure": "Knee Replacement Surgery"] ) HipKneeProcedure such that HipKneeProcedure.status = 'completed' and HipKneeProcedure.performed starts on or before end of FHIRHelpers.ToInterval(QualifyingEncounter.period)</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"> <input id="Initial Population" type="checkbox"/> <label for="Initial Population" class="list-header"><strong>Initial Population</strong></label> <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"> "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions"</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"> <input id="Intervention Comfort Measures" type="checkbox"/> <label for="Intervention Comfort Measures" class="list-header"><strong>Intervention Comfort Measures</strong></label> <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"> (["ProcedureRequest": "Comfort Measures"] P where P.intent = 'order') union (["Procedure": "Comfort Measures"] IntervetionPerformed where IntervetionPerformed.status = 'completed')</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"> <input id="Intervention Comfort Measures on Day of or Day After Procedure" type="checkbox"/> <label for="Intervention Comfort Measures on Day of or Day After Procedure" class="list-header"><strong>Intervention Comfort Measures on Day of or Day After Procedure</strong></label> <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"> from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure, "Intervention Comfort Measures" ComfortMeasure where AnesthesiaProcedure.status = 'completed' and AnesthesiaProcedure.performed ends 1 day after day of start of FHIRHelpers.ToInterval(QualifyingEncounter.period) and Coalesce(ComfortMeasure.authoredOn, start of ComfortMeasure.performed) 1 day or less on or after day of end of AnesthesiaProcedure.performed</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"> <input id="Intervention Comfort Measures on Day of or Day After Start of Hospitalization" type="checkbox"/> <label for="Intervention Comfort Measures on Day of or Day After Start of Hospitalization" class="list-header"><strong>Intervention Comfort Measures on Day of or Day After Start of Hospitalization</strong></label> <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"> "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter with "Intervention Comfort Measures" ComfortMeasure // TODO: Profile of procedure to ensure performed is a Period such that Coalesce(ComfortMeasure.authoredOn, start of ComfortMeasure.performed) 1 day or less on or after day of start of Global."Hospitalization"(QualifyingEncounter)</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"> <input id="Is In Low Risk for VTE or On Anticoagulant" type="checkbox"/> <label for="Is In Low Risk for VTE or On Anticoagulant" class="list-header"><strong>Is In Low Risk for VTE or On Anticoagulant</strong></label> <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"> ( ["Observation": "Risk for venous thromboembolism"] VTERiskAssessment where VTERiskAssessment.value in "Low Risk" )</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"> <input id="Low Risk for VTE or Anticoagulant Administered" type="checkbox"/> <label for="Low Risk for VTE or Anticoagulant Administered" class="list-header"><strong>Low Risk for VTE or Anticoagulant Administered</strong></label> <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"> "Low Risk for VTE or Anticoagulant Administered During ED Visit" union "Low Risk for VTE or Anticoagulant Administered on Day of or Day After Admission" union "Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure"</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"> <input id="Low Risk for VTE or Anticoagulant Administered During ED Visit" type="checkbox"/> <label for="Low Risk for VTE or Anticoagulant Administered During ED Visit" class="list-header"><strong>Low Risk for VTE or Anticoagulant Administered During ED Visit</strong></label> <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"> from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, "ED Visit" EDVisit, "Is In Low Risk for VTE or On Anticoagulant" VTERiskAssessment where FHIRHelpers.ToInterval(EDVisit.period) ends 1 hour or less on or before start of FHIRHelpers.ToInterval(QualifyingEncounter.period) and VTERiskAssessment.issued during FHIRHelpers.ToInterval(EDVisit.period) return QualifyingEncounter</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"> <input id="Low Risk for VTE or Anticoagulant Administered on Day of or Day After Admission" type="checkbox"/> <label for="Low Risk for VTE or Anticoagulant Administered on Day of or Day After Admission" class="list-header"><strong>Low Risk for VTE or Anticoagulant Administered on Day of or Day After Admission</strong></label> <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"> "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter with "Is In Low Risk for VTE or On Anticoagulant" VTERiskAssessment such that VTERiskAssessment.issued during VTEICU."CalendarDayOfOrDayAfter"(start of FHIRHelpers.ToInterval(QualifyingEncounter.period))</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"> <input id="Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure" type="checkbox"/> <label for="Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure" class="list-header"><strong>Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure</strong></label> <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"> from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure, "Is In Low Risk for VTE or On Anticoagulant" VTERiskAssessment where AnesthesiaProcedure.performed ends 1 day after day of start of FHIRHelpers.ToInterval(QualifyingEncounter.period) and VTERiskAssessment.issued during VTEICU."CalendarDayOfOrDayAfter"(end of FHIRHelpers.ToInterval(AnesthesiaProcedure.performed)) return QualifyingEncounter</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"> <input id="Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure" type="checkbox"/> <label for="Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure" class="list-header"><strong>Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure</strong></label> <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"> ( from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, ["MedicationAdministration": medication in "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication where FactorXaMedication.effective starts during VTEICU."CalendarDayOfOrDayAfter"(start of FHIRHelpers.ToInterval(QualifyingEncounter.period)) return QualifyingEncounter ) union ( from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure, ["MedicationAdministration": medication in "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication where AnesthesiaProcedure.status = 'completed' and AnesthesiaProcedure.performed ends 1 day after day of start of FHIRHelpers.ToInterval(QualifyingEncounter.period) and FactorXaMedication.effective starts during VTEICU."CalendarDayOfOrDayAfter"(end of AnesthesiaProcedure.performed) return QualifyingEncounter )</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"> <input id="No VTE Prophylaxis Device Applied or Ordered" type="checkbox"/> <label for="No VTE Prophylaxis Device Applied or Ordered" class="list-header"><strong>No VTE Prophylaxis Device Applied or Ordered</strong></label> <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"> // NOTE: Should be using device.code, but that requires CQL 1.4 ((["DeviceUseStatement": code in "Venous foot pumps (VFP)"] union ["DeviceUseStatement": code in "Intermittent pneumatic compression devices (IPC)"] union ["DeviceUseStatement": code in "Graduated compression stockings (GCS)"] ) D where GetExtension(D.extension, 'http://example.org/fhir/extensions/notDone').value is true //where D.notDone is true // Needs a QI-Core extension to support ) union (( ["DeviceRequest": code in "Venous foot pumps (VFP)"] union ["DeviceRequest": code in "Intermittent pneumatic compression devices (IPC)"] union ["DeviceRequest": code in "Graduated compression stockings (GCS)"] ) D where D.intent ~ ToConcept("Order") and GetExtension(D.extension, 'http://example.org/fhir/extensions/doNotPerform').value is true //where D.doNotPerform is true // Needs a QI-Core extension to support )</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"> <input id="No VTE Prophylaxis Device Due to Medical Reason During ED Visit" type="checkbox"/> <label for="No VTE Prophylaxis Device Due to Medical Reason During ED Visit" class="list-header"><strong>No VTE Prophylaxis Device Due to Medical Reason During ED Visit</strong></label> <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"> from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, "ED Visit" EDVisit, "No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice where FHIRHelpers.ToInterval(EDVisit.period) ends 1 hour or less on or before start of FHIRHelpers.ToInterval(QualifyingEncounter.period) and (singleton from NoVTEDevice.reasonCode in "Medical Reason") and Coalesce(NoVTEDevice.authoredOn, NoVTEDevice.recordedOn) during FHIRHelpers.ToInterval(EDVisit.period)</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"> <input id="No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Admission" type="checkbox"/> <label for="No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Admission" class="list-header"><strong>No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Admission</strong></label> <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"> from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, "No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice where (singleton from NoVTEDevice.reasonCode in "Medical Reason") and Coalesce(NoVTEDevice.authoredOn, NoVTEDevice.recordedOn) during VTEICU."CalendarDayOfOrDayAfter"(start of FHIRHelpers.ToInterval(QualifyingEncounter.period))</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"> <input id="No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure" type="checkbox"/> <label for="No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure" class="list-header"><strong>No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure</strong></label> <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"> from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure, "No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice where NoVTEDevice.reasonCode in "Medical Reason" and AnesthesiaProcedure.status = 'completed' // TODO: Profile of procedure to ensure performed is a Period and AnesthesiaProcedure.performed ends 1 day after day of start of FHIRHelpers.ToInterval(QualifyingEncounter.period) and Coalesce(NoVTEDevice.authoredOn, NoVTEDevice.recordedOn) during VTEICU."CalendarDayOfOrDayAfter"(end of AnesthesiaProcedure.performed) return QualifyingEncounter</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"> <input id="No VTE Prophylaxis Due to Medical Reason" type="checkbox"/> <label for="No VTE Prophylaxis Due to Medical Reason" class="list-header"><strong>No VTE Prophylaxis Due to Medical Reason</strong></label> <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"> ( "No VTE Prophylaxis Medication Due to Medical Reason During ED Visit" intersect "No VTE Prophylaxis Device Due to Medical Reason During ED Visit" ) union ( "No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Admission" intersect "No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Admission" ) union ( "No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure" intersect "No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure" )</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"> <input id="No VTE Prophylaxis Due to Patient Refusal" type="checkbox"/> <label for="No VTE Prophylaxis Due to Patient Refusal" class="list-header"><strong>No VTE Prophylaxis Due to Patient Refusal</strong></label> <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"> "No VTE Prophylaxis Due to Patient Refusal During ED Visit" union "No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Admission" union "No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure"</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"> <input id="No VTE Prophylaxis Due to Patient Refusal During ED Visit" type="checkbox"/> <label for="No VTE Prophylaxis Due to Patient Refusal During ED Visit" class="list-header"><strong>No VTE Prophylaxis Due to Patient Refusal During ED Visit</strong></label> <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"> from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, "ED Visit" EDVisit, "No VTE Prophylaxis Medication or Device Due to Patient Refusal" PatientRefusal where EDVisit.period ends 1 hour or less on or before start of QualifyingEncounter.period and Coalesce(PatientRefusal.effective, PatientRefusal.authoredOn, PatientRefusal.recordedOn) during EDVisit.period return QualifyingEncounter</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"> <input id="No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Admission" type="checkbox"/> <label for="No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Admission" class="list-header"><strong>No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Admission</strong></label> <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"> from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, "No VTE Prophylaxis Medication or Device Due to Patient Refusal" PatientRefusal where Coalesce(start of PatientRefusal.effective, PatientRefusal.authoredOn, PatientRefusal.recordedOn) during VTEICU."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.period) return QualifyingEncounter</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"> <input id="No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure" type="checkbox"/> <label for="No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure" class="list-header"><strong>No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure</strong></label> <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"> from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure, "No VTE Prophylaxis Medication or Device Due to Patient Refusal" PatientRefusal where AnesthesiaProcedure.performed ends 1 day after day of start of QualifyingEncounter.period and Coalesce(start of PatientRefusal.effective, PatientRefusal.authoredOn, PatientRefusal.recordedOn) during VTEICU."CalendarDayOfOrDayAfter"(end of AnesthesiaProcedure.performed) return QualifyingEncounter</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"> <input id="No VTE Prophylaxis Medication Administered or Ordered" type="checkbox"/> <label for="No VTE Prophylaxis Medication Administered or Ordered" class="list-header"><strong>No VTE Prophylaxis Medication Administered or Ordered</strong></label> <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"> (( ["MedicationAdministration": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"] union ["MedicationAdministration": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"] union ["MedicationAdministration": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"] union ["MedicationAdministration": medication in "Warfarin"] ) MedicationAdm where MedicationAdm.notGiven is true ) union // TODO: Tracker for QI-core to add doNotPerform extension for MedicationRequest and suggest to the base Resource (( ["MedicationRequest": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"] union ["MedicationRequest": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"] union ["MedicationRequest": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"] union ["MedicationRequest": medication in "Warfarin"] ) MedicationOrder where MedicationOrder.intent = 'order' and GetExtension(MedicationOrder.extension, 'http://example.org/fhir/extensions/doNotPerform').value is true //MedicationOrder.doNotPerform is true // Needs a QI-Core extension to support )</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"> <input id="No VTE Prophylaxis Medication Due to Medical Reason During ED Visit" type="checkbox"/> <label for="No VTE Prophylaxis Medication Due to Medical Reason During ED Visit" class="list-header"><strong>No VTE Prophylaxis Medication Due to Medical Reason During ED Visit</strong></label> <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"> from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, "ED Visit" EDVisit, "No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication where FHIRHelpers.ToInterval(EDVisit.period) ends 1 hour or less on or before start of FHIRHelpers.ToInterval(QualifyingEncounter.period) and (singleton from NoVTEMedication.reasonCode in "Medical Reason") // TODO: Profile of MedicationAdministration to ensure effective is a Period and Coalesce(NoVTEMedication.authoredOn, start of NoVTEMedication.effective) during FHIRHelpers.ToInterval(EDVisit.period) return QualifyingEncounter</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"> <input id="No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Admission" type="checkbox"/> <label for="No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Admission" class="list-header"><strong>No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Admission</strong></label> <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"> from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, "No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication where (singleton from NoVTEMedication.reasonCode in "Medical Reason") and Coalesce(NoVTEMedication.authoredOn, start of NoVTEMedication.effective) during VTEICU."CalendarDayOfOrDayAfter"(start of FHIRHelpers.ToInterval(QualifyingEncounter.period)) return QualifyingEncounter</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"> <input id="No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure" type="checkbox"/> <label for="No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure" class="list-header"><strong>No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure</strong></label> <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"> from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure, "No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication where NoVTEMedication.reasonCode in "Medical Reason" and AnesthesiaProcedure.status = 'completed' and AnesthesiaProcedure.performed ends 1 day after day of start of FHIRHelpers.ToInterval(QualifyingEncounter.period) // TODO: Profile of MedicationAdministration to ensure effective is a Period and Coalesce(NoVTEMedication.authoredOn, start of NoVTEMedication.effective) during VTEICU."CalendarDayOfOrDayAfter"(end of AnesthesiaProcedure.performed) return QualifyingEncounter</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"> <input id="No VTE Prophylaxis Medication or Device Due to Patient Refusal" type="checkbox"/> <label for="No VTE Prophylaxis Medication or Device Due to Patient Refusal" class="list-header"><strong>No VTE Prophylaxis Medication or Device Due to Patient Refusal</strong></label> <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"> ( "No VTE Prophylaxis Medication Administered or Ordered" union "No VTE Prophylaxis Device Applied or Ordered" ) NoVTEProphylaxis where GetExtension(NoVTEProphylaxis.extension, 'http://example.org/StructureDefinition/notDoneReason').value in "Patient Refusal"</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"> <input id="Numerator" type="checkbox"/> <label for="Numerator" class="list-header"><strong>Numerator</strong></label> <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"> "VTE Prophylaxis Received on Day of or Day After Admission or Procedure" union ( "Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure" intersect ( "Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE" union "Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery" ) ) union "Low Risk for VTE or Anticoagulant Administered" union "No VTE Prophylaxis Due to Medical Reason" union "No VTE Prophylaxis Due to Patient Refusal"</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"> <input id="SCIP VTE Selected Surgery" type="checkbox"/> <label for="SCIP VTE Selected Surgery" class="list-header"><strong>SCIP VTE Selected Surgery</strong></label> <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"> ( ["Procedure": "General Surgery"] union ["Procedure": "Gynecological Surgery"] union ["Procedure": "Hip Fracture Surgery"] union ["Procedure": "Hip Replacement Surgery"] union ["Procedure": "Intracranial Neurosurgery"] union ["Procedure": "Knee Replacement Surgery"] union ["Procedure": "Urological Surgery"] ) P where P.status = 'completed'</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"> <input id="SDE Ethnicity" type="checkbox"/> <label for="SDE Ethnicity" class="list-header"><strong>SDE Ethnicity</strong></label> <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"> SDE."SDE Ethnicity"</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"> <input id="SDE Payer" type="checkbox"/> <label for="SDE Payer" class="list-header"><strong>SDE Payer</strong></label> <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"> SDE."SDE Payer"</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"> <input id="SDE Race" type="checkbox"/> <label for="SDE Race" class="list-header"><strong>SDE Race</strong></label> <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"> SDE."SDE Race"</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"> <input id="SDE Sex" type="checkbox"/> <label for="SDE Sex" class="list-header"><strong>SDE Sex</strong></label> <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"> SDE."SDE Sex"</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"> <input id="VTE Prophylaxis by Medication Administered or Device Applied" type="checkbox"/> <label for="VTE Prophylaxis by Medication Administered or Device Applied" class="list-header"><strong>VTE Prophylaxis by Medication Administered or Device Applied</strong></label> <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"> ( ["MedicationAdministration": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"] VTEMedication where VTEMedication.status = 'completed' and VTEMedication.dosage.route in "Subcutaneous route" ) union ["MedicationAdministration": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"] union ["MedicationAdministration": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"] union ["MedicationAdministration": medication in "Warfarin"] union (( ["DeviceUseStatement": code in "Intermittent pneumatic compression devices (IPC)"] union ["DeviceUseStatement": code in "Venous foot pumps (VFP)"] union ["DeviceUseStatement": code in "Graduated compression stockings (GCS)"] ) DeviceApplied where DeviceApplied.status = 'completed' )</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"> <input id="VTE Prophylaxis Received on Day of or Day After Admission or Procedure" type="checkbox"/> <label for="VTE Prophylaxis Received on Day of or Day After Admission or Procedure" class="list-header"><strong>VTE Prophylaxis Received on Day of or Day After Admission or Procedure</strong></label> <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"> ( from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, "VTE Prophylaxis by Medication Administered or Device Applied" HasVTEProphylaxis // TODO: Profile of MedicationAdministration to ensure effective is a Period where Coalesce(HasVTEProphylaxis.recordedOn, start of HasVTEProphylaxis.effective) during VTEICU."CalendarDayOfOrDayAfter"(start of FHIRHelpers.ToInterval(QualifyingEncounter.period)) return QualifyingEncounter ) union ( from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure, "VTE Prophylaxis by Medication Administered or Device Applied" HasVTEProphylaxis where AnesthesiaProcedure.performed ends 1 day after day of start of FHIRHelpers.ToInterval(QualifyingEncounter.period) and Coalesce(HasVTEProphylaxis.recordedOn, start of HasVTEProphylaxis.effective) during VTEICU."CalendarDayOfOrDayAfter"(end of AnesthesiaProcedure.performed) return QualifyingEncounter )</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"> <input id="GetExtension" type="checkbox"/> <label for="GetExtension" class="list-header"><strong>GetExtension</strong></label> <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">define function GetExtension(Extensions List<Extension>, URL String): singleton from (Extensions E where E.url = URL return E)</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 style="width:80%">codesystem "LOINC" : 'http://loinc.org'</li> <li style="width:80%">codesystem "RequestIntent" : 'http://hl7.org/fhir/request-intent'</li> <li style="width:80%">codesystem "SNOMED CT" : 'http://snomed.info/sct'</li> <li style="width:80%">code "Order" : 'order' from "RequestIntent" display 'Order'</li> <li style="width:80%">code "Principal" : '63161005' from "SNOMED CT" display 'Principal (qualifier value)'</li> <li style="width:80%">code "Risk for venous thromboembolism" : '72136-5' from "LOINC" display 'Risk for venous thromboembolism'</li> <li style="width:80%">valueset "Atrial Fibrillation/Flutter" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.202'</li> <li style="width:80%">valueset "Comfort Measures" : 'http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45'</li> <li style="width:80%">valueset "Direct Thrombin Inhibitor" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.205'</li> <li style="width:80%">valueset "Emergency Department Visit" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292'</li> <li style="width:80%">valueset "Ethnicity" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.837'</li> <li style="width:80%">valueset "General or Neuraxial Anesthesia" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.1743'</li> <li style="width:80%">valueset "General Surgery" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.255'</li> <li style="width:80%">valueset "Glycoprotein IIb/IIIa Inhibitors" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.41'</li> <li style="width:80%">valueset "Graduated compression stockings (GCS)" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.256'</li> <li style="width:80%">valueset "Gynecological Surgery" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.257'</li> <li style="width:80%">valueset "Hemorrhagic Stroke" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.212'</li> <li style="width:80%">valueset "Hip Fracture Surgery" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.258'</li> <li style="width:80%">valueset "Hip Replacement Surgery" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.259'</li> <li style="width:80%">valueset "Injectable Factor Xa Inhibitor for VTE Prophylaxis" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.211'</li> <li style="width:80%">valueset "INR" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.213'</li> <li style="width:80%">valueset "Intensive Care Unit" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.23'</li> <li style="width:80%">valueset "Intermittent pneumatic compression devices (IPC)" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.214'</li> <li style="width:80%">valueset "Intracranial Neurosurgery" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.260'</li> <li style="width:80%">valueset "Intravenous route" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.222'</li> <li style="width:80%">valueset "Ischemic Stroke" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247'</li> <li style="width:80%">valueset "Knee Replacement Surgery" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.261'</li> <li style="width:80%">valueset "Low Dose Unfractionated Heparin for VTE Prophylaxis" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39'</li> <li style="width:80%">valueset "Low Molecular Weight Heparin for VTE Prophylaxis" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.219'</li> <li style="width:80%">valueset "Low Risk" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.400'</li> <li style="width:80%">valueset "Medical Reason" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.473'</li> <li style="width:80%">valueset "Mental Health Diagnoses" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1004'</li> <li style="width:80%">valueset "Obstetrics VTE" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.264'</li> <li style="width:80%">valueset "Obstetrics" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.263'</li> <li style="width:80%">valueset "ONC Administrative Sex" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1'</li> <li style="width:80%">valueset "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.134'</li> <li style="width:80%">valueset "Patient Refusal" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93'</li> <li style="width:80%">valueset "Payer" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591'</li> <li style="width:80%">valueset "Race" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.836'</li> <li style="width:80%">valueset "Subcutaneous route" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.223'</li> <li style="width:80%">valueset "Unfractionated Heparin" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.218'</li> <li style="width:80%">valueset "Urological Surgery" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.272'</li> <li style="width:80%">valueset "Venous foot pumps (VFP)" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.230'</li> <li style="width:80%">valueset "Venous Thromboembolism" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.279'</li> <li style="width:80%">valueset "Warfarin" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232'</li> </ul> </div> <h3><a name="d1e647" href="#toc">Data Criteria (QDM Data Elements)</a></h3> <div> <ul style="padding-left: 50px;"> <li style="width:80%">"Condition: Atrial Fibrillation/Flutter" using "Atrial Fibrillation/Flutter (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.202)</li> <li style="width:80%">"Condition: Obstetrics VTE" using "Obstetrics VTE (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.264)</li> <li style="width:80%">"Condition: Obstetrics" using "Obstetrics (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.263)</li> <li style="width:80%">"Condition: Venous Thromboembolism" using "Venous Thromboembolism (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.279)</li> <li style="width:80%">"Coverage: Payer" using "Payer (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591)</li> <li style="width:80%">"DeviceRequest: Graduated compression stockings (GCS)" using "Graduated compression stockings (GCS) (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.256)</li> <li style="width:80%">"DeviceRequest: Intermittent pneumatic compression devices (IPC)" using "Intermittent pneumatic compression devices (IPC) (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.214)</li> <li style="width:80%">"DeviceRequest: Venous foot pumps (VFP)" using "Venous foot pumps (VFP) (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.230)</li> <li style="width:80%">"DeviceUseStatement: Graduated compression stockings (GCS)" using "Graduated compression stockings (GCS) (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.256)</li> <li style="width:80%">"DeviceUseStatement: Intermittent pneumatic compression devices (IPC)" using "Intermittent pneumatic compression devices (IPC) (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.214)</li> <li style="width:80%">"DeviceUseStatement: Venous foot pumps (VFP)" using "Venous foot pumps (VFP) (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.230)</li> <li style="width:80%">"Encounter: Emergency Department Visit" using "Emergency Department Visit (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292)</li> <li style="width:80%">"MedicationAdministration: Injectable Factor Xa Inhibitor for VTE Prophylaxis" using "Injectable Factor Xa Inhibitor for VTE Prophylaxis (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.211)</li> <li style="width:80%">"MedicationAdministration: Low Dose Unfractionated Heparin for VTE Prophylaxis" using "Low Dose Unfractionated Heparin for VTE Prophylaxis (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39)</li> <li style="width:80%">"MedicationAdministration: Low Molecular Weight Heparin for VTE Prophylaxis" using "Low Molecular Weight Heparin for VTE Prophylaxis (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.219)</li> <li style="width:80%">"MedicationAdministration: Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment" using "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.134)</li> <li style="width:80%">"MedicationAdministration: Warfarin" using "Warfarin (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232)</li> <li style="width:80%">"MedicationRequest: Injectable Factor Xa Inhibitor for VTE Prophylaxis" using "Injectable Factor Xa Inhibitor for VTE Prophylaxis (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.211)</li> <li style="width:80%">"MedicationRequest: Low Dose Unfractionated Heparin for VTE Prophylaxis" using "Low Dose Unfractionated Heparin for VTE Prophylaxis (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39)</li> <li style="width:80%">"MedicationRequest: Low Molecular Weight Heparin for VTE Prophylaxis" using "Low Molecular Weight Heparin for VTE Prophylaxis (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.219)</li> <li style="width:80%">"MedicationRequest: Warfarin" using "Warfarin (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232)</li> <li style="width:80%">"Procedure: Comfort Measures" using "Comfort Measures (http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45)</li> <li style="width:80%">"Procedure: General or Neuraxial Anesthesia" using "General or Neuraxial Anesthesia (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.1743)</li> <li style="width:80%">"Procedure: General Surgery" using "General Surgery (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.255)</li> <li style="width:80%">"Procedure: Gynecological Surgery" using "Gynecological Surgery (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.257)</li> <li style="width:80%">"Procedure: Hip Fracture Surgery" using "Hip Fracture Surgery (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.258)</li> <li style="width:80%">"Procedure: Hip Replacement Surgery" using "Hip Replacement Surgery (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.259)</li> <li style="width:80%">"Procedure: Intracranial Neurosurgery" using "Intracranial Neurosurgery (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.260)</li> <li style="width:80%">"Procedure: Knee Replacement Surgery" using "Knee Replacement Surgery (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.261)</li> <li style="width:80%">"Procedure: Urological Surgery" using "Urological Surgery (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.272)</li> <li style="width:80%">"ProcedureRequest: Comfort Measures" using "Comfort Measures (http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45)</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"> <input id="SDE Ethnicity" type="checkbox"/> <label for="SDE Ethnicity" class="list-header"><strong>SDE Ethnicity</strong></label> <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"> SDE."SDE Ethnicity"</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"> <input id="SDE Payer" type="checkbox"/> <label for="SDE Payer" class="list-header"><strong>SDE Payer</strong></label> <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"> SDE."SDE Payer"</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"> <input id="SDE Race" type="checkbox"/> <label for="SDE Race" class="list-header"><strong>SDE Race</strong></label> <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"> SDE."SDE Race"</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"> <input id="SDE Sex" type="checkbox"/> <label for="SDE Sex" class="list-header"><strong>SDE Sex</strong></label> <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"> SDE."SDE Sex"</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> <!-- <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://hl7.org/fhir/cqi/ecqm/Measure/Identifier/cms"/> <value value="108"/> </identifier> <identifier> <use value="official"/> <system value="http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/nqf"/> <value value="0371"/> </identifier> <version value="1.0.0"/> <name value="VTE_1_FHIR"/> <title value="Venous Thromboembolism Prophylaxis"/> <status value="active"/> <experimental value="true"/> <date value="2018-08-31T00:00:00-04:00"/> <publisher value="The Joint Commission"/> <description value="This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission"/> <approvalDate value="2019-03-08"/> <lastReviewDate value="2019-03-08"/> <effectivePeriod> <start value="2018-01-01T00:00:00-05:00"/> <end value="2018-12-31T00:00:00-05:00"/> </effectivePeriod> <useContext> <code> <code value="program"/> </code> <valueCodeableConcept> <text value="eligibile-hospital"/> </valueCodeableConcept> </useContext> <jurisdiction> <coding> <system value="urn:iso:std:iso:3166"/> <code value="US"/> <display value="United States of America"/> </coding> </jurisdiction> <contributor> <type value="author"/> <name value="The Joint Commission"/> </contributor> <contact> <telecom> <system value="url"/> <value value="https://www.jointcommission.org/"/> </telecom> </contact> <copyright value="Measure specifications are in the Public Domain. 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."/> <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> <reference value="Library/fhirhelpers"/> </resource> </relatedArtifact> <relatedArtifact> <type value="depends-on"/> <resource> <reference value="Library/matglobalcommonfunctions-fhir"/> </resource> </relatedArtifact> <relatedArtifact> <type value="depends-on"/> <resource> <reference value="Library/vteicu-fhir"/> </resource> </relatedArtifact> <relatedArtifact> <type value="depends-on"/> <resource> <reference value="Library/supplementaldataelements-fhir"/> </resource> </relatedArtifact> <library> <reference value="Library/vte-1-fhir"/> </library> <disclaimer value="These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty"/> <scoring> <coding> <system value="http://hl7.org/fhir/measure-scoring"/> <code value="proportion"/> </coding> </scoring> <type> <coding> <system value="http://hl7.org/fhir/measure-type"/> <code value="process"/> </coding> </type> <rationale value="Hospitalized patients at high-risk for VTE may develop an asymptomatic deep vein thrombosis (DVT), and die from pulmonary embolism (PE) even before the diagnosis is suspected. The majority of fatal events occur as sudden or abrupt death, underscoring the importance of prevention as the most critical action step for reducing death from PE (Geerts, et al, 2008). 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 value="increase"/> <guidance value="When low dose unfractionated heparin is administered for VTE Prophylaxis, the intended administration route for low dose unfractionated heparin is subcutaneous. Reasons for no pharmacological and no mechanical VTE prophylaxis must be explicitly documented by the MD/APN/PA or pharmacist and linked with VTE prophylaxis. Ambulation alone is not a sufficient reason for not administering VTE prophylaxis. In order for ambulation/patient ambulating to be considered as an acceptable reason, there needs to be explicit documentation, e.g., "patient out of bed and ambulating in halls - no VTE prophylaxis needed.""/> <group> <identifier> <value value="CMS125-group-1"/> </identifier> <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 value="Initial Population"/> </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 value="Numerator"/> </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 value="Denominator"/> </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 value="Denominator Exclusion"/> </population> </group> </Measure>
© HL7.org (Clinical Quality Information WG). hl7.fhir.us.cqfmeasures#1.0.0 based on FHIR v3.0.2 generated 20/11/2019.
Links: Home
| QA Report | Search
| Version History
| 
| Propose a change