Proportion

define "Initial Population":   Patient.gender = 'female'       and Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( Patient.birthDate ), start of "Measurement Period" ) in Interval[51, 74 )       and exists AdultOutpatientEncounters."Qualifying Encounters"

define "Denominator":   "Initial Population"

define "Denominator Exclusion":   Hospice."Has Hospice"       or ( ( exists "Right Mastectomy Diagnosis"             or exists "Right Mastectomy Procedure"         )           and ( exists "Left Mastectomy"               or exists "Left Mastectomy Procedure"           )       )       or exists "Bilateral Mastectomy Diagnosis"       or exists "Bilateral Mastectomy Procedure"       or Frailty."Advanced Illness and Frailty Exclusion Not Including Over Age 80"       or ( Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( Patient.birthDate ), start of "Measurement Period" ) >= 65           and Frailty."Long Term Care Periods Longer Than 90 Consecutive Days"       )

define "Numerator":   exists ( [DiagnosticReport: "Mammography"] Mammogram         where ( Global."Normalize Interval" ( Mammogram.effective ) ends 27 months or less on or before           end of "Measurement Period"         )           and Mammogram.status in { 'final', 'amended', 'corrected', 'appended' }     )

define "SDE Sex":   case       when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }       when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }       else null     end

define "SDE Sex":   SDE."SDE Sex"

define "Numerator":   exists ( [DiagnosticReport: "Mammography"] Mammogram         where ( Global."Normalize Interval" ( Mammogram.effective ) ends 27 months or less on or before           end of "Measurement Period"         )           and Mammogram.status in { 'final', 'amended', 'corrected', 'appended' }     )

define "Qualifying Encounters":  (     [Encounter: "Office Visit"]     union [Encounter: "Annual Wellness Visit"]     union [Encounter: "Preventive Care Services - Established Office Visit, 18 and Up"]     union [Encounter: "Preventive Care Services-Initial Office Visit, 18 and Up"]     union [Encounter: "Home Healthcare Services"]   ) ValidEncounter   where ValidEncounter.period during "Measurement Period"     and ValidEncounter.status  = 'finished'

define "Initial Population":   Patient.gender = 'female'       and Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( Patient.birthDate ), start of "Measurement Period" ) in Interval[51, 74 )       and exists AdultOutpatientEncounters."Qualifying Encounters"

define "Denominator":   "Initial Population"

define "SDE Payer":   [Coverage: type in "Payer"] Payer         return {           code: Payer.type,           period: Payer.period         }

define "SDE Payer":   SDE."SDE Payer"

define "SDE Ethnicity":   (flatten (       Patient.extension Extension         where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity'           return Extension.extension     )) E       where E.url = 'ombCategory'         or E.url = 'detailed'       return E.value as Coding

define "SDE Ethnicity":   SDE."SDE Ethnicity"

define "Has Hospice":  exists (     [Encounter: "Encounter Inpatient"] DischargeHospice    where DischargeHospice.status = 'finished'       and (          DischargeHospice.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"         or DischargeHospice.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"       )     and DischargeHospice.period ends during "Measurement Period"  )     or exists (       [ServiceRequest: "Hospice care ambulatory"] HospiceOrder         where HospiceOrder.intent = 'order'             and HospiceOrder.authoredOn in "Measurement Period"     )     or exists (       [Procedure: "Hospice care ambulatory"] HospicePerformed         where HospicePerformed.status = 'completed'           and Global."Normalize Interval"(HospicePerformed.performed) overlaps "Measurement Period"     )

define "Right Mastectomy Diagnosis":   ( ( [Condition: "Status Post Right Mastectomy"] )       union ( [Condition: "Unilateral Mastectomy, Unspecified Laterality"] UnilateralMastectomyDiagnosis           where UnilateralMastectomyDiagnosis.bodySite in "Right"       ) ) RightMastectomy       where Global."Normalize Interval" ( RightMastectomy.onset ) starts on or before       end of "Measurement Period"

define "Right Mastectomy Procedure":   [Procedure: "Unilateral Mastectomy Right"] UnilateralMastectomyRightPerformed       where Global."Normalize Interval" ( UnilateralMastectomyRightPerformed.performed ) ends on or before       end of "Measurement Period"         and UnilateralMastectomyRightPerformed.status = 'completed'

define "Left Mastectomy":   ( ( [Condition: "Status Post Left Mastectomy"] )       union ( [Condition: "Unilateral Mastectomy, Unspecified Laterality"] UnilateralMastectomyDiagnosis           where UnilateralMastectomyDiagnosis.bodySite in "Left"       ) ) LeftMastectomy       where Global."Normalize Interval" ( LeftMastectomy.onset ) starts on or before       end of "Measurement Period"

define "Left Mastectomy Procedure":   [Procedure: "Unilateral Mastectomy Left"] UnilateralMastectomyLeftPerformed       where Global."Normalize Interval" ( UnilateralMastectomyLeftPerformed.performed ) ends on or before       end of "Measurement Period"         and UnilateralMastectomyLeftPerformed.status = 'completed'

define "Bilateral Mastectomy Diagnosis":   [Condition: "History of bilateral mastectomy"] BilateralMastectomyHistory       where Global."Normalize Interval" ( BilateralMastectomyHistory.onset ) starts on or before       end of "Measurement Period"

define "Bilateral Mastectomy Procedure":   [Procedure: "Bilateral Mastectomy"] BilateralMastectomyPerformed       where Global."Normalize Interval" ( BilateralMastectomyPerformed.performed ) ends on or before       end of "Measurement Period"         and BilateralMastectomyPerformed.status = 'completed'

define "Has Criteria Indicating Frailty":   //Ask Bryn about devices        exists ( [DeviceRequest: "Frailty Device"] FrailtyDeviceOrder          where FrailtyDeviceOrder.authoredOn during "Measurement Period"        )           // DeviceUseStatement has a known issue with the publication tooling           // so it is removed to allow this IG to publish until that is fixed         //or exists ( [DeviceUseStatement: "Frailty Device"] FrailtyDeviceUse         //  where Global."Normalize Interval"(FrailtyDeviceUse.timing) overlaps "Measurement Period"         //)         or exists ( [Condition: "Frailty Diagnosis"] FrailtyDiagnosis           where Global."Prevalence Period"(FrailtyDiagnosis) overlaps "Measurement Period"         )         or exists ( [Encounter: "Frailty Encounter"] FrailtyEncounter           where FrailtyEncounter.period overlaps "Measurement Period"         )         or exists ( [Observation: "Frailty Symptom"] FrailtySymptomObservation           where Global."Normalize Interval"(FrailtySymptomObservation.effective) overlaps "Measurement Period"         )

define "Outpatient Encounters with Advanced Illness":   ( [Encounter: "Outpatient"]         union [Encounter: "Observation"]         union [Encounter: "ED"]         union [Encounter: "Nonacute Inpatient"] ) OutpatientEncounter          with [Condition: "Advanced Illness"] AdvancedIllnessDiagnosis                   such that exists (                       OutpatientEncounter.diagnosis.condition EncounterDiagnosis                           where EndsWith(EncounterDiagnosis.reference, AdvancedIllnessDiagnosis.id)                   )                   and OutpatientEncounter.period starts 2 years or less on or before          end of "Measurement Period"

define "Inpatient Encounter with Advanced Illness":   [Encounter: "Acute Inpatient"] InpatientEncounter         with [Condition: "Advanced Illness"] AdvancedIllnessDiagnosis                   such that exists (                       InpatientEncounter.diagnosis.condition EncounterDiagnosis                           where EndsWith(EncounterDiagnosis.reference, AdvancedIllnessDiagnosis.id)                   )          and InpatientEncounter.period starts 2 years or less on or before          end of "Measurement Period"

define "Dementia Medications In Year Before or During Measurement Period":   ["MedicationDispense": "Dementia Medications"] DementiaMed         where DementiaMed.whenHandedOver during Interval[                   ( start of "Measurement Period" - 1 year ), end of "Measurement Period"               ]

define "Advanced Illness and Frailty Exclusion Not Including Over Age 80":   //If the measure does NOT include populations age 80 and older, then use this logic:        Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of "Measurement Period")>= 65               and "Has Criteria Indicating Frailty"               and ( Count("Outpatient Encounters with Advanced Illness")>= 2                   or exists ( "Inpatient Encounter with Advanced Illness" )                   or exists "Dementia Medications In Year Before or During Measurement Period"               )

// start here define "Long Term Care Periods During Measurement Period":   ( [Encounter: "Care Services in Long-Term Residential Facility"]                 union [Encounter: "Nursing Facility Visit"] ) LongTermFacilityEncounter                 where LongTermFacilityEncounter.period overlaps "Measurement Period"                 return LongTermFacilityEncounter.period                  intersect "Measurement Period"

define "Long Term Care Periods Longer Than 90 Consecutive Days":   exists ( "Long Term Care Periods During Measurement Period" LongTermCareDuringMP         where duration in days of LongTermCareDuringMP > 90     )

define "Denominator Exclusion":   Hospice."Has Hospice"       or ( ( exists "Right Mastectomy Diagnosis"             or exists "Right Mastectomy Procedure"         )           and ( exists "Left Mastectomy"               or exists "Left Mastectomy Procedure"           )       )       or exists "Bilateral Mastectomy Diagnosis"       or exists "Bilateral Mastectomy Procedure"       or Frailty."Advanced Illness and Frailty Exclusion Not Including Over Age 80"       or ( Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( Patient.birthDate ), start of "Measurement Period" ) >= 65           and Frailty."Long Term Care Periods Longer Than 90 Consecutive Days"       )

define "SDE Race":   (flatten (       Patient.extension Extension         where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race'           return Extension.extension     )) E       where E.url = 'ombCategory'         or E.url = 'detailed'       return E.value as Coding

define "SDE Race":   SDE."SDE Race"