Proportion

define "Initial Population":   Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( Patient.birthDate ), start of "Measurement Period" ) in Interval[50, 75]       and exists AdultOutpatientEncounters."Qualifying Encounters"

define "Denominator":   "Initial Population"

define "Denominator Exclusion":   Hospice."Has Hospice"       or exists "Malignant Neoplasm"       or exists "Total Colectomy Performed"       or Frailty."Advanced Illness and Frailty Exclusion Not Including Over Age 80"         and Frailty."Long Term Care Periods Longer Than 90 Consecutive Days"

define "Numerator":   exists "Colonoscopy Performed"       or exists "Fecal Occult Blood Test Performed"       or exists "Flexible Sigmoidoscopy Performed"       or exists "Fecal Immunochemical Test DNA"       or exists "CT Colonography Performed"

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 "Colonoscopy Performed":   [Procedure: "Colonoscopy"] Colonoscopy       where Colonoscopy.status = 'completed'         and Global."Normalize Interval" ( Colonoscopy.performed ) ends 10 years or less on or before         end of "Measurement Period"

define "Fecal Occult Blood Test Performed":   [Observation: "Fecal Occult Blood Test (FOBT)"] FecalOccultResult       where FecalOccultResult.status in { 'final', 'amended', 'corrected', 'preliminary' }         and FecalOccultResult.value is not null         and Global."Normalize Interval" ( FecalOccultResult.effective ) during day of "Measurement Period"

define "Flexible Sigmoidoscopy Performed":   [Procedure: "Flexible Sigmoidoscopy"] FlexibleSigmoidoscopy       where FlexibleSigmoidoscopy.status = 'completed'         and Global."Normalize Interval" ( FlexibleSigmoidoscopy.performed ) ends 5 years or less on or before         end of "Measurement Period"

define "Fecal Immunochemical Test DNA":   [Observation: "FIT DNA"] FitDNA       where FitDNA.status in { 'final', 'amended', 'corrected', 'preliminary' }         and FitDNA.value is not null         and Global."Normalize Interval" ( FitDNA.effective ) occurs 3 years or less on or before day of         end of "Measurement Period"

define "CT Colonography Performed":   [Procedure: "CT Colonography"] Colonography       where Colonography.status = 'completed'         and Global."Normalize Interval" ( Colonography.performed ) ends 5 years or less on or before         end of "Measurement Period"

define "Numerator":   exists "Colonoscopy Performed"       or exists "Fecal Occult Blood Test Performed"       or exists "Flexible Sigmoidoscopy Performed"       or exists "Fecal Immunochemical Test DNA"       or exists "CT Colonography Performed"

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":   Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( Patient.birthDate ), start of "Measurement Period" ) in Interval[50, 75]       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 "Malignant Neoplasm":   [Condition: "Malignant Neoplasm of Colon"] ColorectalCancer       where Global."Prevalence Period" ( ColorectalCancer ) starts on or before       end of "Measurement Period"

define "Total Colectomy Performed":   [Procedure: "Total Colectomy"] Colectomy       where Colectomy.status = 'completed'         and Global."Normalize Interval" ( Colectomy.performed ) starts on or before         end of "Measurement Period"

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 "Malignant Neoplasm"       or exists "Total Colectomy Performed"       or Frailty."Advanced Illness and Frailty Exclusion Not Including Over Age 80"         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"