Proportion

define "Initial Population":   "Qualifying Encounter During Measurement Period" QualifyingEncounter       with [Patient] BirthDate         such that Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( BirthDate.birthDate ), start of "Measurement Period" ) >= 18

define "Denominator":   "Initial Population"

define "Denominator Exclusions":   "Qualifying Encounter During Measurement Period" QualifyingEncounter       with [Condition: "Diagnosis of Hypertension"] Hypertension         such that Global."Prevalence Period" ( Hypertension ) overlaps before QualifyingEncounter.period

define "Denominator Exceptions":   "Encounter with Medical Reason for Not Obtaining or Patient Declined Blood Pressure Measurement"       union "Encounter with Order for Hypertension Follow Up Declined by Patient"

define "Numerator":   "Encounter with Normal Blood Pressure Reading"       union ( "Encounter with Prehypertensive Blood Pressure Reading"           intersect ( ( "Encounter with Order for Intervention for Hypertension"                 intersect "Encounter with Order for Follow Up Within One Year"             )               union "Encounter with Referral to Alternate Provider for High Blood Pressure Reading"           )       )       union ( "Encounter with First Hypertensive Reading"           intersect ( ( "Encounter with Order for Intervention for Hypertension"                 intersect "Encounter with Order for Follow Up Within 4 Weeks"             )               union "Encounter with Referral to Alternate Provider for High Blood Pressure Reading"           )       )       union ( "Encounter with Second Hypertensive Reading"           intersect ( ( "Encounter with Order for Intervention for Hypertension"                 intersect ( "Encounter with Order for Laboratory Test for Hypertension"                     union "Encounter with Order for Electrocardiogram for Hypertension"                     union "Encounter with Order for Hypertension Medication"                 )             )               union "Encounter with Referral to Alternate Provider for High Blood Pressure Reading"           )       )

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 "Qualifying Encounter During Measurement Period":   [Encounter: "Encounter to Screen for Blood Pressure"] ValidEncounter       where ValidEncounter.period during "Measurement Period"

define "Encounter with Normal Blood Pressure Reading":   "Qualifying Encounter During Measurement Period" QualifyingEncounter       let EncounterLastSystolicBP: Last([Observation: "Systolic blood pressure"] SystolicBP           where SystolicBP.effective during QualifyingEncounter.period           sort by effective       ),       EncounterLastDiastolicBP: Last([Observation: "Diastolic blood pressure"] DiastolicBP           where DiastolicBP.effective during QualifyingEncounter.period           sort by effective       )       where EncounterLastSystolicBP.value included in Interval[1 'mm[Hg]', 120 'mm[Hg]' )         and EncounterLastDiastolicBP.value included in Interval[1 'mm[Hg]', 80 'mm[Hg]' )

define "Encounter with Prehypertensive Blood Pressure Reading":   "Qualifying Encounter During Measurement Period" QualifyingEncounter       let EncounterLastSystolicBP: Last([Observation: "Systolic blood pressure"] SystolicBP           where SystolicBP.effective during QualifyingEncounter.period           sort by effective       ),       EncounterLastDiastolicBP: Last([Observation: "Diastolic blood pressure"] DiastolicBP           where DiastolicBP.effective during QualifyingEncounter.period           sort by effective       )       where EncounterLastSystolicBP.value included in Interval[1 'mm[Hg]', 140 'mm[Hg]' )         and EncounterLastDiastolicBP.value included in Interval[1 'mm[Hg]', 90 'mm[Hg]' )         and ( EncounterLastSystolicBP.value >= 120 'mm[Hg]'             or EncounterLastDiastolicBP.value >= 80 'mm[Hg]'         )

define "Encounter with Order for Intervention for Hypertension":   "Qualifying Encounter During Measurement Period" QualifyingEncounter       with ( [ServiceRequest: "Lifestyle Recommendation"]         union [ServiceRequest: "Weight Reduction Recommended"]         union [ServiceRequest: "Dietary Recommendations"]         union [ServiceRequest: "Recommendation to Increase Physical Activity"]         union [ServiceRequest: "Referral or Counseling for Alcohol Consumption"] ) HighBloodPressureIntervention         such that HighBloodPressureIntervention.authoredOn same day as start of QualifyingEncounter.period

define "Encounter with Order for Follow Up Within One Year":   "Qualifying Encounter During Measurement Period" QualifyingEncounter       with [ServiceRequest: "Follow Up Within One Year"] FollowupOneYear         such that FollowupOneYear.authoredOn same day as start of QualifyingEncounter.period

define "Encounter with Referral to Alternate Provider for High Blood Pressure Reading":   "Qualifying Encounter During Measurement Period" QualifyingEncounter       with [ServiceRequest: "Referral to Primary Care or Alternate Provider"] Referral         such that Referral.authoredOn same day as start of QualifyingEncounter.period           and Referral.reasonCode in "Finding of Elevated Blood Pressure or Hypertension"

define "Encounter with High Blood Pressure Reading":   "Qualifying Encounter During Measurement Period" QualifyingEncounter       let EncounterLastSystolicBP: Last([Observation: "Systolic blood pressure"] SystolicBP           where SystolicBP.effective during QualifyingEncounter.period           sort by effective       ),       EncounterLastDiastolicBP: Last([Observation: "Diastolic blood pressure"] DiastolicBP           where DiastolicBP.effective during QualifyingEncounter.period           sort by effective       )       where EncounterLastSystolicBP.value > 0 'mm[Hg]'         and EncounterLastDiastolicBP.value > 0 'mm[Hg]'         and ( EncounterLastSystolicBP.value >= 140 'mm[Hg]'             or EncounterLastDiastolicBP.value >= 90 'mm[Hg]'         )

define "Encounter with High Blood Pressure Reading Within Year Prior":   "Qualifying Encounter During Measurement Period" QualifyingEncounter       let EncounterLastSystolicBP: Last([Observation: "Systolic blood pressure"] SystolicBP           where SystolicBP.effective 1 year or less before start of QualifyingEncounter.period           sort by effective       ),       EncounterLastDiastolicBP: Last([Observation: "Diastolic blood pressure"] DiastolicBP           where DiastolicBP.effective 1 year or less before start of QualifyingEncounter.period           sort by effective       )       where EncounterLastSystolicBP.value > 0 'mm[Hg]'         and EncounterLastDiastolicBP.value > 0 'mm[Hg]'         and ( EncounterLastSystolicBP.value >= 140 'mm[Hg]'             or EncounterLastDiastolicBP.value >= 90 'mm[Hg]'         )

define "Encounter with First Hypertensive Reading":   "Encounter with High Blood Pressure Reading"       except "Encounter with High Blood Pressure Reading Within Year Prior"

define "Encounter with Order for Follow Up Within 4 Weeks":   "Qualifying Encounter During Measurement Period" QualifyingEncounter       with [ServiceRequest: "Follow Up Within 4 Weeks"] Followup4Weeks         such that Followup4Weeks.authoredOn same day as start of QualifyingEncounter.period

define "Encounter with Second Hypertensive Reading":   "Encounter with High Blood Pressure Reading"       intersect "Encounter with High Blood Pressure Reading Within Year Prior"

define "Encounter with Order for Laboratory Test for Hypertension":   "Qualifying Encounter During Measurement Period" QualifyingEncounter       with [ServiceRequest: "Laboratory Tests for Hypertension"] HypertensionLabs         such that HypertensionLabs.authoredOn same day as start of QualifyingEncounter.period

define "Encounter with Order for Electrocardiogram for Hypertension":   "Qualifying Encounter During Measurement Period" QualifyingEncounter       with ( [ServiceRequest: "12 lead EKG panel"]         union [ServiceRequest: "EKG study"] ) ECG         such that ECG.authoredOn same day as start of QualifyingEncounter.period

define "Encounter with Order for Hypertension Medication":   "Qualifying Encounter During Measurement Period" QualifyingEncounter       with [MedicationRequest: "Pharmacologic Therapy for Hypertension"] AntihypertensiveMedication         such that AntihypertensiveMedication.authoredOn same day as start of QualifyingEncounter.period

define "Numerator":   "Encounter with Normal Blood Pressure Reading"       union ( "Encounter with Prehypertensive Blood Pressure Reading"           intersect ( ( "Encounter with Order for Intervention for Hypertension"                 intersect "Encounter with Order for Follow Up Within One Year"             )               union "Encounter with Referral to Alternate Provider for High Blood Pressure Reading"           )       )       union ( "Encounter with First Hypertensive Reading"           intersect ( ( "Encounter with Order for Intervention for Hypertension"                 intersect "Encounter with Order for Follow Up Within 4 Weeks"             )               union "Encounter with Referral to Alternate Provider for High Blood Pressure Reading"           )       )       union ( "Encounter with Second Hypertensive Reading"           intersect ( ( "Encounter with Order for Intervention for Hypertension"                 intersect ( "Encounter with Order for Laboratory Test for Hypertension"                     union "Encounter with Order for Electrocardiogram for Hypertension"                     union "Encounter with Order for Hypertension Medication"                 )             )               union "Encounter with Referral to Alternate Provider for High Blood Pressure Reading"           )       )

define "Initial Population":   "Qualifying Encounter During Measurement Period" QualifyingEncounter       with [Patient] BirthDate         such that Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( BirthDate.birthDate ), start of "Measurement Period" ) >= 18

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 "Denominator Exclusions":   "Qualifying Encounter During Measurement Period" QualifyingEncounter       with [Condition: "Diagnosis of Hypertension"] Hypertension         such that Global."Prevalence Period" ( Hypertension ) overlaps before QualifyingEncounter.period

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"

define "Encounter with Medical Reason for Not Obtaining or Patient Declined Blood Pressure Measurement":   "Qualifying Encounter During Measurement Period" QualifyingEncounter       with ( [Observation: "Systolic blood pressure"]         union [Observation: "Diastolic blood pressure"] ) NoBPScreen         such that ( NoBPScreen.code in "Medical Reason"             or NoBPScreen.code in "Patient Declined"         )           and NoBPScreen.effective same day as start of QualifyingEncounter.period           and "Not Done"(NoBPScreen)           and NoBPScreen.status = 'final'

define "Encounter with Order for Hypertension Follow Up Declined by Patient":   "Qualifying Encounter During Measurement Period" QualifyingEncounter       with ( [ServiceRequest: "12 lead EKG panel"]         union [ServiceRequest: "EKG study"]         union [ServiceRequest: "Follow Up Within One Year"]         union [ServiceRequest: "Follow Up Within 4 Weeks"]         union [ServiceRequest: "Referral to Primary Care or Alternate Provider"]         union [ServiceRequest: "Lifestyle Recommendation"]         union [ServiceRequest: "Weight Reduction Recommended"]         union [ServiceRequest: "Dietary Recommendations"]         union [ServiceRequest: "Recommendation to Increase Physical Activity"]         union [ServiceRequest: "Referral or Counseling for Alcohol Consumption"]         union [ServiceRequest: "Laboratory Tests for Hypertension"]         union [MedicationRequest: "Pharmacologic Therapy for Hypertension"] ) NoFollowUpOrdered         such that NoFollowUpOrdered.doNotPerform is true           and NoFollowUpOrdered.code in "Patient Declined"           and NoFollowUpOrdered.authoredOn same day as start of QualifyingEncounter.period

define "Denominator Exceptions":   "Encounter with Medical Reason for Not Obtaining or Patient Declined Blood Pressure Measurement"       union "Encounter with Order for Hypertension Follow Up Declined by Patient"