Quality Measure Implementation Guide
5.0.0 - STU5
Quality Measure Implementation Guide
5.0.0 - STU5
This page is part of the Quality Measure STU2 for FHIR R4 Implementation Guide (v5.0.0: STU5 (v5.0.0)) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
| Active as of 2022-02-22 |
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n<div>\n <table class=\"grid dict\">\n \n <tr>\n <th scope=\"row\"><b>Title: </b></th>\n <td style=\"padding-left: 4px;\">EXM146 - Appropriate Testing for Children with Pharyngitis</td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Id: </b></th>\n <td style=\"padding-left: 4px;\">EXM146-FHIR</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Version: </b></th>\n <td style=\"padding-left: 4px;\">4.0.0</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Url: </b></th>\n <td style=\"padding-left: 4px;\"><a href=\"Measure-EXM146-FHIR.html\">EXM146 - Appropriate Testing for Children with Pharyngitis</a></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\">\n <b>\n \n Official\n \n </b>\n </th>\n\n <td style=\"padding-left: 4px;\">\n \n <p style=\"margin-bottom: 5px;\">\n <span>146</span>\n </p>\n \n </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Effective Period: </b></th>\n <td style=\"padding-left: 4px;\">2018-01-01..2018-12-31</td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Experimental: </b></th>\n <td style=\"padding-left: 4px;\">true</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Publisher: </b></th>\n <td style=\"padding-left: 4px;\">HL7 International / Clinical Quality Information</td>\n </tr>\n \n\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Description: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>Percentage of children 2-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode.</p>\n</div></td>\n </tr>\n \n\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Use Context: </b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr>\n <th><b>code</b></th>\n <th><b>value</b></th>\n </tr>\n \n <tr>\n <td>venue</td>\n <td/>\n </tr>\n \n </table>\n </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Jurisdiction: </b></th>\n <td style=\"padding-left: 4px;\">US</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Topic: </b></th>\n <td style=\"padding-left: 4px;\">57024-2</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Purpose: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>This measure has been developed to support improvement in clinical care.</p>\n</div></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Copyright: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA).\nThe Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures.\n(c) 2008 -2014 National Committee for Quality Assurance. All Rights Reserved.\nLimited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications.\nCPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2013 World Health Organization. All Rights Reserved.</p>\n</div></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Disclaimer: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.\nDue to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p>\n</div></td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Basis: </b></th>\n <td style=\"padding-left: 4px;\">\n Encounter\n </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Scoring: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <span>Proportion </span>\n </p>\n \n \n \n </td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Type: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <span>process </span>\n </p>\n \n \n \n </td>\n </tr>\n \n\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Rationale: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>Group A streptococcal bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms (IDSA 2002). The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment (Linder et al. 2005). A study on antibiotic treatment of children with sore throat found that although only 15 to 36 percent of children with sore throat have Strep A pharyngitis, physicians prescribed antibiotics to 53 percent of children with a chief complaint of sore throat between 1995 and 2003 (Linder et al. 2005).</p>\n</div></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Clinical recommendation statement: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>Institute for Clinical Systems Improvement (ICSI) (2007)\nReduce unnecessary use of antibiotics. Antibiotic treatment should be reserved for a bacterial illness. Diagnosis of group A beta streptococcal Pharyngitis should be made by laboratory testing rather than clinically.\nInfectious Disease Society of America (Bisno et al. 2002)\nThe signs and symptoms of group A streptococcal and other (most frequently viral) pharyngitides overlap broadly. Therefore, unless the physician is able with confidence to exclude the diagnosis of streptococcal pharyngitis on epidemiological and clinical grounds alone, a laboratory test should be done to determine whether group A streptococci are present in the pharynx.\nWith the exception of very rare infections by certain other pharyngeal bacterial pathogens (eg, Corynebacterium diphtheriae and Neisseria gonorrhoeae), antimicrobial therapy is of no proven benefit as treatment for acute pharyngitis due to bacteria other than group A streptococci. Therefore, it is extremely important that physicians exclude the diagnosis of group A streptococcal pharyngitis to prevent inappropriate administration of antimicrobials to large numbers of patients with pharyngitis.\nMichigan Quality Improvement Consortium (2007)\nProbability of group A beta hemolytic streptococci (GABHS): Low; Testing: None; Treatment: Symptomatic treatment only. Avoid antibiotics. Probability of GABHS: Intermediate or High; Testing: Throat Culture (TC) OR Rapid Screen; Treatment: If TC is positive, use antibiotics. If TC is negative, use symptomatic treatment only. Avoid antibiotics. If treatment is started and culture result is negative, stop antibiotics. If Rapid Screen is positive, use antibiotics. If Rapid Screen is negative, culture (Culture is optional for age 16 and over) and only use antibiotics if throat culture is positive. (Michigan, 2007)</p>\n</div></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Improvement Notation: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <span>Increased score indicates improvement </span>\n </p>\n \n \n \n </td>\n </tr>\n \n\n \n\n \n \n \n\n \n\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Libraries: </b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n \n <tr>\n <td><a href=\"Library-EXM146-FHIR.html\">EXM146 - Example Proportion Measure Library</a></td>\n </tr>\n \n </table>\n </td>\n </tr>\n \n\n \n\n \n \n <tr>\n <th scope=\"row\"><b>Terminology and Other Dependencies: </b></th>\n <td style=\"padding-left: 4px;\">\n \n <li><code>http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1</code></li>\n \n <li><a href=\"Library-MATGlobalCommonFunctions.html\">MAT Global Common Functions FHIR Libraryversion: null5.0.000)</a></li>\n \n <li><a href=\"Library-Common.html\">Common Libraryversion: null2.0.0)</a></li>\n \n <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html\">Condition Clinical Status Codes</a></li>\n \n <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-ver-status.html\">ConditionVerificationStatus</a></li>\n \n <li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061</code></li>\n \n <li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011</code></li>\n \n <li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012</code></li>\n \n <li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001</code></li>\n \n <li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012</code></li>\n \n </td>\n </tr>\n <tr>\n <th scope=\"row\"><b>Parameters:</b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr>\n <th><b>name</b></th>\n <th><b>use</b></th>\n <th><b>min</b></th>\n <th><b>max</b></th>\n <th><b>type</b></th>\n </tr>\n \n <tr>\n <td>Measurement Period</td>\n <td>In</td>\n <td>0</td>\n <td>1</td>\n <td>Period</td>\n </tr>\n \n <tr>\n <td>Numerator</td>\n <td>Out</td>\n <td>0</td>\n <td>*</td>\n <td>Encounter</td>\n </tr>\n \n <tr>\n <td>Initial Population</td>\n <td>Out</td>\n <td>0</td>\n <td>*</td>\n <td>Encounter</td>\n </tr>\n \n </table>\n </td>\n </tr>\n\n <tr>\n <th scope=\"row\"><b>DataRequirements:</b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr>\n <th><b>Resource Type</b></th>\n <th><b>Resource Elements</b></th>\n <th><b>Valueset Name</b></th>\n <th><b>Valueset</b></th>\n </tr>\n \n <tr>\n <td>Condition(<a href=\"http://hl7.org/fhir/R4/condition.html\">Condition</a>)</td>\n <td>\n \n code\n \n </td>\n <td>\n \n \n Acute Pharyngitis\n \n \n </td>\n <td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011</code></td>\n </tr>\n \n <tr>\n <td>Condition(<a href=\"http://hl7.org/fhir/R4/condition.html\">Condition</a>)</td>\n <td>\n \n code\n \n </td>\n <td>\n \n \n Acute Tonsillitis\n \n \n </td>\n <td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012</code></td>\n </tr>\n \n <tr>\n <td>Observation(<a href=\"http://hl7.org/fhir/R4/observation.html\">Observation</a>)</td>\n <td>\n \n effective\n \n code\n \n value\n \n </td>\n <td>\n \n \n Group A Streptococcus Test\n \n \n </td>\n <td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012</code></td>\n </tr>\n \n <tr>\n <td>Patient(<a href=\"http://hl7.org/fhir/R4/patient.html\">Patient</a>)</td>\n <td>\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/R4/encounter.html\">Encounter</a>)</td>\n <td>\n \n period\n \n type\n \n status\n \n </td>\n <td>\n \n \n Ambulatory/ED Visit\n \n \n </td>\n <td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061</code></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/R4/medicationrequest.html\">MedicationRequest</a>)</td>\n <td>\n \n authoredOn\n \n medication\n \n intent\n \n status\n \n </td>\n <td>\n \n \n Antibiotic Medications\n \n \n </td>\n <td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001</code></td>\n </tr>\n \n </table>\n </td>\n </tr>\n\n \n\n \n <tr>\n <th scope=\"row\"><b>Direct Reference Codes:</b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr>\n <th><b>display</b></th>\n <th><b>code</b></th>\n <th><b>system</b></th>\n </tr>\n \n <tr>\n <td/>\n <td>active</td>\n <td><a href=\"http://hl7.org/fhir/R4/codesystem-condition-clinical.html\">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>\n </tr>\n \n <tr>\n <td/>\n <td>confirmed</td>\n <td><a href=\"http://hl7.org/fhir/R4/codesystem-condition-ver-status.html\">http://terminology.hl7.org/CodeSystem/condition-ver-status</a></td>\n </tr>\n \n </table>\n </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Logic Definitions:</b></th>\n <td style=\"padding-left: 4px;\">\n \n <table class=\"grid-dict\">\n <tr>\n <th><b>Group</b></th>\n <th><b>Scoring</b></th>\n <th><b>Population Criteria</b></th>\n <th><b>Expression</b></th>\n </tr>\n <tr>\n \n <td> </td>\n <td colspan=\"3\" style=\"padding-left: 4px;\">\n \n\n \n\n \n <b>Measure scoring:</b>\n \n <p style=\"margin-bottom: 5px;\">\n <span>Proportion</span>\n </p>\n \n \n\n \n\n \n\n \n\n \n\n \n\n \n\n </td>\n \n <tr>\n <td/>\n <td/>\n <td>Initial Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Initial Population":\n "Pharyngitis Encounters With Antibiotics"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Numerator</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Numerator":\n "Strep Test Encounters"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Denominator</td>\n <td>\n \n <pre><code class=\"language-cql\"/></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Denominator Exclusion</td>\n <td>\n \n <pre><code class=\"language-cql\"/></pre>\n \n </td>\n </tr>\n \n \n \n </tr>\n </table>\n \n\n <table class=\"grid-dict\">\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>EXM146-FHIR</td>\n \n \n <td>Is Between 2 and 17 Years of Age at Start of Measurement Period</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">// Region: Initial Population\ndefine "Is Between 2 and 17 Years of Age at Start of Measurement Period":\n AgeInYearsAt(start of "Measurement Period") >= 2\n and AgeInYearsAt(start of "Measurement Period") <= 17</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>EXM146-FHIR</td>\n \n \n <td>Measurement Period Encounters</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Measurement Period Encounters":\n [Encounter: "Ambulatory/ED Visit"] Encounter\n where Encounter.period during "Measurement Period"\n and Encounter.status = 'finished'\n and "Is Between 2 and 17 Years of Age at Start of Measurement Period"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>EXM146-FHIR</td>\n \n \n <td>Pharyngitis</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Pharyngitis":\n ([Condition: code in "Acute Pharyngitis"]\n union [Condition: code in "Acute Tonsillitis"]) Pharyngitis\n where Pharyngitis.clinicalStatus ~ Global.active\n and Pharyngitis.verificationStatus ~ Global.confirmed</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>EXM146-FHIR</td>\n \n \n <td>Antibiotics</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Antibiotics":\n [MedicationRequest: medication in "Antibiotic Medications"] Prescription\n where Prescription.status = 'active'\n and Prescription.intent = 'order'</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>EXM146-FHIR</td>\n \n \n <td>Pharyngitis Encounters With Antibiotics</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Pharyngitis Encounters With Antibiotics":\n "Measurement Period Encounters" Encounters\n with "Pharyngitis" Pharyngitis such that\n Common."Includes Or Starts During"(Pharyngitis, Encounters)\n with "Antibiotics" Antibiotics such that Antibiotics.authoredOn\n 3 days or less after FHIRHelpers.ToInterval(Encounters.period)</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>EXM146-FHIR</td>\n \n \n <td>Strep Test Encounters</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">// EndRegion: Denominator Exclusions\n\n// Region: Denominator Exceptions\n\n// None\n\n// EndRegion: Denominator Exceptions\n\n// Region: Numerator\ndefine "Strep Test Encounters":\n "Pharyngitis Encounters With Antibiotics" Encounters\n with [Observation: code in "Group A Streptococcus Test"] Tests\n such that Tests.value is not null\n and Tests.effective starts during\n Interval[start of FHIRHelpers.ToInterval(Encounters.period) - 3 days,\n end of FHIRHelpers.ToInterval(Encounters.period) + 3 days]</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>EXM146-FHIR</td>\n \n \n <td>Numerator</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Numerator":\n "Strep Test Encounters"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>EXM146-FHIR</td>\n \n \n <td>Initial Population</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Initial Population":\n "Pharyngitis Encounters With Antibiotics"</code></pre>\n </td>\n \n </tr>\n \n </table>\n </td>\n </tr>\n \n \n \n\n </table>\n</div>\n</div>"
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"valueString" : "define \"Pharyngitis Encounters With Antibiotics\":\n \"Measurement Period Encounters\" Encounters\n with \"Pharyngitis\" Pharyngitis such that\n Common.\"Includes Or Starts During\"(Pharyngitis, Encounters)\n with \"Antibiotics\" Antibiotics such that Antibiotics.authoredOn\n 3 days or less after FHIRHelpers.ToInterval(Encounters.period)"
},
{
"url" : "displaySequence",
"valueInteger" : 4
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "EXM146-FHIR"
},
{
"url" : "name",
"valueString" : "Strep Test Encounters"
},
{
"url" : "statement",
"valueString" : "// EndRegion: Denominator Exclusions\n\n// Region: Denominator Exceptions\n\n// None\n\n// EndRegion: Denominator Exceptions\n\n// Region: Numerator\ndefine \"Strep Test Encounters\":\n \"Pharyngitis Encounters With Antibiotics\" Encounters\n with [Observation: code in \"Group A Streptococcus Test\"] Tests\n such that Tests.value is not null\n and Tests.effective starts during\n Interval[start of FHIRHelpers.ToInterval(Encounters.period) - 3 days,\n end of FHIRHelpers.ToInterval(Encounters.period) + 3 days]"
},
{
"url" : "displaySequence",
"valueInteger" : 5
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "EXM146-FHIR"
},
{
"url" : "name",
"valueString" : "Numerator"
},
{
"url" : "statement",
"valueString" : "define \"Numerator\":\n \"Strep Test Encounters\""
},
{
"url" : "displaySequence",
"valueInteger" : 6
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "EXM146-FHIR"
},
{
"url" : "name",
"valueString" : "Initial Population"
},
{
"url" : "statement",
"valueString" : "define \"Initial Population\":\n \"Pharyngitis Encounters With Antibiotics\""
},
{
"url" : "displaySequence",
"valueInteger" : 7
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/Library/effective-data-requirements-exm146",
"version" : "1.0.0",
"name" : "EffectiveDataRequirements",
"title" : "Module Definition Library - EXM146",
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/library-type",
"code" : "module-definition"
}
]
},
"date" : "2022-02-22T10:37:03-07:00",
"description" : "This library is used as an example module definition in the FHIR Quality Measure Implementation Guide",
"relatedArtifact" : [
{
"type" : "depends-on",
"display" : "Library FHIRHelpers",
"resource" : "http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1"
},
{
"type" : "depends-on",
"display" : "Library Global",
"resource" : "http://hl7.org/fhir/us/cqfmeasures/Library/MATGlobalCommonFunctions|5.0.000"
},
{
"type" : "depends-on",
"display" : "Library Common",
"resource" : "http://hl7.org/fhir/us/cqfmeasures/Library/Common|2.0.0"
},
{
"type" : "depends-on",
"display" : "Code system ConditionClinicalStatusCodes",
"resource" : "http://terminology.hl7.org/CodeSystem/condition-clinical"
},
{
"type" : "depends-on",
"display" : "Code system ConditionVerificationStatusCodes",
"resource" : "http://terminology.hl7.org/CodeSystem/condition-ver-status"
},
{
"type" : "depends-on",
"display" : "Value set Ambulatory/ED Visit",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061"
},
{
"type" : "depends-on",
"display" : "Value set Acute Pharyngitis",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011"
},
{
"type" : "depends-on",
"display" : "Value set Acute Tonsillitis",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012"
},
{
"type" : "depends-on",
"display" : "Value set Antibiotic Medications",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001"
},
{
"type" : "depends-on",
"display" : "Value set Group A Streptococcus Test",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012"
}
],
"parameter" : [
{
"name" : "Measurement Period",
"use" : "in",
"min" : 0,
"max" : "1",
"type" : "Period"
},
{
"name" : "Numerator",
"use" : "out",
"min" : 0,
"max" : "*",
"type" : "Encounter"
},
{
"name" : "Initial Population",
"use" : "out",
"min" : 0,
"max" : "*",
"type" : "Encounter"
}
],
"dataRequirement" : [
{
"type" : "Condition",
"profile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Condition"
],
"mustSupport" : [
"code"
],
"codeFilter" : [
{
"path" : "code",
"valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011"
}
]
},
{
"type" : "Condition",
"profile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Condition"
],
"mustSupport" : [
"code"
],
"codeFilter" : [
{
"path" : "code",
"valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012"
}
]
},
{
"type" : "Observation",
"profile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Observation"
],
"mustSupport" : [
"effective",
"code",
"value"
],
"codeFilter" : [
{
"path" : "code",
"valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012"
}
]
},
{
"type" : "Patient",
"profile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Patient"
]
},
{
"type" : "Encounter",
"profile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Encounter"
],
"mustSupport" : [
"period",
"type",
"status"
],
"codeFilter" : [
{
"path" : "type",
"valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061"
}
]
},
{
"type" : "MedicationRequest",
"profile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/MedicationRequest"
],
"mustSupport" : [
"authoredOn",
"medication",
"intent",
"status"
],
"codeFilter" : [
{
"path" : "medication",
"valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001"
}
]
}
]
}
],
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
"valueCode" : "Encounter"
},
{
"url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem",
"valueReference" : {
🔗 "reference" : "Device/software-system-example"
}
},
{
"url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
"valueCanonical" : "#effective-data-requirements-exm146"
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/Measure/EXM146-FHIR",
"identifier" : [
{
"use" : "official",
"system" : "http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm",
"value" : "146"
}
],
"version" : "4.0.0",
"name" : "EXM146",
"title" : "EXM146 - Appropriate Testing for Children with Pharyngitis",
"status" : "active",
"experimental" : true,
"date" : "2022-02-22",
"publisher" : "HL7 International / Clinical Quality Information",
"contact" : [
{
"telecom" : [
{
"system" : "url",
"value" : "http://www.hl7.org/Special/committees/cqi"
}
]
}
],
"description" : "Percentage of children 2-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode.",
"useContext" : [
{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "venue",
"display" : "Venue"
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/intended-venue-codes",
"code" : "ec",
"display" : "EC"
}
]
}
}
],
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "US"
}
]
}
],
"purpose" : "This measure has been developed to support improvement in clinical care.",
"copyright" : "Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). \r\nThe Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. \r\n(c) 2008 -2014 National Committee for Quality Assurance. All Rights Reserved. \r\nLimited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications.\r\nCPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2013 World Health Organization. All Rights Reserved.",
"approvalDate" : "2016-01-01",
"lastReviewDate" : "2016-09-01",
"effectivePeriod" : {
"start" : "2018-01-01",
"end" : "2018-12-31"
},
"topic" : [
{
"coding" : [
{
"system" : "http://loinc.org",
"code" : "57024-2",
"display" : "Health Quality Measure Document"
}
]
}
],
"library" : [
🔗 "http://hl7.org/fhir/us/cqfmeasures/Library/EXM146-FHIR"
],
"disclaimer" : "The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND. \n Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].",
"scoring" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
"code" : "proportion",
"display" : "Proportion"
}
]
},
"type" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-type",
"code" : "process"
}
]
}
],
"rationale" : "Group A streptococcal bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms (IDSA 2002). The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment (Linder et al. 2005). A study on antibiotic treatment of children with sore throat found that although only 15 to 36 percent of children with sore throat have Strep A pharyngitis, physicians prescribed antibiotics to 53 percent of children with a chief complaint of sore throat between 1995 and 2003 (Linder et al. 2005).",
"clinicalRecommendationStatement" : "Institute for Clinical Systems Improvement (ICSI) (2007) \n Reduce unnecessary use of antibiotics. Antibiotic treatment should be reserved for a bacterial illness. Diagnosis of group A beta streptococcal Pharyngitis should be made by laboratory testing rather than clinically. \nInfectious Disease Society of America (Bisno et al. 2002) \nThe signs and symptoms of group A streptococcal and other (most frequently viral) pharyngitides overlap broadly. Therefore, unless the physician is able with confidence to exclude the diagnosis of streptococcal pharyngitis on epidemiological and clinical grounds alone, a laboratory test should be done to determine whether group A streptococci are present in the pharynx. \nWith the exception of very rare infections by certain other pharyngeal bacterial pathogens (eg, Corynebacterium diphtheriae and Neisseria gonorrhoeae), antimicrobial therapy is of no proven benefit as treatment for acute pharyngitis due to bacteria other than group A streptococci. Therefore, it is extremely important that physicians exclude the diagnosis of group A streptococcal pharyngitis to prevent inappropriate administration of antimicrobials to large numbers of patients with pharyngitis. \nMichigan Quality Improvement Consortium (2007)\nProbability of group A beta hemolytic streptococci (GABHS): Low; Testing: None; Treatment: Symptomatic treatment only. Avoid antibiotics. Probability of GABHS: Intermediate or High; Testing: Throat Culture (TC) OR Rapid Screen; Treatment: If TC is positive, use antibiotics. If TC is negative, use symptomatic treatment only. Avoid antibiotics. If treatment is started and culture result is negative, stop antibiotics. If Rapid Screen is positive, use antibiotics. If Rapid Screen is negative, culture (Culture is optional for age 16 and over) and only use antibiotics if throat culture is positive. (Michigan, 2007)",
"improvementNotation" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
"code" : "increase",
"display" : "Increased score indicates improvement"
}
]
},
"guidance" : "This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. If the patient has more than one episode, include all episodes in the measure.",
"group" : [
{
"population" : [
{
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "initial-population",
"display" : "Initial Population"
}
]
},
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Initial Population"
}
},
{
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "numerator",
"display" : "Numerator"
}
]
},
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Numerator"
}
},
{
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "denominator",
"display" : "Denominator"
}
]
},
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Denominator"
}
},
{
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "denominator-exclusion",
"display" : "Denominator Exclusion"
}
]
},
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Denominator Exclusion"
}
}
]
}
]
}
IG © 2019+ HL7 International / Clinical Quality Information. Package hl7.fhir.us.cqfmeasures#5.0.0 based on FHIR 4.0.1. Generated 2024-11-04
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