This page is part of the Healthcare Associated Infection Reports (HAI) Long Term Care Facilities (LTCF) (v0.1.0: STU 1 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions
XML Format: Questionnaire-hai-ltcf-questionnaire-mdro-cdi-summary
Raw xml
<Questionnaire xmlns="http://hl7.org/fhir"> <id value="hai-ltcf-questionnaire-mdro-cdi-summary"/> <!-- **TODO** This needs to be un-commented once the HAI has been published (before publication of the HAI-LTCF IG) --> <!-- <profile value="http://hl7.org/fhir/us/hai/StructureDefinition/hai-population-summary-questionnaire" /> --> <meta> <versionId value="2"/> <lastUpdated value="2019-07-05T01:19:42.000-04:00"/> </meta> <language value="en-US"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml" lang="en-US"> <h1 xmlns:xsl="http://www.w3.org/1999/XSL/Transform">MDRO and CDI LabID Event Reporting Monthly Summary Data for LTCF</h1> <p xmlns:xsl="http://www.w3.org/1999/XSL/Transform"> <p>This Questionnaire instance defines the questions and possible answers in the MDRO and CDI LabID Event Reporting Monthly Summary Data for LTCF. It records the monthly aggregate data for Multi-Drug Resistant Organisms (MDRO) and Clostridium difficile (C. diff, CDI).</p> <p>For further details see the NHSN website <a href="https://www.cdc.gov/nhsn/">https://www.cdc.gov/nhsn/</a> for reporting healthcare-associated infections in long-term care facilities. The concepts reported in this document-type are defined for the NHSN "<i>LabID Event Protocol for LTCF</i>" and the corresponding data collection form "<i>57.139 MDRO and CDI Monthly Monitoring for LTCF</i>".</p> </p> <h2 xmlns:xsl="http://www.w3.org/1999/XSL/Transform">Questionnaire Details</h2> <table xmlns:xsl="http://www.w3.org/1999/XSL/Transform"> <tr> <td> <b>Id:</b> </td> <td>hai-ltcf-questionnaire-mdro-cdi-summary</td> </tr> <tr> <td> <b>Meta:</b> </td> <td> <ul style="list-style:none; padding-left:0; margin:0 0;"> <li>2</li> <li>2019-07-05T01:19:42.000-04:00</li> <li>http://hl7.org/fhir/us/hai/StructureDefinition/hai-population-summary-questionnaire</li> </ul> </td> </tr> <tr> <td> <b>Language:</b> </td> <td>en-US</td> </tr> <tr> <td> <b>Url:</b> </td> <td>http://hl7.org/fhir/us/hai-ltcf/Questionnaire/hai-ltcf-questionnaire-mdro-cdi-summary</td> </tr> <tr> <td> <b>Identifier:</b> </td> <td> <span>hai-questionnaire-opc-sdom-summary-v1</span> </td> </tr> <tr> <td> <b>Version:</b> </td> <td>Version: 1.0.0</td> </tr> <tr> <td> <b>Name:</b> </td> <td>HAI-LTCF-questionnaire-mdro-cdi-summary</td> </tr> <tr> <td> <b>Status:</b> </td> <td>draft</td> </tr> <tr> <td> <b>Experimental:</b> </td> <td>false</td> </tr> <tr> <td> <b>Subject Type:</b> </td> <td>Group</td> </tr> <tr> <td> <b>Date:</b> </td> <td>2019-08-01</td> </tr> <tr> <td> <b>Publisher:</b> </td> <td>HL7</td> </tr> <tr> <td> <b>Jurisdiction:</b> </td> <td> <span title="Code system: urn:iso:std:iso:3166">Code: US</span> </td> </tr> <tr> <td> <b>Code:</b> </td> <td> <ul style="list-style:none; padding-left:0; margin:0 0;"> <li>Summary data reporting outpatient procedure component events at a facility</li> <li>Code system: <a href="CodeSystem-2.16.840.1.113883.6.277.html">http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277</a> </li> <li>Code: 1657-6</li> </ul> </td> </tr> </table> <br xmlns:xsl="http://www.w3.org/1999/XSL/Transform"/> <br xmlns:xsl="http://www.w3.org/1999/XSL/Transform"/> <h2 xmlns:xsl="http://www.w3.org/1999/XSL/Transform">Questionnaire Items</h2> <table border="1" xmlns:xsl="http://www.w3.org/1999/XSL/Transform"> <tr> <th align="left">Group</th> <th align="left">text</th> <th align="left">linkId</th> <th align="left">type</th> <th align="left">required</th> <th align="left">repeats</th> <th align="left">enableWhen</th> <th align="left">answerValueSet</th> </tr> <tr> <td/> <td>Facility ID</td> <td>facility-id</td> <td>url</td> <td>true</td> <td>false</td> <td/> <td/> </tr> <tr> <td/> <td>First Day of Period Reported</td> <td>report-period-start</td> <td>date</td> <td>true</td> <td>false</td> <td/> <td/> </tr> <tr> <td/> <td>Last Day of Period Reported</td> <td>report-period-end</td> <td>date</td> <td>true</td> <td>false</td> <td/> <td/> </tr> <tr> <td/> <td>Facility Location Code</td> <td>facility-location-code</td> <td>choice</td> <td>true</td> <td>false</td> <td/> <td> <a href="ValueSet-2.16.840.1.113883.13.19.html">http://hl7.org/fhir/us/hai-ltcf/ValueSet/2.16.840.1.113883.13.19</a> </td> </tr> <tr> <td colspan="8">The Summary Data Group a set of summary data for a population in the defined NHSN protocol.</td> </tr> <tr> <td/> <td>Summary Data Group</td> <td>summary-data-group</td> <td>group</td> <td>true</td> <td>false</td> <td/> <td/> <tr> <td>Summary Data Group</td> <td>Resident Days</td> <td>resident-days</td> <td>integer</td> <td>true</td> <td>false</td> <td/> <td/> </tr> <tr> <td>Summary Data Group</td> <td>Resident Admissions</td> <td>resident-admissions</td> <td>integer</td> <td>true</td> <td>false</td> <td/> <td/> </tr> <tr> <td>Summary Data Group</td> <td>Number of Admissions on C. diff Treatment</td> <td>number-admissions-on-c-diff-treatment</td> <td>integer</td> <td>true</td> <td>false</td> <td/> <td/> </tr> <tr> <td>Summary Data Group</td> <td>Number of C. diff Treatment Starts</td> <td>number-c-diff-treatment-starts</td> <td>integer</td> <td>true</td> <td>false</td> <td/> <td/> </tr> </tr> <tr> <td colspan="8">The Report No Events Group contains statements that there are no events to report for a particular type of event.</td> </tr> <tr> <td/> <td>Report no events</td> <td>report-no-events-group</td> <td>group</td> <td>false</td> <td>false</td> <td/> <td/> <tr> <td>Report no events</td> <td>Report no labID event - All specimens - Methicillin-resistant Staphylococcus aureus</td> <td>no-lab-id-event-mrsa</td> <td>boolean</td> <td>false</td> <td>false</td> <td/> <td/> </tr> <tr> <td>Report no events</td> <td>Report no labID event - All specimens - Methicillin-sensitive Staphylococcus aureus</td> <td>no-lab-id-event-mssa</td> <td>boolean</td> <td>false</td> <td>false</td> <td/> <td/> </tr> <tr> <td>Report no events</td> <td>Report no labID event - All specimens - Vancomycin resistant Enterococcus</td> <td>no-lab-id-event-vre</td> <td>boolean</td> <td>false</td> <td>false</td> <td/> <td/> </tr> <tr> <td>Report no events</td> <td>Report no labID event - All specimens - CephR Klebsiella</td> <td>no-lab-id-event-cephr-klebsiella</td> <td>boolean</td> <td>false</td> <td>false</td> <td/> <td/> </tr> <tr> <td>Report no events</td> <td>Report no labID event - All specimens - CRE E. coli</td> <td>no-lab-id-event-mrsa-cre-e-coli</td> <td>boolean</td> <td>false</td> <td>false</td> <td/> <td/> </tr> <tr> <td>Report no events</td> <td>Report no labID event - All specimens - CRE Enterobacter</td> <td>no-lab-id-event-mrsa-cre-enterobacter</td> <td>boolean</td> <td>false</td> <td>false</td> <td/> <td/> </tr> <tr> <td>Report no events</td> <td>Report no labID event - All specimens - CRE Klebsiella</td> <td>no-lab-id-event-cre-klebsiella</td> <td>boolean</td> <td>false</td> <td>false</td> <td/> <td/> </tr> <tr> <td>Report no events</td> <td>Report no labID event - All specimens - Acinetobacter</td> <td>no-lab-id-event-mdr-acinetobacter</td> <td>boolean</td> <td>false</td> <td>false</td> <td/> <td/> </tr> <tr> <td>Report no events</td> <td>Report no labID event - All specimens - Clostridium difficile</td> <td>no-lab-id-event-c-difficile</td> <td>boolean</td> <td>false</td> <td>false</td> <td/> <td/> </tr> </tr> </table> </div> </text> <url value="http://hl7.org/fhir/us/hai-ltcf/Questionnaire/hai-ltcf-questionnaire-mdro-cdi-summary"/> <identifier> <value value="hai-ltcf-questionnaire-mdro-cdi-summary-v1"/> </identifier> <version value="1.0.0"/> <name value="HAI_LTCF_questionnaire_mdro_cdi_summary"/> <title value="MDRO and CDI LabID Event Reporting Monthly Summary Data for LTCF"/> <status value="draft"/> <experimental value="false"/> <subjectType value="Group"/> <date value="2019-08-01"/> <publisher value="HL7"/> <description value="This Questionnaire instance defines the questions and possible answers in the MDRO and CDI LabID Event Reporting Monthly Summary Data for LTCF. It records the monthly aggregate data for Multi-Drug Resistant Organisms (MDRO) and Clostridium difficile (C. diff, CDI)."/> <jurisdiction> <coding> <system value="urn:iso:std:iso:3166"/> <code value="US"/> </coding> </jurisdiction> <code> <system value="http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277"/> <code value="1657-6"/> <display value="Summary data reporting outpatient procedure component events at a facility"/> </code> <item> <linkId value="facility-id"/> <text value="Facility ID"/> <type value="url"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="report-period-start"/> <text value="First Day of Period Reported"/> <type value="date"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="report-period-end"/> <text value="Last Day of Period Reported"/> <type value="date"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="facility-location-code"/> <text value="Facility Location Code"/> <type value="choice"/> <required value="true"/> <repeats value="false"/> <answerValueSet value="http://hl7.org/fhir/us/hai-ltcf/ValueSet/2.16.840.1.113883.13.19"/> </item> <item> <linkId value="summary-data-group"/> <code> <system value="http://loinc.org"/> <code value="51900-9"/> <display value="Population Summary note"/> </code> <text value="Summary Data Group"/> <type value="group"/> <required value="true"/> <repeats value="false"/> <item> <linkId value="summary-data-group-display"/> <text value="The Summary Data Group a set of summary data for a population in the defined NHSN protocol."/> <type value="display"/> </item> <item> <linkId value="resident-days"/> <code> <system value="http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277"/> <code value="1369-8"/> <display value="Resident days"/> </code> <text value="Resident Days"/> <type value="integer"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="resident-admissions"/> <code> <system value="http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277"/> <code value="1370-6"/> <display value="Resident admissions"/> </code> <text value="Resident Admissions"/> <type value="integer"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="number-admissions-on-c-diff-treatment"/> <code> <system value="http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277"/> <code value="1371-4"/> <display value="Number of admissions on C. diff treatment"/> </code> <text value="Number of Admissions on C. diff Treatment"/> <type value="integer"/> <required value="true"/> <repeats value="false"/> </item> <item> <linkId value="number-c-diff-treatment-starts"/> <code> <system value="http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277"/> <code value="1372-2"/> <display value="Number of residents started on antibiotic treatment for C. diff"/> </code> <text value="Number of C. diff Treatment Starts"/> <type value="integer"/> <required value="true"/> <repeats value="false"/> </item> </item> <item> <linkId value="report-no-events-group"/> <code> <system value="http://loinc.org"/> <code value="90252-8"/> <display value="Report no events"/> </code> <text value="Report no events"/> <type value="group"/> <required value="false"/> <repeats value="false"/> <item> <linkId value="report-no-events-group-display"/> <text value="The Report No Events Group contains statements that there are no events to report for a particular type of event."/> <type value="display"/> </item> <item> <linkId value="no-lab-id-event-mrsa"/> <code> <system value="http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277"/> <code value="3030-4"/> <display value="Report no labID event - All specimens - Methicillin-resistant Staphylococcus aureus"/> </code> <text value="Report no labID event - All specimens - Methicillin-resistant Staphylococcus aureus"/> <type value="boolean"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="no-lab-id-event-mssa"/> <code> <system value="http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277"/> <code value="1307-8"/> <display value="Report no labID event - All specimens - Methicillin-sensitive Staphylococcus aureus"/> </code> <text value="Report no labID event - All specimens - Methicillin-sensitive Staphylococcus aureus"/> <type value="boolean"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="no-lab-id-event-vre"/> <code> <system value="http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277"/> <code value="3033-8"/> <display value="Report no labID event - All specimens - Vancomycin resistant Enterococcus"/> </code> <text value="Report no labID event - All specimens - Vancomycin resistant Enterococcus"/> <type value="boolean"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="no-lab-id-event-cephr-klebsiella"/> <code> <system value="http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277"/> <code value="3036-1"/> <display value="Report no labID event - All specimens - CephR Klebsiella"/> </code> <text value="Report no labID event - All specimens - CephR Klebsiella"/> <type value="boolean"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="no-lab-id-event-mrsa-cre-e-coli"/> <code> <system value="http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277"/> <code value="3039-5"/> <display value="Report no labID event - All specimens - CRE E. coli"/> </code> <text value="Report no labID event - All specimens - CRE E. coli"/> <type value="boolean"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="no-lab-id-event-mrsa-cre-enterobacter"/> <code> <system value="http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277"/> <code value="3042-9"/> <display value="Report no labID event - All specimens - CRE Enterobacter"/> </code> <text value="Report no labID event - All specimens - CRE Enterobacter"/> <type value="boolean"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="no-lab-id-event-cre-klebsiella"/> <code> <system value="http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277"/> <code value="3045-2"/> <display value="Report no labID event - All specimens - CRE Klebsiella"/> </code> <text value="Report no labID event - All specimens - CRE Klebsiella"/> <type value="boolean"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="no-lab-id-event-mdr-acinetobacter"/> <code> <system value="http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277"/> <code value="3048-6"/> <display value="Report no labID event - All specimens - Acinetobacter"/> </code> <text value="Report no labID event - All specimens - Acinetobacter"/> <type value="boolean"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="no-lab-id-event-c-difficile"/> <code> <system value="http://hl7.org/fhir/us/hai-ltcf/CodeSystem/2.16.840.1.113883.6.277"/> <code value="3051-0"/> <display value="Report no labID event - All specimens - Clostridium difficile"/> </code> <text value="Report no labID event - All specimens - Clostridium difficile"/> <type value="boolean"/> <required value="false"/> <repeats value="false"/> </item> </item> </Questionnaire>
