Quality Measure Implementation Guide
1.0.0-ballot - ballot International flag

This page is part of the Quality Measure Implementation Guide (v1.0.0-ballot: STU1 (v1.0.0) Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. . For a full list of available versions, see the Directory of published versions

Measure: EXM130 - Colorectal Cancer Screening Measure (Experimental)

Official URL: http://hl7.org/fhir/uv/cqm/Measure/EXM130-FHIR Version: 8.0.000
Active as of 2022-02-22 Computable Name: EXM130
Other Identifiers: http://example.org/fhir/cqi/ecqm/Measure/Identifier/cms#130 (use: official, ), http://example.org/fhir/cqi/ecqm/Measure/Identifier/nqf#0034 (use: official, )

Usage:Venue: EC

Copyright/Legal: This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved. Limited 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 third party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2017 American Medical Association. LOINC(R) copyright 2004-2017 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R] ) copyright 2004-2017 International Health Terminology Standards Development Organisation. ICD-10 copyright 2017 World Health Organization. All Rights Reserved.

Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer

This measure has been developed to support improvement in clinical care.

Title: EXM130 - Colorectal Cancer Screening Measure
Id: EXM130-FHIR
Version: 8.0.000
Url: EXM130 - Colorectal Cancer Screening Measure
Official

130

Official

0034

Effective Period: 2018-01-01..2018-12-31
Experimental: true
Publisher: HL7 International / Clinical Quality Information
Description:

Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer

Use Context:
code value
venue
Jurisdiction: 001
Topic: 57024-2
Purpose:

This measure has been developed to support improvement in clinical care.

Copyright:

This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved. Limited 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 third party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2017 American Medical Association. LOINC(R) copyright 2004-2017 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R] ) copyright 2004-2017 International Health Terminology Standards Development Organisation. ICD-10 copyright 2017 World Health Organization. All Rights Reserved.

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. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Scoring:

Proportion

Type:

process

Rationale:

Colorectal cancer represents 8 percent of all new cancer cases and is the second leading cause of cancer deaths in the United States. In 2017, there were an estimated 135,430 new cases of colorectal cancer and an estimated 50,260 deaths attributed to it. According to the National Cancer Institute, about 4.3 percent of men and women will be diagnosed with colorectal cancer at some point during their lifetimes. For most adults, older age is the most important risk factor for colorectal cancer, although being male and black are also associated with higher incidence and mortality. Colorectal cancer is most frequently diagnosed among people 65 to 74 years old (Howlader et al. 2017). Screening can be effective for finding precancerous lesions (polyps) that could later become malignant, and for detecting early cancers that can be more easily and effectively treated. Precancerous polyps usually take about 10 to 15 years to develop into colorectal cancer, and most can be found and removed before turning into cancer. The five-year relative survival rate for people whose colorectal cancer is found in the early stage before it has spread is about 90 percent (American Cancer Society 2017).

Clinical recommendation statement:

The U. S. Preventive Services Task Force (2016) recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. This is a Grade A recommendation (U.S. Preventive Services Task Force 2016). Screening tests: -Colonoscopy (every 10 years) -Flexible sigmoidoscopy (every 5 years) -Fecal occult blood test (annually) -FIT-DNA (every 3 years) -Computed tomographic colonography (every 5 years)

Improvement Notation:

Increased score indicates improvement

Supplemental Data Elements:

SDE Ethnicity

SDE Payer

SDE Race

SDE Sex

Libraries:
EXM130 - Colorectal Cancer Screening Library
Terminology and Other Dependencies:
  • Supplemental Data Elements Libraryversion: null2.0.0)
  • http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1
  • MAT Global Common Functions FHIR Libraryversion: null5.0.000)
  • Adult Outpatient Encounters Common Libraryversion: null2.0.000)
  • Hospice FHIR Libraryversion: null2.0.000)
  • http://snomed.info/sct|http://snomed.info/sct/731000124108/version/201709
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019
  • Parameters:
    name use min max type
    Measurement Period In 0 1 Period
    SDE Sex Out 0 1 Coding
    Numerator Out 0 1 boolean
    Denominator Out 0 1 boolean
    SDE Payer Out 0 * Resource
    Initial Population Out 0 1 boolean
    SDE Ethnicity Out 0 * Coding
    Denominator Exclusion Out 0 1 boolean
    SDE Race Out 0 * Coding
    DataRequirements:
    Resource Type Resource Elements Valueset Name Valueset
    Coverage(Coverage) period type Payer http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
    Patient(Patient) extension value url
    Encounter(Encounter) type Office Visit http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
    Encounter(Encounter) type Annual Wellness Visit http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240
    Encounter(Encounter) type Preventive Care Services - Established Office Visit, 18 and Up http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025
    Encounter(Encounter) type Preventive Care Services-Initial Office Visit, 18 and Up http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023
    Encounter(Encounter) type Home Healthcare Services http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016
    Encounter(Encounter) period hospitalization hospitalization.dischargeDisposition type status Encounter Inpatient http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
    Condition(Condition) code onset Malignant Neoplasm of Colon http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001
    Observation(Observation) effective code value status FIT DNA http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039
    Observation(Observation) effective code value status Fecal Occult Blood Test (FOBT) http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011
    Procedure(Procedure) code performed status Colonoscopy http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020
    Procedure(Procedure) code performed status Total Colectomy http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019
    Procedure(Procedure) code performed status CT Colonography http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038
    Procedure(Procedure) code performed status Hospice care ambulatory http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15
    Procedure(Procedure) code performed status Flexible Sigmoidoscopy http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010
    ServiceRequest(ServiceRequest) code authoredOn intent Hospice care ambulatory http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15
    Direct Reference Codes:
    display code system
    Discharge to home for hospice care (procedure) 428361000124107 http://snomed.info/sct
    Discharge to healthcare facility for hospice care (procedure) 428371000124100 http://snomed.info/sct
    Logic Definitions:
    Group Scoring Population Criteria Expression
    Measure scoring:

    Proportion

    Initial Population
    define "Initial Population":
    	Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of "Measurement Period") in Interval[50, 75]
    			and exists AdultOutpatientEncounters."Qualifying Encounters"
    Numerator
    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"
    Denominator
    define "Denominator":
    	true
    Denominator Exclusion
    define "Denominator Exclusion":
    	Hospice."Has Hospice"
    		or exists "Malignant Neoplasm Ever"
    		or exists "Total Colectomy Performed"
    Library Name Name
    SupplementalDataElements SDE Sex
    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
    Library Name Name
    EXM130-FHIR SDE Sex
    define "SDE Sex":
      SDE."SDE Sex"
    Library Name Name
    EXM130-FHIR Colonoscopy Performed
    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"
    Library Name Name
    EXM130-FHIR Fecal Occult Blood Test Performed
    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"
    Library Name Name
    EXM130-FHIR Flexible Sigmoidoscopy Performed
    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"
    Library Name Name
    EXM130-FHIR Fecal Immunochemical Test DNA
    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"
    Library Name Name
    EXM130-FHIR CT Colonography Performed
    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"
    Library Name Name
    EXM130-FHIR Numerator
    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"
    Library Name Name
    EXM130-FHIR Denominator
    define "Denominator":
    	true
    Library Name Name
    SupplementalDataElements SDE Payer
    define "SDE Payer":
      [Coverage: type in "Payer"] Payer
            return {
              code: Payer.type,
              period: Payer.period
            }
    Library Name Name
    EXM130-FHIR SDE Payer
    define "SDE Payer":
      SDE."SDE Payer"
    Library Name Name
    AdultOutpatientEncounters Qualifying Encounters
    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'
    Library Name Name
    EXM130-FHIR Initial Population
    define "Initial Population":
    	Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of "Measurement Period") in Interval[50, 75]
    			and exists AdultOutpatientEncounters."Qualifying Encounters"
    Library Name Name
    SupplementalDataElements SDE Ethnicity
    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
    Library Name Name
    EXM130-FHIR SDE Ethnicity
    define "SDE Ethnicity":
      SDE."SDE Ethnicity"
    Library Name Name
    Hospice Has Hospice
    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"
        )
    Library Name Name
    EXM130-FHIR Malignant Neoplasm Ever
    define "Malignant Neoplasm Ever":
    	[Condition: "Malignant Neoplasm of Colon"] ColorectalCancer
    		where Global."Normalize Interval"(ColorectalCancer.onset) starts on or before end of "Measurement Period"
    Library Name Name
    EXM130-FHIR Total Colectomy Performed
    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"
    Library Name Name
    EXM130-FHIR Denominator Exclusion
    define "Denominator Exclusion":
    	Hospice."Has Hospice"
    		or exists "Malignant Neoplasm Ever"
    		or exists "Total Colectomy Performed"
    Library Name Name
    SupplementalDataElements SDE Race
    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
    Library Name Name
    EXM130-FHIR SDE Race
    define "SDE Race":
      SDE."SDE Race"