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measure-EXM165_FHIR3-8.5.000.json
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measure-EXM165_FHIR3-8.5.000.json
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{
"resourceType": "Measure",
"id": "measure-EXM165-FHIR3-8.5.000",
"meta": {
"versionId": "2",
"lastUpdated": "2019-12-12T22:16:52.350-07:00",
"profile": [
"http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table style=\"width: 60%; border-bottom: none;\" class=\"header_table\"> <!-- <tr th:if=\"${resource.hasId()}\" style=\"vertical-align: top;\"><th style=\"background-color:#656565; width:20%\" scope=\"row\"><span class=\"td_label\">Id: </span></th><td style=\"width:80%\" colspan=\"3\" th:narrative=\"${resource.id}\"></td></tr> --><tr style=\"vertical-align: top;\"><td scope=\"row\" style=\"background-color:#656565; width:20%\"><span class=\"td_label\">Measure Title</span></td><td colspan=\"1\" style=\"width:60%\"><h1 style=\"font-size:10px\">Controlling High Blood Pressure</h1></td><td scope=\"row\" style=\"background-color:#656565; width:10%\"><span class=\"td_label\">Measure ID</span></td><td colspan=\"1\" style=\"width:10%\"><h1 style=\"font-size:10px\">EXM165</h1></td></tr> <!-- <th:block th:each=\"ident, iter : ${resource.identifier}\"><tr th:if=\"${ident.type.coding[0].code == 'CMS'}\" style=\"vertical-align: top;\"><td style=\"background-color:#656565; width:20%\" scope=\"row\"><span class=\"td_label\">eCQM Identifier (Measure Authoring Tool)</span></td><td style=\"width:30%\" th:narrative=\"${ident.value}\"></td><td style=\"background-color:#656565; width:20%\" scope=\"row\"><span class=\"td_label\">eCQM Version number</span></td><td style=\"width:30%\" th:narrative=\"${resource.version}\"></td></tr></th:block><th:block th:each=\"ident, iter : ${resource.identifier}\"><tr th:if=\"${ident.type.coding[0].code == 'NQF'}\" style=\"vertical-align: top;\"><td style=\"background-color:#656565; width:20%\" scope=\"row\"><span class=\"td_label\">NQF Number</span></td><td style=\"width:30%\" th:narrative=\"${ident.value}\"></td><td style=\"background-color:#656565; width:20%\" scope=\"row\"><span class=\"td_label\">GUID</span></td><td style=\"width:30%\" th:narrative=\"${resource.url}\"></td></tr></th:block> --><tr style=\"vertical-align: top;\"><td scope=\"row\" style=\"background-color:#656565; width:20%\"><span class=\"td_label\">Description</span></td><td colspan=\"3\" style=\"width:80%\"><div style=\"width:660px;overflow-x:hidden;overflow-y:auto\"><pre><p>Percentage of patients 18-85 years of age who had a diagnosis of hypertension overlapping the measurement period and whose most recent blood pressure was adequately controlled (<140/90mmHg) during the measurement period</p>\r\n</pre>\r\n </div>\r\n </td>\r\n </tr>\r\n <tr>\r\n <td scope=\"row\" style=\"background-color:#656565; width:20%\"><span class=\"td_label\">Measurement Period</span></td>\r\n <td colspan=\"3\" style=\"width:80%\">January 1 - December 31</td>\r\n </tr>\r\n <!-- <tr>\r\n <td style=\"background-color:#656565; width:20%\" scope=\"row\"><span class=\"td_label\">Measure Steward</span></td>\r\n <td style=\"width:80%\" colspan=\"3\" th:narrative=\"${resource.publisher}\"></td>\r\n </tr>\r\n <tr>\r\n <td style=\"background-color:#656565; width:20%\" scope=\"row\"><span class=\"td_label\">Measure Developer</span></td>\r\n <td style=\"width:80%\" colspan=\"3\" th:narrative=\"${resource.publisher}\"></td>\r\n </tr> -->\r\n <!-- <tr th:if=\"${resource.hasDisclaimer()}\">\r\n <td style=\"background-color:#656565; width:20%\" scope=\"row\"><span class=\"td_label\">Disclaimer</span></td>\r\n <td style=\"width:80%\" colspan=\"3\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\r\n <pre th:text=\"${resource.disclaimer}\"></pre>\r\n </div>\r\n </td>\r\n </tr> -->\r\n <tr>\r\n <td scope=\"row\" style=\"background-color:#656565; width:20%\"><span class=\"td_label\">Copyright and Disclaimer Notice</span></td>\r\n <td colspan=\"3\" style=\"width:80%\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\r\n <pre>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.\r\n \r\nDue to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</pre>\r\n <br/>\r\n <pre>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. <br> 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. <br> 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.</pre>\r\n </div>\r\n </td>\r\n </tr>\r\n <tr>\r\n <td scope=\"row\" style=\"background-color:#656565; width:20%\"><span class=\"td_label\">Clinical Recommendation Statement</span></td>\r\n <td colspan=\"3\" style=\"width:80%\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\"><p>The U.S. Preventive Services Task Force (2015) recommends screening for high blood pressure in adults age 18 years and older. This is a grade A recommendation.</p>\r\n<p>American College of Cardiology/American Heart Association (2017)<br/>\r\n-For adults with confirmed hypertension and known CVD or 10-year ASCVD event risk of 10% or higher, a blood pressure target of less than 130/80 mmHg is recommended<br/>\r\n-For adults with confirmed hypertension, without additional markers of increased CVD risk, a blood pressure target of less than 130/80 mmHg may be reasonable (Note: clinical trial evidence is strongest for a target blood pressure of 140/90 mmHg in this population. However observational studies suggest that these individuals often have a high lifetime risk and would benefit from blood pressure control earlier in life)</p>\r\n<p>American College of Physicians and the American Academy of Family Physicians (2017):<br/>\r\n-Initiate intensifying pharmacologic treatment in adults aged 60 and older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mmHg (Grade: weak recommendation, quality of evidence: low)<br/>\r\n-Initiate intensifying pharmacologic treatment in adults aged 60 and older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mmHg to reduce the risk of recurrent stroke (Grade: weak recommendation, quality of evidence: moderate)</p>\r\n<p>American Diabetes Association (2018):<br/>\r\nMost patients with diabetes and hypertension should be treated to a systolic blood pressure goal of <140 mmHg and a diastolic blood pressure goal of <90 mmHg (Level of evidence: A)</p>\r\n<p>Report from the Eighth Joint National Committee (2014)<br/>\r\n-In the general population younger than 60 years, initiate pharmacologic treatment to lower blood pressure at diastolic blood pressure (DBP) of 90 mmHg or higher and treat to a goal of DBP of lower than 90 mmHg (Grade: A (for ages 30-59), Grade: E (for ages 18-29))<br/>\r\n-In the general population younger than 60 years, initiate pharmacologic treatment to lower blood pressure at systolic blood pressure (SBP) to 140 mmHg or higher and treat to a goal of SBP of lower than 140 mmHg (Grade: E)<br/>\r\n-In the general population aged 60 years and older, initiate pharmacologic treatment to lower blood pressure at SBP of 150 mmHg or higher or a DBP of 90 mmHg or higher and treat to a goal of SBP lower than 150 mmHg and goal of DBP lower than 90 mmHg</p>\r\n</div>\r\n </td>\r\n </tr>\r\n \r\n <tr style=\"vertical-align: top;\">\r\n <td rowspan=\"14\" scope=\"row\" style=\"background-color:#656565; width:20%\"><span class=\"td_label\">References</span></td>\r\n <td colspan=\"3\" style=\"width:80%\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\r\n <pre>American Diabetes Association. (2018). 9. Cardiovascular disease and risk management: Standards of medical care in diabetes 2018. Diabetes Care, 41(Suppl. 1), S86-S104.</pre>\r\n </div>\r\n </td>\r\n </tr>\r\n \r\n \r\n <tr style=\"vertical-align: top;\">\r\n \r\n <td colspan=\"3\" style=\"width:80%\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\r\n <pre>Benjamin, E. J., Blaha, M. J., Chiuve, S. E., et al. (2017). Heart disease and stroke statistics-2017 update: A report from the American Heart Association. Circulation, 135(10), e146-e603.doi: 10.1161/CIR.0000000000000485</pre>\r\n </div>\r\n </td>\r\n </tr>\r\n \r\n \r\n <tr style=\"vertical-align: top;\">\r\n \r\n <td colspan=\"3\" style=\"width:80%\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\r\n <pre>Centers for Disease Control and Prevention. (2012). Vital signs: Getting blood pressure under control. Retrieved from https://www.cdc.gov/vitalsigns/hypertension/index.html</pre>\r\n </div>\r\n </td>\r\n </tr>\r\n \r\n \r\n <tr style=\"vertical-align: top;\">\r\n \r\n <td colspan=\"3\" style=\"width:80%\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\r\n <pre>Centers for Disease Control and Prevention. Division for Heart Disease and Stroke Prevention. (2016). High blood pressure fact sheet. Retrieved from https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_bloodpressure.htmhttps://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_bloodpressure.htm. </pre>\r\n </div>\r\n </td>\r\n </tr>\r\n \r\n \r\n <tr style=\"vertical-align: top;\">\r\n \r\n <td colspan=\"3\" style=\"width:80%\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\r\n <pre>Centers for Disease Control and Prevention, National Center for Health Statistics. (2015). Underlying Cause of Death 1999-2013 on CDC WONDER Online Database. Data are from the Multiple Cause of Death Files, 1999-2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Retrieved from http://wonder.cdc.gov/ucd-icd10.html</pre>\r\n </div>\r\n </td>\r\n </tr>\r\n \r\n \r\n <tr style=\"vertical-align: top;\">\r\n \r\n <td colspan=\"3\" style=\"width:80%\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\r\n <pre>Crim, M. T., Yoon, S. S., Ortiz, E., et al. (2012). National surveillance definitions for hypertension prevalence and control among adults. Circulation: Cardiovascular Quality and Outcomes. 2012, ;5(3), :343-–351. doi: 10.1161/ CIRCOUTCOMES.111.963439.</pre>\r\n </div>\r\n </td>\r\n </tr>\r\n \r\n \r\n <tr style=\"vertical-align: top;\">\r\n \r\n <td colspan=\"3\" style=\"width:80%\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\r\n <pre>James, P. A., Oparil, S., Carter, B. L., et al (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC8). JAMA. 311(5), 507-520. doi:10.1001/jama.2013.284427</pre>\r\n </div>\r\n </td>\r\n </tr>\r\n \r\n \r\n <tr style=\"vertical-align: top;\">\r\n \r\n <td colspan=\"3\" style=\"width:80%\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\r\n <pre>Moran, A. E., Odden, M. C., Thanataveerat, A., et al.Tzong KY, Rasmussen PW, Guzman D, Williams L, Bibbins-Domingo K, Coxson PG, Goldman L. (2015). Cost-effectiveness of hypertension therapy according to 2014 guidelines. [published correction appears in N Engl J. Med. 2015;372:1677]. New England Journal of Medicine,. 2015 ;372, :447-–455. doi: 10.1056/NEJMsa1406751. [published correction appears on page 1677] \r\nFarley TA, Dalal MA, Mostashari F, Frieden TR. Deaths preventable in the US by improvements in the use of clinical preventive services. Am J Prev Med. 2010;38:600-9.</pre>\r\n </div>\r\n </td>\r\n </tr>\r\n \r\n \r\n <tr style=\"vertical-align: top;\">\r\n \r\n <td colspan=\"3\" style=\"width:80%\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\r\n <pre>Patel, S. A., Winkel, M., Ali, M. K., et al. (2015). Cardiovascular mortality associated with 5 leading risk factors: National and state preventable fractions estimated from survey data. Annals of Internal Medicine, 163(4), :245–253. doi: 10.7326/M14-1753</pre>\r\n </div>\r\n </td>\r\n </tr>\r\n \r\n \r\n <tr style=\"vertical-align: top;\">\r\n \r\n <td colspan=\"3\" style=\"width:80%\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\r\n <pre>Qaseem, A., Wilt, T. J., Rich, R., et al. (2017). Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: A clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Annals of Internal Medicine, 166(6), 430-437.</pre>\r\n </div>\r\n </td>\r\n </tr>\r\n \r\n \r\n <tr style=\"vertical-align: top;\">\r\n \r\n <td colspan=\"3\" style=\"width:80%\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\r\n <pre>SPRINT Research Group,; Wright, J. T., Jr., Williamson, J. D., et al. (2015). A randomized trial of intensive versus standard blood-pressure control. New England Journal of Medicine, 373(22), 2103–2116.</pre>\r\n </div>\r\n </td>\r\n </tr>\r\n \r\n \r\n <tr style=\"vertical-align: top;\">\r\n \r\n <td colspan=\"3\" style=\"width:80%\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\r\n <pre>U.S. Preventive Services Task Force. (2015). Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 163(10), 778-787.</pre>\r\n </div>\r\n </td>\r\n </tr>\r\n \r\n \r\n <tr style=\"vertical-align: top;\">\r\n \r\n <td colspan=\"3\" style=\"width:80%\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\r\n <pre>Whelton, P. K., Carey, R. M., Aronow, W. S., et al. (2017). Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, . https://doi.org/10.1161/HYP.0000000000000065</pre>\r\n </div>\r\n </td>\r\n </tr>\r\n \r\n \r\n <tr style=\"vertical-align: top;\">\r\n \r\n <td colspan=\"3\" style=\"width:80%\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\r\n <pre>Yoon, S. S., Fryar, C. D., & Carroll, M. D. (2015). Hypertension prevalence and control among adults: United States, 2011-2014. NCHS Data Brief No. 220. Hyattsville, MD: National Center for Health Statistics.</pre>\r\n </div>\r\n </td>\r\n </tr>\r\n \r\n <tr>\r\n <td colspan=\"4\" scope=\"row\" style=\"background-color:#656565; width:100%\"><span class=\"td_label\">Characteristics</span></td>\r\n </tr>\r\n <tr>\r\n <td scope=\"row\" style=\"width:20%\"><span>Scoring</span></td>\r\n <td colspan=\"3\" style=\"width:80%\">Proportion</td>\r\n </tr>\r\n <!-- <tr th:if=\"${resource.hasCompositeScoring()}\">\r\n <td style=\"width:20%\" scope=\"row\"><span class=\"td_label\">Composite Scoring</span></td>\r\n <td style=\"width:80%\" colspan=\"3\" th:narrative=\"${resource.compositeScoring.getText().substring(0, 1).toUpperCase() + resource.compositeScoring.getText().substring(1)}\"></td>\r\n </tr> -->\r\n \r\n <tr style=\"vertical-align: top;\">\r\n <td rowspan=\"1\" scope=\"row\" style=\"width:20%\"><span>Type</span></td>\r\n <td colspan=\"3\" style=\"width:80%\">Process</td>\r\n </tr>\r\n \r\n <!-- <tr th:if=\"${resource.hasStatus()}\" style=\"vertical-align: top;\">\r\n <td style=\"background-color:#656565; width:20%\" scope=\"row\"><span class=\"td_label\">Status</span></td>\r\n <td style=\"width:80%\" colspan=\"3\" th:narrative=\"${resource.status.toString().substring(0, 1).toUpperCase() + resource.status.toString().substring(1).toLowerCase()}\"></td>\r\n </tr>\r\n <tr th:if=\"${resource.hasPurpose()}\" style=\"vertical-align: top;\">\r\n <td style=\"background-color:#656565; width:20%\" scope=\"row\"><span class=\"td_label\">Purpose</span></td>\r\n <td style=\"width:80%\" colspan=\"3\" th:narrative=\"${resource.purpose}\"></td>\r\n </tr>\r\n <tr th:if=\"${resource.hasUsage()}\" style=\"vertical-align: top;\" >\r\n <td style=\"background-color:#656565; width:20%\" scope=\"row\"><span class=\"td_label\">Usage</span></td>\r\n <td style=\"width:80%\" colspan=\"3\" th:narrative=\"${resource.usage}\"></td>\r\n </tr>\r\n <th:block th:each=\"context, iter : ${resource.useContext}\" >\r\n <tr style=\"vertical-align: top;\">\r\n <td th:if=\"${iter.index == 0}\" th:rowspan=\"${iter.size}\" style=\"background-color:#656565; width:20%\" scope=\"row\"><span class=\"td_label\">Use Context</span></td>\r\n <td style=\"width:80%\" colspan=\"3\" th:narrative=\"${context}\"></td>\r\n </tr>\r\n </th:block>\r\n <th:block th:each=\"topics, iter : ${resource.topic}\" >\r\n <tr style=\"vertical-align: top;\">\r\n <td th:if=\"${iter.index == 0}\" th:rowspan=\"${iter.size}\" style=\"background-color:#656565; width:20%\" scope=\"row\"><span class=\"td_label\">Topic</span></td>\r\n <td style=\"width:80%\" colspan=\"3\" th:narrative=\"${topics}\"></td>\r\n </tr>\r\n </th:block>\r\n <th:block th:each=\"cont, iter : ${resource.contributor}\" >\r\n <tr style=\"vertical-align: top;\">\r\n <td th:if=\"${iter.index == 0}\" th:rowspan=\"${iter.size}\" style=\"background-color:#656565; width:20%\" scope=\"row\"><span class=\"td_label\">Contributor</span></td>\r\n <td style=\"width:80%\" colspan=\"3\">\r\n <b><span th:narrative=\"${cont.type.toCode()}\"></span>: </b><span th:narrative=\"${cont.name}\"></span>\r\n </td>\r\n </tr>\r\n </th:block> -->\r\n <!-- <th:block th:each=\"lib, iter : ${resource.library}\" >\r\n <tr style=\"vertical-align: top;\">\r\n <td th:if=\"${iter.index == 0}\" th:rowspan=\"${iter.size}\" style=\"background-color:#656565; width:20%\" scope=\"row\"><span class=\"td_label\">Library</span></td>\r\n <td style=\"width:80%\" colspan=\"3\">\r\n <p th:if=\"${lib.hasIdentifier()}\"><b>identifier: </b><span th:narrative=\"${lib.identifier}\"></span></p>\r\n <p th:if=\"${lib.hasReference()}\"><b>reference: </b><span th:narrative=\"${lib.reference}\"></span></p>\r\n <p th:if=\"${lib.hasDisplay()}\"><b>display: </b><span th:narrative=\"${lib.display}\"></span></p>\r\n </td>\r\n </tr>\r\n </th:block> -->\r\n \r\n <!-- <tr th:if=\"${resource.hasRateAggregation()}\" >\r\n <td style=\"background-color:#656565; width:20%\" scope=\"row\"><span class=\"td_label\">Rate Aggregation</span></td>\r\n <td style=\"width:80%\" colspan=\"3\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\r\n <pre th:text=\"${resource.rateAggregation}\"></pre>\r\n </div>\r\n </td>\r\n </tr>\r\n <tr th:if=\"${resource.hasRationale()}\">\r\n <td style=\"background-color:#656565; width:20%\" scope=\"row\"><span class=\"td_label\">Rationale</span></td>\r\n <td style=\"width:80%\" colspan=\"3\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\r\n <pre th:text=\"${resource.rationale}\"></pre>\r\n </div>\r\n </td>\r\n </tr> -->\r\n <tr>\r\n <td scope=\"row\" style=\"width:20%\"><span>Improvement Notation</span></td>\r\n <td colspan=\"3\" style=\"width:80%\">A higher rate indicates better performance.</td>\r\n \r\n </tr>\r\n <tr>\r\n <td scope=\"row\" style=\"width:20%\"><span>Guidance</span></td>\r\n <td colspan=\"3\" style=\"width:80%\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\"><p>In reference to the numerator element, only blood pressure readings performed by a clinician or a remote monitoring device are acceptable for numerator compliance with this measure.</p>\r\n<p>Do not include BP readings:<br/>\r\n-Taken during an acute inpatient stay or an ED visit<br/>\r\n-Taken on the same day as a diagnostic test or diagnostic or therapeutic procedure that requires a change in diet or change in medication on or one day before the day of the test or procedure, with the exception of fasting blood tests.<br/>\r\n-Reported by or taken by the member</p>\r\n<p>If no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed \"not controlled.\"</p>\r\n<p>If there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading.</p>\r\n</div>\r\n </td>\r\n </tr>\r\n <tr>\r\n <td colspan=\"4\" scope=\"row\" style=\"background-color:#656565; width:100%\"><span class=\"td_label\">Definitions</span></td>\r\n </tr>\r\n \r\n \r\n <!-- <th:block th:each=\"groups, iter : ${resource.uniquePopulationGroup}\" >\r\n <tr style=\"vertical-align: top;\">\r\n <td style=\"background-color:#656565; width:20%\" scope=\"row\"><span class=\"td_label\" th:text=\"${groups.identifier.value}\"></span></td>\r\n <td style=\"width:80%\" colspan=\"3\">\r\n <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\r\n <pre th:text=\"${pops.description}\"></pre>\r\n </div>\r\n </td>\r\n </tr>\r\n </th:block> -->\r\n </table>\r\n <table style=\"width: 60%; border-top: none; border-bottom: none\" class=\"header_table\">\r\n \r\n </table>\r\n <table style=\"width: 60%; border-top: none;\" class=\"header_table\">\r\n <!-- <th:block th:each=\"supples, iter : ${resource.supplementalData}\">\r\n <tr>\r\n <th th:if=\"${iter.index == 0}\" th:rowspan=\"${iter.size}\" scope=\"row\"><b>Supplemental Data:</b></th>\r\n <td style=\"width:80%\" colspan=\"3\" >\r\n <p style=\"margin-bottom: 5px;\" th:narrative=\"${supples.identifier}\"></p>\r\n <p style=\"margin-bottom: 5px;\" th:each=\"uses : ${supples.usage}\">\r\n <b>usage: </b>\r\n <span th:narrative=\"${uses}\"></span>\r\n </p>\r\n <p style=\"margin-bottom: 5px;\" th:if=\"${supples.hasCriteria()}\">\r\n <b>criteria: </b>\r\n <span th:narrative=\"${supples.criteria}\"></span>\r\n </p>\r\n <p style=\"margin-bottom: 5px;\" th:if=\"${supples.hasPath()}\">\r\n <b>path: </b>\r\n <span th:narrative=\"${supples.path}\"></span>\r\n </p>\r\n </td>\r\n </tr>\r\n </th:block> -->\r\n <!-- <th:block th:each=\"param, iter : ${resource.parameter}\">\r\n <tr style=\"vertical-align: top;\">\r\n <th th:if=\"${iter.index == 0}\" th:rowspan=\"${iter.size}\" scope=\"row\"><b>Parameter: </b></th>\r\n <td style=\"width:80%\" colspan=\"3\" >\r\n <span th:if=\"${param.hasName()}\">\r\n <b>name: </b>\r\n <span th:narrative=\"${param.name}\"></span>\r\n <br/>\r\n </span>\r\n <b>use: </b>\r\n <span th:narrative=\"${param.use.toCode()}\"></span>\r\n <br/>\r\n <span th:if=\"${param.hasMin()}\">\r\n <b>minimum cardinality: </b>\r\n <span th:narrative=\"${param.min}\"></span>\r\n <br/>\r\n </span>\r\n <span th:if=\"${param.hasMax()}\">\r\n <b>maximum cardinality: </b>\r\n <span th:narrative=\"${param.max}\"></span>\r\n <br/>\r\n </span>\r\n <b>type: </b>\r\n <span th:narrative=\"${param.type}\"></span>\r\n <br/>\r\n <span th:if=\"${param.hasDocumentation()}\">\r\n <b>documentation: </b>\r\n <span th:narrative=\"${param.documentation}\"></span>\r\n <br/>\r\n </span>\r\n <span th:if=\"${param.hasProfile()}\">\r\n <b>profile: </b>\r\n <span th:narrative=\"${param.profile}\"></span>\r\n <br/>\r\n </span>\r\n <p style=\"margin-bottom: 5px;\"></p>\r\n </td>\r\n </tr>\r\n </th:block> -->\r\n <!-- <th:block th:each=\"dataReq, iter : ${resource.dataRequirement}\">\r\n <tr style=\"vertical-align: top;\">\r\n <th th:if=\"${iter.index == 0}\" th:rowspan=\"${iter.size}\" scope=\"row\" ><b>Data Requirements: </b></th>\r\n <td style=\"width:80%\" colspan=\"3\" th:narrative=\"${dataReq}\"></td>\r\n </tr>\r\n </th:block> -->\r\n </table>\r\n <h2><a name=\"toc\">Table of Contents</a></h2>\r\n <ul style=\"padding-left: 50px;\">\r\n <li><a href=\"#d1e405\">Population Criteria</a></li>\r\n <li><a href=\"#d1e649\">Definitions</a></li>\r\n <li><a href=\"#d1e650\">Functions</a></li>\r\n <li><a href=\"#d1e555\">Terminology</a></li>\r\n <li><a href=\"#d1e647\">Data Criteria (QDM Data Elements)</a></li>\r\n <li><a href=\"#d1e767\">Supplemental Data Elements</a></li>\r\n <li><a href=\"#d1e879\">Risk Adjustment Variables</a></li>\r\n </ul>\r\n <div style=\"float:left; background:teal; height:3px; width:80%\"></div>\r\n \r\n <pre><br/></pre>\r\n <h3><a name=\"d1e405\" href=\"#toc\">Population Criteria</a></h3>\r\n <div>\r\n <ul style=\"list-style:none;padding-left:10px;\">\r\n <li style=\"list-style:none;padding-left:0px;\" class=\"list-unstyled\">\r\n \r\n <div class=\"treeview hover p-l-10\">\r\n <ul class=\"list-unstyled\">\r\n <li class=\"list-unstyled\"><input id=\"Initial Population\" type=\"checkbox\"/><label for=\"Initial Population\" class=\"list-header\"><strong>Initial Population</strong></label>\r\n <ul class=\"code\">\r\n <li class=\"list-unstyled\">\r\n <div class=\"treeview hover p-l-10\">\r\n <ul>\r\n <li style=\"padding-left: 0px;\">\r\n <div>\r\n <pre class=\"cql-definition-body\">\tCommon.CalendarAgeInYearsAt(FHIRHelpers.ToDate(Patient.birthDate), end of \"Measurement Period\") between 18 and 85\r\n\t\tand exists \"Essential Hypertension Diagnosis\"\r\n\t\tand exists AdultOutpatientEncounters.\"Qualifying Encounters\"(\"Measurement Period\")</pre>\r\n </div></li>\r\n </ul>p;\r\n </div></li>\r\n </ul></li>\r\n </ul>\r\n </div>\r\n \r\n \r\n <div class=\"treeview hover p-l-10\">\r\n <ul class=\"list-unstyled\">\r\n <li class=\"list-unstyled\"><input id=\"Numerator\" type=\"checkbox\"/><label for=\"Numerator\" class=\"list-header\"><strong>Numerator</strong></label>\r\n <ul class=\"code\">\r\n <li class=\"list-unstyled\">\r\n <div class=\"treeview hover p-l-10\">\r\n <ul>\r\n <li style=\"padding-left: 0px;\">\r\n <div>\r\n <pre class=\"cql-definition-body\">\t\"Has Diastolic Blood Pressure Less Than 90\"\r\n\t\tand \"Has Systolic Blood Pressure Less Than 140\"</pre>\r\n </div></li>\r\n </ul>p;\r\n </div></li>\r\n </ul></li>\r\n </ul>\r\n </div>\r\n \r\n \r\n <div class=\"treeview hover p-l-10\">\r\n <ul class=\"list-unstyled\">\r\n <li class=\"list-unstyled\"><input id=\"Denominator\" type=\"checkbox\"/><label for=\"Denominator\" class=\"list-header\"><strong>Denominator</strong></label>\r\n <ul class=\"code\">\r\n <li class=\"list-unstyled\">\r\n <div class=\"treeview hover p-l-10\">\r\n <ul>\r\n <li style=\"padding-left: 0px;\">\r\n <div>\r\n <pre class=\"cql-definition-body\">\t\"Initial Population\"</pre>\r\n </div></li>\r\n </ul>p;\r\n </div></li>\r\n </ul></li>\r\n </ul>\r\n </div>\r\n \r\n \r\n <div class=\"treeview hover p-l-10\">\r\n \r\n </div>\r\n \r\n \r\n </li>\r\n </ul>\r\n </div>\r\n\r\n <h3><a name=\"d1e649\" href=\"#toc\">Definitions</a></h3>\r\n <div>\r\n <ul style=\"list-style:none;padding-left: 10px;\">\r\n <li style=\"list-style:none;\" class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"list-style:none;padding-left:0;\" class=\"list-unstyled\">\r\n <li class=\"list-unstyled\">\r\n <div class=\"treeview hover p-l-10\">\r\n <input id=\"Blood Pressure Days\" type=\"checkbox\"/>\r\n <label for=\"Blood Pressure Days\" class=\"list-header\"><strong>Blood Pressure Days</strong></label>\r\n <ul style=\"margin-right: 20%; opacity: 1;\" class=\"code\">\r\n <li class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"padding-left: 0px;\">\r\n <li style=\"padding-left: 0px;\" class=\"list-unstyled\">\r\n <div>\r\n <pre class=\"cql-definition-body\">\t( ( \"Qualifying Diastolic Blood Pressure Reading\" DBPExam\r\n\t\t\t\treturn date from DBPExam.effective\r\n\t\t)\r\n\t\t\tintersect ( \"Qualifying Systolic Blood Pressure Reading\" SBPExam\r\n\t\t\t\t\treturn date from SBPExam.effective\r\n\t\t\t)\r\n\t)</pre>\r\n </div></li>\r\n </ul>p;\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div>\r\n <div>\r\n <ul style=\"list-style:none;padding-left: 10px;\">\r\n <li style=\"list-style:none;\" class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"list-style:none;padding-left:0;\" class=\"list-unstyled\">\r\n <li class=\"list-unstyled\">\r\n <div class=\"treeview hover p-l-10\">\r\n <input id=\"Denominator\" type=\"checkbox\"/>\r\n <label for=\"Denominator\" class=\"list-header\"><strong>Denominator</strong></label>\r\n <ul style=\"margin-right: 20%; opacity: 1;\" class=\"code\">\r\n <li class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"padding-left: 0px;\">\r\n <li style=\"padding-left: 0px;\" class=\"list-unstyled\">\r\n <div>\r\n <pre class=\"cql-definition-body\">\t\"Initial Population\"</pre>\r\n </div></li>\r\n </ul>p;\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div>\r\n <div>\r\n <ul style=\"list-style:none;padding-left: 10px;\">\r\n <li style=\"list-style:none;\" class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"list-style:none;padding-left:0;\" class=\"list-unstyled\">\r\n <li class=\"list-unstyled\">\r\n <div class=\"treeview hover p-l-10\">\r\n <input id=\"End Stage Renal Disease Encounter\" type=\"checkbox\"/>\r\n <label for=\"End Stage Renal Disease Encounter\" class=\"list-header\"><strong>End Stage Renal Disease Encounter</strong></label>\r\n <ul style=\"margin-right: 20%; opacity: 1;\" class=\"code\">\r\n <li class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"padding-left: 0px;\">\r\n <li style=\"padding-left: 0px;\" class=\"list-unstyled\">\r\n <div>\r\n <pre class=\"cql-definition-body\">\t[\"Encounter\": \"ESRD Monthly Outpatient Services\"] ESRDEncounter\r\n\t\twhere ESRDEncounter.status.value in { 'planned', 'arrived', 'triaged', 'in-progress', 'onleave', 'finished' }\r\n\t\t and ESRDEncounter.period starts before end of \"Measurement Period\"</pre>\r\n </div></li>\r\n </ul>p;\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div>\r\n <div>\r\n <ul style=\"list-style:none;padding-left: 10px;\">\r\n <li style=\"list-style:none;\" class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"list-style:none;padding-left:0;\" class=\"list-unstyled\">\r\n <li class=\"list-unstyled\">\r\n <div class=\"treeview hover p-l-10\">\r\n <input id=\"End Stage Renal Disease Procedures\" type=\"checkbox\"/>\r\n <label for=\"End Stage Renal Disease Procedures\" class=\"list-header\"><strong>End Stage Renal Disease Procedures</strong></label>\r\n <ul style=\"margin-right: 20%; opacity: 1;\" class=\"code\">\r\n <li class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"padding-left: 0px;\">\r\n <li style=\"padding-left: 0px;\" class=\"list-unstyled\">\r\n <div>\r\n <pre class=\"cql-definition-body\">\t( [\"Procedure\": \"Vascular Access for Dialysis\"]\r\n\t\tunion [\"Procedure\": \"Kidney Transplant\"]\r\n\t\tunion [\"Procedure\": \"Dialysis Services\"] ) ESRDProcedure\r\n\t\twhere ESRDProcedure.status = 'completed'\r\n and ESRDProcedure.performed starts before end of \"Measurement Period\"</pre>\r\n </div></li>\r\n </ul>p;\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div>\r\n <div>\r\n <ul style=\"list-style:none;padding-left: 10px;\">\r\n <li style=\"list-style:none;\" class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"list-style:none;padding-left:0;\" class=\"list-unstyled\">\r\n <li class=\"list-unstyled\">\r\n <div class=\"treeview hover p-l-10\">\r\n <input id=\"Essential Hypertension Diagnosis\" type=\"checkbox\"/>\r\n <label for=\"Essential Hypertension Diagnosis\" class=\"list-header\"><strong>Essential Hypertension Diagnosis</strong></label>\r\n <ul style=\"margin-right: 20%; opacity: 1;\" class=\"code\">\r\n <li class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"padding-left: 0px;\">\r\n <li style=\"padding-left: 0px;\" class=\"list-unstyled\">\r\n <div>\r\n <pre class=\"cql-definition-body\">\t[\"Condition\": \"Essential Hypertension\"] Hypertension\r\n where Hypertension.verificationStatus = 'confirmed'\r\n and (Hypertension.assertedDate 6 months or less on or after start of \"Measurement Period\"\r\n or Hypertension.assertedDate before end of \"Measurement Period\"\r\n )</pre>\r\n </div></li>\r\n </ul>p;\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div>\r\n <div>\r\n <ul style=\"list-style:none;padding-left: 10px;\">\r\n <li style=\"list-style:none;\" class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"list-style:none;padding-left:0;\" class=\"list-unstyled\">\r\n <li class=\"list-unstyled\">\r\n <div class=\"treeview hover p-l-10\">\r\n <input id=\"Has Diastolic Blood Pressure Less Than 90\" type=\"checkbox\"/>\r\n <label for=\"Has Diastolic Blood Pressure Less Than 90\" class=\"list-header\"><strong>Has Diastolic Blood Pressure Less Than 90</strong></label>\r\n <ul style=\"margin-right: 20%; opacity: 1;\" class=\"code\">\r\n <li class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"padding-left: 0px;\">\r\n <li style=\"padding-left: 0px;\" class=\"list-unstyled\">\r\n <div>\r\n <pre class=\"cql-definition-body\">\t\"Lowest Diastolic Reading on Most Recent Blood Pressure Day\".value < 90</pre>\r\n </div></li>\r\n </ul>p;\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div>\r\n <div>\r\n <ul style=\"list-style:none;padding-left: 10px;\">\r\n <li style=\"list-style:none;\" class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"list-style:none;padding-left:0;\" class=\"list-unstyled\">\r\n <li class=\"list-unstyled\">\r\n <div class=\"treeview hover p-l-10\">\r\n <input id=\"Has Systolic Blood Pressure Less Than 140\" type=\"checkbox\"/>\r\n <label for=\"Has Systolic Blood Pressure Less Than 140\" class=\"list-header\"><strong>Has Systolic Blood Pressure Less Than 140</strong></label>\r\n <ul style=\"margin-right: 20%; opacity: 1;\" class=\"code\">\r\n <li class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"padding-left: 0px;\">\r\n <li style=\"padding-left: 0px;\" class=\"list-unstyled\">\r\n <div>\r\n <pre class=\"cql-definition-body\">\t\"Lowest Systolic Reading on Most Recent Blood Pressure Day\".value < 140</pre>\r\n </div></li>\r\n </ul>p;\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div>\r\n <div>\r\n <ul style=\"list-style:none;padding-left: 10px;\">\r\n <li style=\"list-style:none;\" class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"list-style:none;padding-left:0;\" class=\"list-unstyled\">\r\n <li class=\"list-unstyled\">\r\n <div class=\"treeview hover p-l-10\">\r\n <input id=\"Initial Population\" type=\"checkbox\"/>\r\n <label for=\"Initial Population\" class=\"list-header\"><strong>Initial Population</strong></label>\r\n <ul style=\"margin-right: 20%; opacity: 1;\" class=\"code\">\r\n <li class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"padding-left: 0px;\">\r\n <li style=\"padding-left: 0px;\" class=\"list-unstyled\">\r\n <div>\r\n <pre class=\"cql-definition-body\">\tCommon.CalendarAgeInYearsAt(FHIRHelpers.ToDate(Patient.birthDate), end of \"Measurement Period\") between 18 and 85\r\n\t\tand exists \"Essential Hypertension Diagnosis\"\r\n\t\tand exists AdultOutpatientEncounters.\"Qualifying Encounters\"(\"Measurement Period\")</pre>\r\n </div></li>\r\n </ul>p;\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div>\r\n <div>\r\n <ul style=\"list-style:none;padding-left: 10px;\">\r\n <li style=\"list-style:none;\" class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"list-style:none;padding-left:0;\" class=\"list-unstyled\">\r\n <li class=\"list-unstyled\">\r\n <div class=\"treeview hover p-l-10\">\r\n <input id=\"Lowest Diastolic Reading on Most Recent Blood Pressure Day\" type=\"checkbox\"/>\r\n <label for=\"Lowest Diastolic Reading on Most Recent Blood Pressure Day\" class=\"list-header\"><strong>Lowest Diastolic Reading on Most Recent Blood Pressure Day</strong></label>\r\n <ul style=\"margin-right: 20%; opacity: 1;\" class=\"code\">\r\n <li class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"padding-left: 0px;\">\r\n <li style=\"padding-left: 0px;\" class=\"list-unstyled\">\r\n <div>\r\n <pre class=\"cql-definition-body\">\tFirst(\r\n \"Qualifying Diastolic Blood Pressure Reading\" DBPReading\r\n\t\t where DBPReading.effective same day as \"Most Recent Blood Pressure Day\"\r\n return singleton from (\r\n DBPReading.component C\r\n where C.code ~ \"Diastolic blood pressure\"\r\n return C.value as Quantity\r\n )\r\n\t\t\tsort ascending\r\n\t)</pre>\r\n </div></li>\r\n </ul>p;\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div>\r\n <div>\r\n <ul style=\"list-style:none;padding-left: 10px;\">\r\n <li style=\"list-style:none;\" class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"list-style:none;padding-left:0;\" class=\"list-unstyled\">\r\n <li class=\"list-unstyled\">\r\n <div class=\"treeview hover p-l-10\">\r\n <input id=\"Lowest Systolic Reading on Most Recent Blood Pressure Day\" type=\"checkbox\"/>\r\n <label for=\"Lowest Systolic Reading on Most Recent Blood Pressure Day\" class=\"list-header\"><strong>Lowest Systolic Reading on Most Recent Blood Pressure Day</strong></label>\r\n <ul style=\"margin-right: 20%; opacity: 1;\" class=\"code\">\r\n <li class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"padding-left: 0px;\">\r\n <li style=\"padding-left: 0px;\" class=\"list-unstyled\">\r\n <div>\r\n <pre class=\"cql-definition-body\">\tFirst(\r\n \"Qualifying Systolic Blood Pressure Reading\" SBPReading\r\n\t\t where SBPReading.effective same day as \"Most Recent Blood Pressure Day\"\r\n return singleton from (\r\n SBPReading.component C\r\n where C.code ~ \"Systolic blood pressure\"\r\n return C.value as Quantity\r\n )\r\n sort ascending\r\n\t)</pre>\r\n </div></li>\r\n </ul>p;\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div>\r\n <div>\r\n <ul style=\"list-style:none;padding-left: 10px;\">\r\n <li style=\"list-style:none;\" class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"list-style:none;padding-left:0;\" class=\"list-unstyled\">\r\n <li class=\"list-unstyled\">\r\n <div class=\"treeview hover p-l-10\">\r\n <input id=\"Most Recent Blood Pressure Day\" type=\"checkbox\"/>\r\n <label for=\"Most Recent Blood Pressure Day\" class=\"list-header\"><strong>Most Recent Blood Pressure Day</strong></label>\r\n <ul style=\"margin-right: 20%; opacity: 1;\" class=\"code\">\r\n <li class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"padding-left: 0px;\">\r\n <li style=\"padding-left: 0px;\" class=\"list-unstyled\">\r\n <div>\r\n <pre class=\"cql-definition-body\">\tMax(\"Blood Pressure Days\")</pre>\r\n </div></li>\r\n </ul>p;\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div>\r\n <div>\r\n <ul style=\"list-style:none;padding-left: 10px;\">\r\n <li style=\"list-style:none;\" class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"list-style:none;padding-left:0;\" class=\"list-unstyled\">\r\n <li class=\"list-unstyled\">\r\n <div class=\"treeview hover p-l-10\">\r\n <input id=\"Numerator\" type=\"checkbox\"/>\r\n <label for=\"Numerator\" class=\"list-header\"><strong>Numerator</strong></label>\r\n <ul style=\"margin-right: 20%; opacity: 1;\" class=\"code\">\r\n <li class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"padding-left: 0px;\">\r\n <li style=\"padding-left: 0px;\" class=\"list-unstyled\">\r\n <div>\r\n <pre class=\"cql-definition-body\">\t\"Has Diastolic Blood Pressure Less Than 90\"\r\n\t\tand \"Has Systolic Blood Pressure Less Than 140\"</pre>\r\n </div></li>\r\n </ul>p;\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div>\r\n <div>\r\n <ul style=\"list-style:none;padding-left: 10px;\">\r\n <li style=\"list-style:none;\" class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"list-style:none;padding-left:0;\" class=\"list-unstyled\">\r\n <li class=\"list-unstyled\">\r\n <div class=\"treeview hover p-l-10\">\r\n <input id=\"Pregnancy Or Renal Diagnosis Exclusions\" type=\"checkbox\"/>\r\n <label for=\"Pregnancy Or Renal Diagnosis Exclusions\" class=\"list-header\"><strong>Pregnancy Or Renal Diagnosis Exclusions</strong></label>\r\n <ul style=\"margin-right: 20%; opacity: 1;\" class=\"code\">\r\n <li class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"padding-left: 0px;\">\r\n <li style=\"padding-left: 0px;\" class=\"list-unstyled\">\r\n <div>\r\n <pre class=\"cql-definition-body\">\t( [\"Condition\": \"Pregnancy\"]\r\n\t\tunion [\"Condition\": \"End Stage Renal Disease\"]\r\n\t\tunion [\"Condition\": \"Kidney Transplant Recipient\"]\r\n\t\tunion [\"Condition\": \"Chronic Kidney Disease, Stage 5\"] ) PregnancyESRDDiagnosis\r\n where PregnancyESRDDiagnosis.verificationStatus = 'confirmed'\r\n and PregnancyESRDDiagnosis.assertedDate before end of \"Measurement Period\"</pre>\r\n </div></li>\r\n </ul>p;\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div>\r\n <div>\r\n <ul style=\"list-style:none;padding-left: 10px;\">\r\n <li style=\"list-style:none;\" class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"list-style:none;padding-left:0;\" class=\"list-unstyled\">\r\n <li class=\"list-unstyled\">\r\n <div class=\"treeview hover p-l-10\">\r\n <input id=\"Qualifying Diastolic Blood Pressure Reading\" type=\"checkbox\"/>\r\n <label for=\"Qualifying Diastolic Blood Pressure Reading\" class=\"list-header\"><strong>Qualifying Diastolic Blood Pressure Reading</strong></label>\r\n <ul style=\"margin-right: 20%; opacity: 1;\" class=\"code\">\r\n <li class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"padding-left: 0px;\">\r\n <li style=\"padding-left: 0px;\" class=\"list-unstyled\">\r\n <div>\r\n <pre class=\"cql-definition-body\">\t[\"Observation\": \"Blood pressure\"] BloodPressure \r\n\t where BloodPressure.status in {'final', 'amended'} \r\n and BloodPressure.effective during \"Measurement Period\"\r\n // TODO: Turn this into a value set\r\n\t //and not (GetEncounter(BloodPressure.\"context\").class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS' })\r\n and exists (\r\n BloodPressure.component DiastolicBP \r\n where FHIRHelpers.ToConcept(DiastolicBP.code) ~ \"Diastolic blood pressure\"\r\n and DiastolicBP.value.unit = 'mm[Hg]'\r\n )</pre>\r\n </div></li>\r\n </ul>p;\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div>\r\n <div>\r\n <ul style=\"list-style:none;padding-left: 10px;\">\r\n <li style=\"list-style:none;\" class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"list-style:none;padding-left:0;\" class=\"list-unstyled\">\r\n <li class=\"list-unstyled\">\r\n <div class=\"treeview hover p-l-10\">\r\n <input id=\"Qualifying Systolic Blood Pressure Reading\" type=\"checkbox\"/>\r\n <label for=\"Qualifying Systolic Blood Pressure Reading\" class=\"list-header\"><strong>Qualifying Systolic Blood Pressure Reading</strong></label>\r\n <ul style=\"margin-right: 20%; opacity: 1;\" class=\"code\">\r\n <li class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"padding-left: 0px;\">\r\n <li style=\"padding-left: 0px;\" class=\"list-unstyled\">\r\n <div>\r\n <pre class=\"cql-definition-body\">\t[\"Observation\": \"Blood pressure\"] BloodPressure \r\n\t where BloodPressure.status in {'final', 'amended'} \r\n and BloodPressure.effective during \"Measurement Period\"\r\n // TODO: Turn this into a value set\r\n\t and not (GetEncounter(BloodPressure.\"context\").class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS'})\r\n and exists (\r\n BloodPressure.component SystolicBP \r\n where FHIRHelpers.ToConcept(SystolicBP.code) ~ \"Systolic blood pressure\"\r\n and SystolicBP.value.unit = 'mm[Hg]'\r\n )</pre>\r\n </div></li>\r\n </ul>p;\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div>\r\n <h3><a name=\"d1e650\" href=\"#toc\">Functions</a></h3>\r\n <div>\r\n <ul style=\"list-style:none;padding-left: 10px;\">\r\n <li style=\"list-style:none;\" class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"list-style:none;padding-left:0;\" class=\"list-unstyled\">\r\n <li class=\"list-unstyled\">\r\n <div class=\"treeview hover p-l-10\">\r\n <input id=\"GetEncounter\" type=\"checkbox\"/>\r\n <label for=\"GetEncounter\" class=\"list-header\"><strong>GetEncounter</strong></label>\r\n <ul style=\"margin-right: 20%; opacity: 1;\" class=\"code\">\r\n <li class=\"list-unstyled\">\r\n <div>\r\n <ul style=\"padding-left: 0px;\">\r\n <li style=\"padding-left: 0px;\" class=\"list-unstyled\">\r\n <div>\r\n <pre class=\"cql-definition-body\">define function GetEncounter(reference Reference):\r\n singleton from ( [Encounter: id in Common.GetId(reference.reference)] )</pre>\r\n </div></li>\r\n </ul>p;\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div></li>\r\n </ul>\r\n </div>\r\n <h3><a name=\"d1e555\" href=\"#toc\">Terminology</a></h3>\r\n <div>\r\n <ul style=\"padding-left: 50px;\">\r\n <li style=\"width:80%\">codesystem \"LOINC\" : '2.16.840.1.113883.6.1'</li>\r\n <li style=\"width:80%\">code \"Birth date\" : '21112-8' from \"LOINC\" display 'Birth date'</li>\r\n <li style=\"width:80%\">code \"Blood pressure\" : '85354-9' from \"LOINC\" display 'blood pressure'</li>\r\n <li style=\"width:80%\">code \"Diastolic blood pressure\" : '8462-4' from \"LOINC\" display 'Diastolic blood pressure'</li>\r\n <li style=\"width:80%\">code \"Systolic blood pressure\" : '8480-6' from \"LOINC\" display 'Systolic blood pressure'</li>\r\n <li style=\"width:80%\">valueset \"Chronic Kidney Disease, Stage 5\" : '2.16.840.1.113883.3.526.3.1002'</li>\r\n <li style=\"width:80%\">valueset \"Dialysis Services\" : '2.16.840.1.113883.3.464.1003.109.12.1013'</li>\r\n <li style=\"width:80%\">valueset \"ED\" : '2.16.840.1.113883.3.464.1003.101.12.1085'</li>\r\n <li style=\"width:80%\">valueset \"Encounter Inpatient\" : '2.16.840.1.113883.3.666.5.307'</li>\r\n <li style=\"width:80%\">valueset \"End Stage Renal Disease\" : '2.16.840.1.113883.3.526.3.353'</li>\r\n <li style=\"width:80%\">valueset \"ESRD Monthly Outpatient Services\" : '2.16.840.1.113883.3.464.1003.109.12.1014'</li>\r\n <li style=\"width:80%\">valueset \"Essential Hypertension\" : '2.16.840.1.113883.3.464.1003.104.12.1011'</li>\r\n <li style=\"width:80%\">valueset \"Ethnicity\" : '2.16.840.1.114222.4.11.837'</li>\r\n <li style=\"width:80%\">valueset \"Kidney Transplant Recipient\" : '2.16.840.1.113883.3.464.1003.109.12.1029'</li>\r\n <li style=\"width:80%\">valueset \"Kidney Transplant\" : '2.16.840.1.113883.3.464.1003.109.12.1012'</li>\r\n <li style=\"width:80%\">valueset \"ONC Administrative Sex\" : '2.16.840.1.113762.1.4.1'</li>\r\n <li style=\"width:80%\">valueset \"Payer\" : '2.16.840.1.114222.4.11.3591'</li>\r\n <li style=\"width:80%\">valueset \"Pregnancy\" : '2.16.840.1.113883.3.526.3.378'</li>\r\n <li style=\"width:80%\">valueset \"Race\" : '2.16.840.1.114222.4.11.836'</li>\r\n <li style=\"width:80%\">valueset \"Vascular Access for Dialysis\" : '2.16.840.1.113883.3.464.1003.109.12.1011'</li>\r\n </ul>\r\n </div>\r\n <h3><a name=\"d1e647\" href=\"#toc\">Data Criteria (QDM Data Elements)</a></h3>\r\n <div>\r\n <ul style=\"padding-left: 50px;\">\r\n \r\n </ul>\r\n </div>\r\n <h3><a name=\"d1e767\" href=\"#toc\">Supplemental Data Elements</a></h3>\r\n \r\n <div>\r\n <ul style=\"list-style:none;padding-left: 25px;\">\r\n <li>None</li>\r\n </ul>\r\n </div>\r\n <h3><a name=\"d1e879\" href=\"#toc\">Risk Adjustment Variables</a></h3>\r\n <div>\r\n <ul style=\"list-style:none;padding-left: 25px;\">\r\n <li>None</li>\r\n </ul>\r\n </div>\r\n <div style=\"float:left; background:teal; height:3px; width:80%\"></div>\r\n <table>\r\n \r\n <!-- <th:block th:each=\"con, iter : ${resource.content}\">\r\n <tr th:if=\"${con.contentType == 'text/cql'}\" style=\"vertical-align: top;\">\r\n <td style=\"background-color:#656565; width:20%\" scope=\"row\"><span class=\"td_label\">Content</span></td>\r\n <td style=\"width:80%\" ><b>type: </b><span th:text=\"${con.contentType}\"></span></td>\r\n </tr>\r\n <tr th:if=\"${con.contentType == 'text/cql'}\">\r\n <td style=\"width:100%\" colspan=\"2\" >\r\n <th:block th:if=\"${con.getData() != null }\" >\r\n <pre><code th:class=\"${con.contentType == 'text/cql' ? 'language-cql' : 'language-xml'}\" th:text=\"${new java.lang.String(con.getData())}\"></code></pre>\r\n </th:block>\r\n <th:block th:if=\"${con.getData() == null }\" >\r\n <span><i><content is empty></i></span>\r\n </th:block>\r\n </td>\r\n </tr>\r\n </th:block > -->\r\n </table>\r\n</div>"
},
"extension": [
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
"valueCode": "boolean"
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],
"url": "http://hl7.org/fhir/us/cqfmeasures/Measure/measure-EXM165-FHIR3",
"version": "1.0.000",
"name": "EXM165",
"title": "Controlling High Blood Pressure",
"status": "active",
"experimental": true,
"publisher": "National Committee for Quality Assurance (NCQA)",
"description": "Percentage of patients 18-85 years of age who had a diagnosis of hypertension overlapping the measurement period and whose most recent blood pressure was adequately controlled (<140/90mmHg) during the measurement period",
"purpose": "Patients 18-85 years of age who had a visit and diagnosis of essential hypertension overlapping the measurement period",
"approvalDate": "2016-01-01",
"lastReviewDate": "2016-09-01",
"effectivePeriod": {
"start": "2019-01-01",
"end": "2019-12-31"
},
"useContext": [
{
"code": {
"code": "program"
},
"valueCodeableConcept": {
"text": "eligible-provider"
}
}
],
"jurisdiction": [
{
"coding": [
{
"system": "urn:iso:std:iso:3166",
"code": "US"
}
]
}
],
"topic": [
{
"coding": [
{
"system": "http://loinc.org",
"code": "57024-2",
"display": "Health Quality Measure Document"
}
]
}
],
"contributor": [
{
"type": "author",
"name": "National Committee for Quality Assurance"
}
],
"contact": [
{
"telecom": [
{
"system": "url",
"value": "http://www.ncqa.org/"
}
]
}
],
"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. <br> 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. <br> 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.",
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},
{
"type": "citation",
"citation": "SPRINT Research Group,; Wright, J. T., Jr., Williamson, J. D., et al. (2015). A randomized trial of intensive versus standard blood-pressure control. New England Journal of Medicine, 373(22), 2103–2116."
},
{
"type": "citation",
"citation": "U.S. Preventive Services Task Force. (2015). Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 163(10), 778-787."
},
{
"type": "citation",
"citation": "Whelton, P. K., Carey, R. M., Aronow, W. S., et al. (2017). Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, . https://doi.org/10.1161/HYP.0000000000000065"
},
{
"type": "citation",
"citation": "Yoon, S. S., Fryar, C. D., & Carroll, M. D. (2015). Hypertension prevalence and control among adults: United States, 2011-2014. NCHS Data Brief No. 220. Hyattsville, MD: National Center for Health Statistics."
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"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 \nDue to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].",
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"rationale": "High blood pressure (HBP), also known as hypertension, is when the pressure in blood vessels is higher than normal (Centers for Disease Control and Prevention [CDC], 2016). The causes of hypertension are multiple and multifaceted and can be based on genetic predisposition, environmental risk factors, being overweight and obese, sodium intake, potassium intake, physical activity, and alcohol use. High Blood Pressure is common, according to the National Health and Nutrition Examination Survey (NHANES), approximately 85.7 million adults >= 20 years of age had HBP (140/90 mm Hg) between 2011 to 2014 (Crim, 2012. Between 2011-2014 the prevalence of hypertension (>=140/90 mm Hg) among US adults 60 and older was approximately 67.2 percent (Benjamin et al., 2017). \n\nHBP, known as the “silent killer,” increases risks of heart disease and stroke which are two of the leading causes of death in the U.S. (Yoon, Fryar, & Carroll, 2015). A person who has HBP is four times more likely to die from a stroke and three times more likely to die from heart disease (CDC, 2012) The National Vital Statistics Systems Center for Disease Control and Prevention reported that in 2014 there were approximately 73,300 deaths directly due to HBP and 410,624 deaths with any mention of HBP (CDC, 20145).Between 2004 and 2014 the number of deaths due to HBP rose by 34.1 percent (Benjamin et al., 2017). Managing and treating HBP would reduce cardiovascular disease mortality for males and females by 30.4 percent and 38.0 percent, respectively (Patel et al., 2015).\n\nThe estimated annual average direct and indirect cost of HBP from 2012 to 2013 was $51.2 billion (Benjamin et al., 2017). Total direct costs of HBP is projected to increase to $200 billion by 2030 (Benjamin et al., 2017). A study on cost-effectiveness on treating hypertension found that controlling HBP in patients with cardiovascular disease and systolic blood pressures of >=160 mm Hg could be effective and cost-saving (Moran et al., 2015). \n\nMany studies have shown that controlling high blood pressure reduces cardiovascular events and mortality. The Systolic Blood Pressure Intervention Trial (SPRINT) investigated the impact of obtaining a SBP goal of <120 mm Hg compared to a SBP goal of <140 mm Hg among patients 50 and older with established cardiovascular disease and found that the patients with the former goal had reduced cardiovascular events and mortality (SPRINT Research Group et al., 2015). \n\nControlling HBP will significantly reduce the risks of cardiovascular disease mortality and lead to better health outcomes like reduction of heart attacks, stroke, and kidney disease (James et al., 2014). Thus, the relationship between the measure (control of hypertension) and the long-term clinical outcomes listed is well established.",
"clinicalRecommendationStatement": "The U.S. Preventive Services Task Force (2015) recommends screening for high blood pressure in adults age 18 years and older. This is a grade A recommendation. \n\nAmerican College of Cardiology/American Heart Association (2017)\n-For adults with confirmed hypertension and known CVD or 10-year ASCVD event risk of 10% or higher, a blood pressure target of less than 130/80 mmHg is recommended\n-For adults with confirmed hypertension, without additional markers of increased CVD risk, a blood pressure target of less than 130/80 mmHg may be reasonable (Note: clinical trial evidence is strongest for a target blood pressure of 140/90 mmHg in this population. However observational studies suggest that these individuals often have a high lifetime risk and would benefit from blood pressure control earlier in life)\n\nAmerican College of Physicians and the American Academy of Family Physicians (2017): \n-Initiate intensifying pharmacologic treatment in adults aged 60 and older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mmHg (Grade: weak recommendation, quality of evidence: low)\n-Initiate intensifying pharmacologic treatment in adults aged 60 and older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mmHg to reduce the risk of recurrent stroke (Grade: weak recommendation, quality of evidence: moderate)\n\nAmerican Diabetes Association (2018):\nMost patients with diabetes and hypertension should be treated to a systolic blood pressure goal of <140 mmHg and a diastolic blood pressure goal of <90 mmHg (Level of evidence: A)\n\nReport from the Eighth Joint National Committee (2014)\n-In the general population younger than 60 years, initiate pharmacologic treatment to lower blood pressure at diastolic blood pressure (DBP) of 90 mmHg or higher and treat to a goal of DBP of lower than 90 mmHg (Grade: A (for ages 30-59), Grade: E (for ages 18-29))\n-In the general population younger than 60 years, initiate pharmacologic treatment to lower blood pressure at systolic blood pressure (SBP) to 140 mmHg or higher and treat to a goal of SBP of lower than 140 mmHg (Grade: E)\n-In the general population aged 60 years and older, initiate pharmacologic treatment to lower blood pressure at SBP of 150 mmHg or higher or a DBP of 90 mmHg or higher and treat to a goal of SBP lower than 150 mmHg and goal of DBP lower than 90 mmHg",
"improvementNotation": "increase",
"guidance": "In reference to the numerator element, only blood pressure readings performed by a clinician or a remote monitoring device are acceptable for numerator compliance with this measure. \n\nDo not include BP readings:\n-Taken during an acute inpatient stay or an ED visit\n-Taken on the same day as a diagnostic test or diagnostic or therapeutic procedure that requires a change in diet or change in medication on or one day before the day of the test or procedure, with the exception of fasting blood tests.\n-Reported by or taken by the member\n\n\nIf no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed \"not controlled.\"\n\nIf there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading.",
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